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IN  EXCHANGE. 


Digitized  by 

the  Internet  Archive 

in  2014 

https://archive.org/details/albanymedicalann2719medi 


ALBANY 
MEDICAL  ANNALS 


Journal  of  the  Alumni  Association  of  the 
Albany  Medical  College 


VOLUME  XXVII 


'Ao-^aA^s  Kat  tyirtSov  cora)  to  aov  cSo?»    'Ek  ckotov  fJAV  c£aye 
<£aos,  €K  0€  7ra0ovs  ava\f/v\qv 


9 


ALBANY,  N.  Y. 

PRESS  OF  BRANDOW  PRINTING  CO. 
1906 


ALUMNI  COMMITTEE 

Albert  Vander  Veer,  M.  D.  Willis  G.  Tucker,  M.  D. 

Andrew  MacFarlane,  M.  D. 


EDITED  BY 

J.  Montgomery  Mosher,  M.  D. 


Editors  of  the  Following  Departments 

Albert  Vander  Veer,  M.  D.  and  Arthur  W.  Elting,  M.  D. — Surgery 
Samuel  B.  Ward,  M.  D.  and  Hermon  C.  Gordinier,  M.  D—  Medicine 
James  P.  Boyd,  M.  D.  and  H.  Judson  Lipes,  M.  D—  Obstetrics 
Henry  Hun,  M.  D. — Neurology 
Frederic  C.  Curtis,  M.  D.  and  Harry  W.  Carey,  M.  D. — Dermatology 

G.  Alder  Blumer,  M.  D. — Psychiatry 
Richard  M.  Pearce,  M.  D.,  Charles  K.  Winne,  Jr.,  M.  D.  and  Leon 
K.  Baldauf,  M.  D. — Pathology  and  Bacteriology 
Charles  M.  Culver,  M.  D. — Ophthalmology 
Clement  F.  Theisen,  M.  D. — Laryngology,  Rhinology  and  Otology 
Henry  L.  K.  Shaw,  M.  D. — Pediatrics 
Joseph  D.  Craig,  M.  D. — Public  Health 
Arthur  J.  Bedell,  M.  D. — Medical  News 
Spencer  L.  Dawes,  M-  D.— Materia  Medica  and  Therapeutics 
Arthur  !.  Laird,  M.  D. — Clinical  Microscopy 
Miss  Ada  Bunnell/  B.  L.  S.—The  New  York  State  Medical  Library 
.  .John  A-  Sampson,  M.  D. — Gynecology 


Contributors 

TO 

ALBANY  MEDICAL  ANNALS,  VOLUME  XXVII 


Alva  E.  Abrams,  M.  D.,  Hartford, 
Conn. 

La  Salle  Archambault,  M.  D.,  Co- 
hoes,  N.  Y. 

Robert  Babcock,  M.  D.,  Albany, 
N.  Y. 

Arthur  J.  Bedell,  M.  D.,  Albany, 
N.  Y. 

George  E.  Beilby,  M.  D.,  Albany, 
N.  Y. 

John  M.  Berry,  M.  D.,  Troy,  N.  Y. 

Kenneth  D.  BLickfan,  M.  D.,  Balls- 
ton  Spa,  N.  Y. 

G.  Alder  Blumer,  M.  D.,  Provi- 
dence, R.  I. 

George  Blumer,  M.  D.,  New  Haven, 
Conn. 

Reed   Brockway   Bontecue,   M.  D., 

Troy,  N.  Y. 
James    P.   Boyd,    M.   D.,  Albany, 

N.  Y. 

W.  P.  Brierley,  M.  D.,  Albany, 
N.  Y. 

Lawrason  Brown,  M.  D.,  Saranac 

Lake,  N.  Y. 
Joseph  D.  Bryant,  M.  D.,  New  York 

City. 

Miss  Ada  Bunnell,  B.  L.  S.,  Albany, 
N.  Y. 

Harry  W.  Carey,  M.  D.,  Troy,  N.  Y. 

Frederick  T.  Clark,  M.  D.,  West- 
field,  Mass. 

Grover  Cleveland,  Princeton,  N.  J. 

Harold  D.  Cochrane,  M.  D.,  Albany, 
N.  Y. 

Robert  G.  Cook,  M.  D.,  Rochester, 
N.  Y. 


Joseph   D.   Craig,   M.   D.,  Albany, 
N.  Y. 

T.   D.  Crothers,  M.   D.,  Hartford, 
Conn. 

Charles  M.  Culver,  M.  D.,  Albany, 
N.  Y. 

Charles    Greene   Cumston,    M.  D., 

Boston,  Mass. 
Frederic  C.  Curtis,  M.  D.,  Albany, 

N.  Y. 

Spencer  L.  Dawes,  M.  D.,  Albany, 
N.  Y. 

J.  Lewi  Donhauser,  Albany,  N.  Y. 
William   M.   Dwyer,    M.   D.,  Am- 
sterdam, N.  Y. 

Arthur  W.  Elting,  M.  D.,  Albany, 
N.  Y. 

E.  V.  Frederick,  M.  D.,  Peterboro, 
Ontario,  Canada. 

Hermon  C.  Gordinier,  M.  D.,  Troy, 
N.  Y. 

George  M.  Gould,  M.  D.,  Philadel- 
phia, Pa. 

Eugene  E.  Hinman,  M.  D.,  Albany, 
N.  Y. 

John  Van  Rensselaer  Hoff,  M.  D., 

Omaha,  Neb. 
Arthur    Holding,    M.    D.,  Albany, 

N.  Y. 

Henry  Hun,  M.  D.,  Albany,  N.  Y. 

R.  H.  Irish,  M.  D,  Troy,  N.  Y. 

Holmes  C.  Jackson,  Ph.  D.,  Albany, 
N.  Y. 

Arthur   T.   Laird,   M.   D.,  Albany, 
N.  Y. 


69209 


CONTRIBUTORS  TO  VOLUME  XXVII 


George  Gustave  Lempe,  M.  D.,  Al- 
bany, N.  Y. 

H.  Judson  Lipes,  M.  D.,  Albany, 
N.  Y. 

William  Mabon,  M.  D.,  New  York 
City. 

Andrew  MacFarlane,  M.  D.,  Albany, 
N.  Y. 

St.  Clair  McKelway,  LL.  D.,  Brook- 
lyn, N.  Y. 

J.  D.  Montmarquet,  M.  D.,  Cohoes, 
N.  Y. 

Charles  H.  Moore,  M.  D.,  Albany, 
N.  Y. 

Douglas  C  Moriarta,  M.  D.,  Sara- 
toga Springs,  N.  Y. 

J.  Montgomery  Mosher,  M.  D.,  Al- 
bany, N.  Y. 

Daniel  V.  O'Leary,  M.  D.,  Albany, 
N.  Y. 

Daniel  V.  O'Leary,  Jr.,  M.  D.,  Al- 
bany, N.  Y. 

Ellwood  Oliver,  M.  D.,  Ancram, 
N.  Y. 

Flavius  Packer,  M.  D.,  New  York 
City. 

Richard  M.  Pearce,  M.  D.,  Albany, 
N.  Y. 

Herbert  D.  Pease,  M.  D.,  Albany, 
N.  Y. 


H.   E.   Robertson,   M.   D.,  Albany, 

N.  Y. 

Thomas    Avery     Rogers,    M.  D.t 

Plattsburgh,  N.  Y. 
James  F.   Rooney,  M.   D.,  Albany, 

N.  Y. 

John  A.  Sampson,  M.  D.,  Albany, 

N.  Y. 

Henry  L.  K.  Shaw,  M.  D.,  Albany, 

N.  Y. 

Edwin   F.    Sibley,   M.   D.,  Albany, 

N.  Y. 

E.  MacD.  Stanton,  M.  D.,  Chicago, 
111. 

Charles  B.  Tefft,  M.  D.,  Utica,  N.  Y. 
Clement  F.  Theisen,  M.  D.,  Albany, 
N.  Y. 

Willis  G.  Tucker,  M.  D.,  Albany, 
N.  Y. 

A.  Vander  Veer,  M.  D.,  Albany, 
N.  Y. 

James  N.  Vander  Veer,  M.  D.,  Al- 
bany, N.  Y. 

Howard  Van  Rensselaer,  M.  D.,  Al- 
bany, N.  Y. 

James  W.  Wiltse,  M.  D.,  Albany, 
N.  Y. 

Charles  K.  Winne,  Jr.,  M.  D.,  Al- 
bany, N.  Y. 


Vol.  xxvii  JANUARY,  1906 


No.  i 


ALBANY 
MEDICAL  ANNALS 


©tiainal  Communications 

ORGANIZATION,  METHODS  AND  RESPONSIBILITIES 
IN  THE  STUDY  OF  MEDICINE. 

Opening  Address,  Albany  Medical  College,  September  ip,  1905. 
By  A.  VANDER  VEER,  M.  D., 

Professor  of  Surgery,  Albany  Medical  College. 

Mr.  Chancellor  and  Gentlemen: 

Rotation  in  the  discharge  of  certain  official  duties  connected 
with  this  college,  is  not  yet,  in  the  process  of  administrative  evolu- 
tion, abolished.  Years  of  past  work  remind  me  that  this  is  the 
third  time  I  have  been  called  upon  to  discharge  this  duty,  and  for 
the  present  occasion  I  have  believed  it  not  without  interest  to 
dwell  somewhat  upon  organization,  methods,  and  responsibilities, 
as  they  have  been  met  by  men  who  have  had  in  charge  the  wel- 
fare of  the  Albany  Medical  College  since  its  inception. 

The  organization  of  this  college  developed  from  the  best  of 
motives,  having  in  mind  the  good  of  the  medical  student  and  the 
placing  of  our  profession  on  a  higher  plane  of  usefulness.  The 
ambition  of  one  man  to  impart  to  those  who  were  earnest  in  their 
desire  to  obtain  a  knowledge  of  anatomy  and  surgery, — that 
which  he  had  acquired, — developed  the  private  school,  and  later, 
by  Act  of  the  Legislature,  the  medical  college.  This  man  was 
Dr.  Alden  March,  Dr.  James  H.  Armsby  soon  after  being  asso- 
ciated with  him.  In  organization  the  former  was  brave  and 
strong.  He  succeeded  in  securing  this  building  and  rearranging 
it  for  amphitheatre  and  lecture  room  work.  In  those  days  men 
desiring  to  practice  medicine  did  not,  necessarily,  have  to  grad- 
uate from  a  medical  college,  but  with  the  evidence  of  having,  in 
one  way  or  another,  acquired  some  knowledge  of  the  medical 
profession,  they  were  frequently  licensed  by  county  societies.  Dr. 
March  saw,  and  was  foremost  among  those  who  early  recognized 


2  ORGANIZATION,  METHODS  AND  RESPONSIBILITIES 

that  if  false  doctrines,  and  the  ignorant  work  of  incompetent 
men,  were  to  be  corrected,  it  must  be  done  through  better  methods 
employed  in  the  instruction  of  those  who  were  being  trusted  by 
the  public  as  physicians.  In  the  evolution  of  this  thought  he 
gathered  about  him  the  best  men  that  could  be  obtained.  He 
made  few  mistakes  in  his  associates.  Let  history  speak :  Where 
will  you  find  a  record  of  work  better  performed  than  by  Dr. 
James  MacNaughton  in  his  palmy  days  of  youthful  and  middle 
age  vigor?  It  is  not  generally  known,  but  nevertheless  true,  that 
he  did  much,  based  upon  scientific  observation,  to  modify  the 
heroic  treatment  of  disease,  in  a  rational  way  to  lessen  the  dangers 
of  a  wrong  diagnosis,  and  administration  of  harsh  and  uncalled 
for  medicines. 

Consider  for  a  moment  the  splendid  work  of  T.  Romeyn  Beck, 
on  "Medical  Jurisprudence,"  the  greatest  in  his  day ;  the  same 
of  Bedford,  in  his  "Clinical  Obstetrics,"  also  the  continuous  lec- 
tures on  the  same  subject  by  Harry  Green  and  Ebenezer  Emmons, 
professors  of  obstetrics,  the  latter  also  in  natural  history  and 
chemistry  ;  later  Amos  Dean  in  his  lectures  on  "Medical  Juris- 
prudence," Lewis  C.  Beck,  in  chemistry  and  pharmacy,  David 
M.  Reece,  in  theory  and  practice  of  medicine,  and  David  M. 
McLachlan,  on  materia  medica  and  pharmacy.  In  their  day  these 
men  possessed  a  national  reputation.  That  the  methods  employed 
resulted  in  developing  men  of  great  strength,  one  has  but  to  go 
over  the  list  of  the,  then,  graduates,  to  recognize  how  prominent 
they  afterwards  became  in  civil,  hospital,  college,  army  and  navy 
life,  occupying  some  of  the  most  important  positions  in  the  gift 
of  the  people  and  the  Government.  The  public  and  professional 
life  of  the  original  faculty  of  this  college  is  now  history,  and  one 
has  but  to  re-read  it  to  realize  how  thoroughly  these  men  met 
their  responsibilities  in  educating  students  of  our  present  institu- 
tion. Methods  developed  into  realities  that  brought  success  to 
the  Albany  Medical  College  soon  after  its  work  became  known, 
and  at  once  it  occupied  a  place  of  respect  and  confidence  through- 
out the  land. 

It  was  during  this  early  period  that  Dr.  Thomas  Hun,  after 
a  thorough  education  in  this  country  and  abroad,  began  his 
famous  lectures  on  "The  Institutes  of  Medicine."  What  an  inter- 
esting essay  could  be  written  on  the  evolution  of  his  subject  from 
that  period  to  the  present  time. 

Dr.  March,  in  the  work  of  organizing,  early  recognized  the  im- 


A.  VANDER  VEER 


3 


portance  of  having  a  good  museum  and  to  it  he  brought  his  own 
anatomical  and  pathological  preparations.  In  this  work  he  was 
ably  assisted  by  Dr.  James  H.  Armsby,  who,  in  securing  an  appro- 
priation from  the  Legislature,  was  able  to  purchase  specimens,  and 
to  add  his  own  collection,  so  that  very  soon  the  museum  of  the 
Albany  Medical  College  became  famous,  and  was  of  real  value 
as' a  factor  in  the  education  of  its  students. 

In  giving  instruction  Dr.  March  also  realized  the  importance 
.  of  adopting  methods  that  would  keep  the  school  abreast  of  what 
.was  being  done  elsewhere.  He  had  determined,  and  availed  him- 
self of  seeing  what  was  being  done  by  able  men  in  this  country 
and  abroad.  Going  to  New  York,  Boston,  Philadelphia,  and 
Europe  meant  much  in  those  days  of  difficult  transportation,  but 
from  these  visits  he  gained  brilliant  inspiration  and  was  among 
the  first  in  this  country  to  establish  a  regular  surgical  clinic,  for 
the  purpose  of  giving  the  students  clinical  instruction  in  surgery. 
These  clinics  were  started,  and  for  many  years  maintained,  in  the 
ampitheatre  we  are  now  occupying.  The,  then,  faculty,  was  well 
organized,  and  giving  satisfactory  results  in  didactic  work,  on  a 
basis  of  two  lecture  courses  of  fourteen  to  sixteen  weeks  each, 
and  two  year  candidates  being  graduated  on  passing  an  examina- 
tion before  the  faculty  and  Board  of  Curators.  At  this  early 
date  the  State  manifested  an  interest  in  controlling  medical  educa- 
tion, for,  in  return  for  the  appropriation  made,  they  required  the 
appointing  of  a  Board  of  Curators,  before  whom  students  must 
be  examined,  and  if  found  incompetent  they  could  not  be  granted 
their  diploma,  although  "having  passed  the  faculty."  Of  the  list 
of  those  constituting  the  Board  of  Curators,  from  time  to  time, 
it  is  interesting  to  note  that  the  descendents  of  such  men  as  Staats, 
Wing,  Boyd,  MacXaughton,  Cogswell,  Bigelow,  Freeman,  Craig, 
Babcock  and  Snow,  of  Albany  ;  Vedder,  of  Schenectady  ;  Whiton 
and  McLean,  of  Troy,  and  Featherstonhaugh,  of  Cohoes,  are  to- 
day represented  in  the  administrative  work  of  the  college. 

The  faculty  had  been  working  earnestly  for  a  period  of  ten 
years,  when  they  desired  to  make  use  of  still  more  advanced 
methods,  and  in  order  to  accomplish  this  the  establishing  of  a  hos- 
pital became  necessary.  Doctors  March,  Thomas  Hun,  Armsby, 
and  James  MacXaughton  were  unceasing  in  their  efforts,  and 
their  first  clinical  work  was  done  in  a  small  building — long  since 
passed  away — on  the  corner  of  Lvdius  '  Street,  now  Madison 
Avenue,  and  Dove  Street.    In  1849  a  charter  was  obtained  and 


4 


ORGANIZATION,  METHODS  AND  RESPONSIBILITIES 


the  building  secured  now  standing  on  the  corner  of  Eagle  and 
Howard  Streets. 

The  next  fifteen  to  twenty  years,  under  what  we  would  now 
term  the  old  regime,  was  probably  the  most  prosperous  period 
connected  with  the  work  of  the  early  organizers  of  the  college. 
They  had  performed  their  duty  well  and  good  results  followed. 
They  had  met  the  responsibilities  that  came  to  them  in  a  manly 
manner ;  they  had  done  their  best,  and  it  was  appreciated  both  by 
the  public,  and  by  the  medical  profession,  the  former  through  the 
Board  of  Trustees  of  the  college,  in  doing  much  that  was  possible 
to  advance  the  interests  of  the  institution,  the  latter  in  its  favorable 
criticisms  in  county,  State,  and  National  medical  societies. 

The  organization  of  the  Albany  Hospital  proved  of  great  help 
to  the  teaching  force  of  the  college.  Here  methods  could  be 
adopted  and  made  use  of,  such  as  bedside  instruction,  first  so 
earnestly  advocated  by  Drs.  Thomas  Hun  and  Howard  Townsend, 
and  employed,  to  a  certain  degree,  by  Doctors  March  and  Armsby, 
not  only  aiding  the  student,  but  giving  a  reputation  to  the  col- 
lege that  was  soon  recognized  by  the  country  at  large.  For 
several  years  this  hospital  was  visited  by  members  of  the  medical 
profession  from  cities  in  this  and  other  states,  in  order  that  they 
might  note  its  work,  and  the  good  it  was  accomplishing.  It  is 
very  interesting  to  read  the  reports  made  for  the  following  few 
years  after  the  hospital  was  organized.  I  have  in  my  possession 
the  original  manuscript  letter  of  Dr.  Thomas  Hun,  to  the  Board 
of  Governors,  in  which  he  states  that  the  hospital  was  becoming 
so  crowded  with  patients  suffering  from  tuberculosis,  that  pro- 
vision should  be  made  for  them  in  some  other  way. 

I  have  sometimes  thought  that  this  suggestion  of  his  must 
have  resulted  later  in  there  being  introduced  into  the  by-laws 
of  the  hospital,  a  clause  forbidding  the  entrance  and  retaining 
of  incurable  cases. 

However,  there  inevitably  came  a  time  when  great  changes 
occurred  in  the  teaching  force  of  the  college.  As  an  Albany  poet 
has  so  well  said  "Time,  the  tomb  builder,"  was  at  work,  and 
not  long  after  the  close  of  the  Civil  War,  by  death,  and  resigna- 
tion, the  original  faculty  ceased  from  their  earthly  labors.  They 
had  made  some  preparation  for  this  change,  it  is  true,  but  not 
such  as  the  men  who  followed  later  have  done.  They  had  intro- 
duced some  new  men,  but  almost  coincident  with  these  additions 
these  zealous  professors  and  adjuncts  were  scattered.    The  bril- 


A.  VANDER  VEER 


5 


liant,  noble,  Howard  Townsend,  and  the  scholarly  James  E. 
Pomfret,  died,  later;  the  good  anatomist,  Henry  Haskins,  and 
J.  V.  Lansing,  the  model  clinical  instructor  moved  to,  and  took 
charge  of  a  State  institution,  while  the  earnest  and  advanced 
thinker,  S.  Oakley  Vander  Poel,  and  the  charming,  most  courteous 
J.  S.  Mosher,  moved  to  New  York  to  take  charge  of  the  Quaran- 
tine Station  of  that  great  port.  To  my  mind  this  became  the  most 
trying  period  in  the  existence  of  the  college.  During  a  short 
time  following  the  death  of  Doctors  March,  MacNaughton  and 
Armsby,  and  the  appointing  of  some  of  the  men  who  make  up 
the  present  faculty,  a  few  able  professors  were  secured  from 
New  York  and  elsewhere.  However,  following  the  loyal  con- 
sultations held  by  the  Dean,  Dr.  Thomas  Hun,  Doctors  Quacken- 
bush,  Swinburne,  some  of  the  members  of  the  present  faculty, 
and  members  of  the  Board  of  Trustees,  a  re-organization  was 
brought  about,  and  a  very  complete  teaching  force,  both  didactic 
and  clinical,  installed.  Doctors  Vander  Poel  and  Mosher  having 
returned  from  New  York  again  became  active  members  of  the 
faculty.  During  the  administration  of  the  original  faculty,  it 
must  be  noted,  and  aided  later  by  enthusiastic  adjuncts,  important 
additions  and  changes  had  been  made  to  and  in  the  college  build- 
ing. In  addition  the  Albany  Hospital  had  been  twice  enlarged, 
St.  Peter's  and  the  Child's  Hospitals  established,  the  County 
Hospital  made  use  of  for  instruction,  and  with  new  dispensaries 
Albany,  as  a  medical  centre,  had  advanced  very  materially. 

Who  will  dare  to  assert  that  the  original  faculty  and  Board 
of  Trustees  connected  with  this  institution,  failed  in  their  primary 
organization,  in  the  originating  and  adopting  of  new  methods,  or 
in  meeting  their  responsibilities  as  they  presented  from  time  to 
time? 

Following  their  appointment  what  has  the  present  faculty 
accomplished  ?  They  came  into  control  when  bacteriology,  patho- 
logy, experimental  and  preventive  medicine  and  clinical  instruc- 
tion were  subjects  claiming  attention,  and  recognized  as  of  great 
importance ;  organized  and  adopted  in  very  few  institutions,  but 
grasped  and  brought  into  the  curriculum  of  this  college  with  a 
vigor  and  degree  of  success  exceedingly  pleasing  to  all  interested. 
One  of  the  advances  made  at  this  time  was  increasing  the  length 
of  the  term  from  sixteen  to  eighteen  and  twenty  weeks,  and  three 
years  study  instead  of  two,  with  later  a  complete  four  years* 
course  of  thirty-two  weeks  each,  all  of  which  led  to  greater  de- 


6 


ORGANIZATION,  METHODS  AND  RESPONSIBILITIES 


mands  being  made  upon  the  teaching  force  of  the  medical  pro- 
fession in  this  city  and  adjoining  territory. 

The  new  faculty  early  recognized  that  in  final  examinations 
a  number  of  honest  men  were  plucked  because  they  were  not 
properly  prepared  for  the  study  of  medicine,  and  failed  in  con- 
sequence. This  seemed  to  be  an  injustice  to  them  and  in  addi- 
tion to  the  other  changes  made  a  preliminary  examination  was 
required,  the  very  first  adopted  by  any  medical  college  in  this 
State.  It  resulted  in  the  loss  of  some  students,  but  it  brought 
us  better  men,  and  final  examinations  were  not  so  distressing. 
The  examinations  were  changed  to  both  verbal  and  written,  and 
to  monthly,  mid-winter  and  final. 

Realizing  the  injustice  done  their  own  students,  by  other  col- 
leges passing  men  who  had  attended  a  less  number  of  courses, 
and  given  less  time  to  acquiring  their  education,  the  faculty 
urged,  and  finally  were  successful,  in  their  efforts,  assisted  by 
many  good  men  in  the  profession,  in  seeing  a  State  Board  of 
Medical  Examiners  appointed  by  the  State,  before  whom  all 
graduates  of  medical  colleges  had  to  pass  an  examination  before 
being  permitted  to  practice.  This  law  abolished  the  Board  of 
Curators.  The  present  faculty  met  the  responsibility,  in  the 
increased  work  called  for,  in  a  brave,  progressive  manner.  It  is 
true  imperfect  accommodations  were  afforded  at  first,  in  this 
line  of  work,  but  in  consultation  with  friends  of  the  college,  with 
men  of  financial  ability,  and  generous  disposition,  there  came, 
in  course  of  time,  the  Bender  Hygienic  Laboratory,  in  which 
some  of  the  very  best  instruction  has  been  given.  I  need  not 
dwell  upon  the  history  of  this  plant.  Clinical  instruction  de- 
veloped as  has  section  work,  and  we  have  found  it  necessary  to 
make  use  of  other  institutions  in  the  city.  In  line  with  the  pro- 
gressive policy,  and  adoption  of  new  methods,  St.  Peter's  and 
the  Child's  Hospitals  have  been  enlarged,  St.  Margaret's  Home, 
and  the  South  End  Dispensary  established,  the  various  orphan 
asylums,  the  Home  for  Incurables,  the  Albany  Guild  for  the 
Care  of  the  Sick,  and  county  institutions  have  been  made  use  of 
to  the  advantage  of  our  students. 

I  cannot  refrain  from  speaking  of  the  splendid  new  Albany 
Hospital  plant,  with  which  you  are  well  acquainted.  I  might  say 
in  its  construction  does  it  not  illustrate  that  the  present  faculty, 
trustees,  and  board  of  governors  seem  willing  and  able  to  meet 
the  responsibilities  that  have  devolved  upon  them? 


A.  VANDER  VEER 


7 


And  now,  this  term,  we  will  enter  upon  a  line  of  work  that  will 
demonstrate  the  earnest  wish  of  the  present  authorities  to  meet 
all  professional  demands.  As  you  know,  there  have  been  estab- 
lished two  new  departments,  one  of  physiological  chemistry,  the 
other  experimental  physiology.  The  former  you  will  become 
acquainted  with  more  particularly  this  present  session ;  both  in 
a  year  from  now  will  be  thoroughly  organized  and  the  very  latest 
methods  made  use  of  pertaining  to  such  a  line  of  instruction. 
The  faculty  feel  very  thankful  in  having  secured  so  able  a 
teacher  as  Dr.  Jackson,  who  is  with  you  to-day. 

It  cannot  be  denied  that  in  this  building  we  have  now  reached 
our  maximum  ability  to  meet  all  new  requirements.  New  build- 
ings must  be  provided,  and  in  this  we  believe  our  friends  will 
soon  aid  us.  No  institution  has  a  more  loyal  number  of  grad- 
uates, and  they  have  already  shown  a  strong  desire  to  assist  us 
in  this  direction.  Let  me  say  here,  that  from  the  time  of  the 
earliest  graduates,  few  colleges  have  shown  a  more  keen  and 
earnest  desire  to  advance  its  own  students  than  has  this  insti- 
tution. 

I  have  spoken  somewhat  of  our  new  faculty ;  the  time  of  its 
organization  is  pretty  well  known  to  you  all ;  we  have  been  a 
unit  in  our  desire  to  do  everything  possible  for  the  good  of  our 
students.  A  quarter  of  a  century  of  harmonius  work  speaks 
well  for  our  good  intentions. 

Sorrow  has  come  to  us  in  parting  with  our  fellow  workers. 
We  met  with  a  great  loss  in  the  death  of  J.  V.  P.  Quackenbush, 
Edward  R.  Hun,  Jacob  S.  Mosher,  John  P.  Gray,  John  Swin- 
burne, Franklin  Townsend,  Jr.,  S.  Oakley  Vander  Poel,  Thomas 
Hun,  and  Maurice  Perkins,  and  Harrison  E.  Webster  by  resig- 
nation, while  others,  by  reason  of  physical  disabilities,  are  unable 
to  go  on  with  their  work,  but  their  good  wishes  are  ever  with 
us.  Vacancies  have  been  filled,  others  will  follow,  and  who 
of  you  now  student  will  have  so  worked  as  to  merit  recognition? 

While  new  buildings  are  desirable,  yet  honest  instruction  can 
be  given  by  teachers,  assisted  by  students,  in  the  college  plant  as 
it  stands  to-day,  and  in  connection  with  the  other  associate 
institutions.  I  doubt  if  a  new  building  could  be  constructed  con- 
taining better  lecture  rooms  than  some  of  those  we  now 
occupy. 

And  now,  young  men,  you  who  are  to  become  members  of 
the  great  profession  of  medicine,  who  are  to  occupy  important 


8  ORGANIZATION,  METHODS  AND  RESPONSIBILITIES 

positions,  and  upon  whom  will  rest  the  critical  eye  of  public 
opinion;  you  who  some  day  are  to  become  tutors,  instructors, 
lecturers,  professors  in  this  college,  and  other  like  institutions; 
you  who  are  to  become  attending  physicians  and  surgeons  to 
the  hospitals  of  this  and  other  cities  and  countries,  what  are 
your  ideas  of  organization,  methods,  and  your  own  responsi- 
bilities? 

May  I  venture  a  few  suggestions?  Of  the  men  who  have 
occupied  the  seats  you  are  now  occupying,  a  few  have  become 
the  most  eminent  in  this  country,  and  I  dare  say  they  illustrate 
the  thought  and  evidence  of  systematic  work  from  the  begin- 
ning of  their  career. 

Organization  begins  in  student  life.  I  trust  that  you  who 
are  members  of  the  junior  and  senior  classes  have,  by  this  time, 
realized,  and  fully  grasped  the  importance  of  systematic  work  in 
your  studies,  by  thorough  quizzing,  by  means  of  quiz  classes, 
special  societies,  your  recitations,  etc.;  that  you  have  adopted 
such  methods  in  the  taking  of  notes,  listening  to  didatic  lectures, 
more  particularly  in  connection  with  your  clinical  instruction, 
and  I  hope  you  will  make  use  of  that  most  admirable  of  methods, 
the  card  system,  in  conjunction  with  diagrams  and  charts,  so 
as  to  place  on  record  truths  that  later  will  be  of  value  to  you. 

You  of  the  freshman  and  sophomore  years  have  much  rest- 
ing upon  you  in  the  proper  organization  and  disposal  of  your 
time.  Those  of  you  who  are  wise  will  devote  certain  hours  to 
study,  certain  hours  to  recreation.  You  will  adopt  methods, 
such  as  your  attention  will  be  called  to  by  members  of  the 
faculty  and  instructors,  and  which  you  will  do  well  to  follow. 
Concise  methods  will  make  you  good  observers,  good  observers 
become  thinkers,  while  thinkers  in  medicine  and  surgery  become 
the  eminent  men  in  our  profession.  Your  responsibilities  are 
great  and  are  to  be  noted  in  the  disposal  of  your  time.  Nothing 
reacts  so  much  to  the  benefit  of  the  teacher  and  student  as 
loyal,  attentive  attendance.  This  applies  not  only  to  the  teacher, 
but  equally  so  to  students.  I  have  seen  very  many  men  earnest 
in  soliciting  some  appointment  as  instructor  or  otherwise  in  the 
college,  who  have  failed  sadly  in  attention  to  their  duties.  I 
have  seen  many  a  student  lose  golden  opportunities  because  of 
his  heedlessness  in  attending  to  his  work.  Let  us  dwell  on  this 
a  little  more  concisely :  Observations  made  along  parallel  lines 
are  not  invidious  or  out  of  place.    Think  of  the  commercial  life 


A.  VANDER  VEER 


9 


of  this  country.  There  has  never  been  a  period  of  such  con- 
tinuous success,  but  when  you  talk  with  the  leading  and  most 
successful  men  in  life  you  will* realize  that  they  dwell  upon  the 
way  in  which  business  is  organized,  the  methods  adopted,  and 
the  responsibilities  of  those  who  are  factors  in  its  success. 
Sons  of  railroad  presidents,  sons  of  men  controlling  great  com- 
mercial houses,  are  now  being  made  to  fill  the  most  menial 
positions.  In  many  instances  college  graduates  are  made  to 
become  conversant  with  every  step  that  leads  to  the  most  honor- 
able positions  offered  in  business.  Read  the  life  of  one  man 
like  that  of  Joseph  Jefferson,  if  you  wish  to  know  what  can 
be  accomplished  by  the  observance  of  strict  methods,  and  recog- 
nition of  a  responsibility,  in  order  that  he  might  become  a 
successful  actor. 

I  do  not  deem  it  out  of  place  to  speak  to  you  young  men  at 
the  present  time  as  though  I  were  saying  something  at  com- 
mencement exercises,  when  you  have  received  your  diplomas, 
and  are  expected  to  enter  upon  a  more  responsible  period  of 
your  existence.  When  your  work  is  accomplished,  and  the 
law  says  you  are  a  doctor  in  medicine,  and  you  have  commenced 
the  practice  of  your  profession,  you  will  find  that  the  public 
at  large  demands  that  you  be  ready  at  all  hours.  Their  call  upon 
you  is  in  a  time  of  distress,  and  the  fee  is  to  be  your  reward, 
from  their  point  of  view.  Many  are  honest  in  believing  it 
will  requite  the  efforts  you  make  in  behalf  of  their  sick  ones, 
but  you  know  well  you  are  working  for  something  more  than 
this.  The  physician  working  for  success  does  not  ask,  when 
the  call  comes,  during  rain  or  shine,  night  or  day,  from  rich 
or  poor,  whether  the  man  is  able  to  pay  his  fee  or  not.  That 
is  not  the  motive  urging  him  to  respond  to  the  call.  He  knows 
that  ultimately  many  of  these  bills  must  be  cancelled,  although 
following  the  result  of  labor  carried  out  at  all  hours  of  the 
day  or  night,  and,  when  in  reality,  it  was  a  great  tax  upon  his 
physical  strength.  He  goes  to  discharge  the  responsibilities  that 
rest  upon  him  after  years  of  labor  in  acquiring  a  profession 
he  loves,  and  to  succeed  he  must  love  that  profession  and  work 
for  the  solution  of  the  hidden  problems  it  constantly  presents. 

Remember  that  "  whatever  comes  from  the  brain  carries  the 
hue  of  the  place  it  comes  from,  and  whatever  comes  from  the 
heart,  carries  the  beat  and  color  of  its  birth  place." 

Acquaint  yourselves  with  these  facts :    "  Twenty  per  cent,  of 


IO  ORGANIZATION,  METHODS  AND  RESPONSIBILITIES 

human  beings  die  before  they  are  a  year  old ;  25  per  cent,  before 
reaching  the  age  of  five ;  50  per  cent,  only  reaching  the  age 
of  25,  and  the  average  length  of  life  is  40  years." 

Which  of  you  here  are  to  be  of  that  number  who  must,  in- 
evitably, in  the  future,  aid,  to  a  greater  or  lesser  degree,  in  the 
lengthening  of  human  life,  because  of  the  methods  imparted 
to  you  in  just  such  institutions  as  we  now  represent? 

The  belief  exists  that  owing  to  the  advances  made  in  diagno- 
sis and  treatment,  over  50  per  cent,  more  babies  are  saved  than 
was  the  case  10  years  ago. 

"  There  is  a  best  way  to  live,  and  it  is  best  to  live  the  best 
way."  The  responsibility  for  what  we  are  depends  upon  our- 
selves. Say  what  we  will,  the  demand  for  properly  prepared 
men,  through  accumulated  instruction,  and  otherwise,  in  com- 
mercial and  professional  life,  was  never  so  great  as  at  the 
present  time.  I  have,  not  infrequently,  heard  young  men  ex- 
press regret  that  they  had  not  lived  a  decade  or  two  ago,  when 
greater  opportunities,  in  the  discoveries  of  the  day,  presented 
for  acquiring  recognition  and  reputation — an  error  in  their  esti- 
mate of  possibilities. 

To-day  our  profession,  in  the  school  of  investigation  and 
research,  present  to  the  careful  student  as  good  opportuities 
as  the  past  has  ever  offered. 

It  yet  devolves  upon  the  student  of  medicine  to  grapple  with 
the  only  partially  solved  questions  of  the  water  and  milk  sup- 
ply of  our  great  cities.  I  believe  there  are  those  here  to-day 
who  will  yet  see  that  most  difficult  problem,  i.  e.,  the  true  knowl- 
edge and  proper  treatment  of  cancer  solved.  You  know  some- 
thing in  regard  to  the  earnestness  with  which  this  fearful 
affliction  of  the  human  family  is  being  studied  at  present. 

Think  of  the  present  careful  investigation  into  the  etiology 
and  treatment  of  pneumonia. 

Of  the  advances  that  have  been  made  in  the  investigation 
and  treatment  of  that  hitherto  fatal  malady,  tetanus,  you  are 
well  acquainted.  The  preparation  of  the  tetanus  antitoxin  serum 
is  part  of  your  instruction  here. 

Consider  for  a  moment  what  has  been  accomplished  in  the 
past  five  or  ten  years.  Do  some  general  reading  aside  from 
medicine.  This  is  not  the  place  and  time  will  not  permit  my 
elaborating  this  thought.  Begin  now,  and  in  the  organization 
of  your  life's  work  think  of  all  the  possibilities  that  may  present. 


A.  VAXDER  VEER 


I  I 


Do  not  forget  the  obligations  that  ,come  to  you  in  fitting  your- 
selves to  become  members  of  general  and  special  socities.  Ob- 
serve the  example  placed  before  you  by  your  present  faculty. 
Of  all  the  special  societies  or  associations  in  this  country,  I 
think  there  is  but  one  or  two  which  is  not  here  represented. 
But  I  will  not  encroach  further  upon  your  time  in  referring  to 
this  fascinating  subject.  I  do  want  to  impress  upon  you  the 
importance  of  every  day  engaging  in  the  systematic  reading  of 
some  of  the  best  literature  published.  You  cannot  estimate 
how  much  can  be  accomplished  by  devoting  ten.  thirty  or  sixty 
minutes  daily  in  this  manner.  This  applies  to  current  medical 
publications  as  well  as  to  the  daily  papers,  etc.  I  know  of  noth- 
ing so  charming  as  in  the  boarding  house  circle  to  note  the 
enquiry  made  by  some  attentive  reader  in  exclaming  "  I  wonder 
what  there  is  in  this  radium  and  x-ray  treatment  of  cancer; 
what  is  this  new  anaesthetic,  scopolamin,  that  we  hear  so  much 
about  ? "  "Will  someone  tell  me  what  kinetic  demography 
means ? "  "I  wish  someone  would  explain  to  me  the  mosquito 
theory  of  disease,  the  varieties  of  mosquitos  and  how  infection 
occurs  ?  "  These  are  but  a  few  of  the  many  questions  that  are 
ofTered,  and  yet  how  delightful  it  is  to  have  some  one  or  more 
bright  medical  students  present  who  can  answer  intelligently, 
or,  if  the  word  is  not  familiar  to  him,  to  take  up  his  latest  medi- 
cal dictionary  and  explain  his  answer  clearly.  These  are  the 
men  who  later  on  in  life  conquer  success  along  their  pathway. 
These  are  the  men  who,  when  in  practice,  are  able  to  meet 
calmly  the  discussion  of  such  subjects  as  the  "  natural  bone 
setter,"  the  work  of  the  clairvoyant,  and  other  like  questions 
that  are  ever  presenting  themselves.  In  like  manner  they  are 
able  to  enlighten  their  interrogators  on  the  "  isms  "  of  Christian 
Science,  faith  cures  and  the  like. 

You  cannot  blame  the  physician  of  the  past  for  being  some- 
what of  a  sceptic,  but  you  cannot  give  him  too  much  credit 
who  patiently  investigates,  selects  the  truths  for  his  patients,  and 
impressively  and  convincingly  to  the  public  explains  away  the 
chaff. 

May  you  so  live  that  in  the  future  you  may  be  able  to  do 
your  full  share,  and  in  all  your  work  remember  organization, 
methods  and  responsibilities. 

And  now,  in  behalf  of  the  faculty,  I  extend  to  you  a  renewed 
welcome  for  the  coming  college  year.    Our  homes  will  be  open 


12 


IRIDOCYCLITIS 


to  you  for  social  enjoyment.  We  again  welcome  you  to  the 
city,  in  which  there  is  much  for  your  intellectual  comfort.  From 
the  libraries  which  you  are  permitted  to  visit  you  will  be  able 
to  gather  much  of  value.  Be  careful  of  your  time  and  make 
good  use  of  the  present  that  you  may  not  in  the  near  future 
gather  a  chapter  of  regrets.  Bear  this  in  mind  that  in  every 
member  of  the  faculty  you  have  a  friend. 


IRIDOCYCLITIS. 

Its  Commoner  Forms  and  Their  Treatment,  with  Report 

of  Cases. 

Read  before  the  Hampden  District  Medical  Society,  Springfield,  Mass., 
October  iy,  1905. 

By  FREDERICK  T.  CLARK,  M.  D., 

Attending  Surgeon,  Eye,  Ear,  Nose  and  Throat  Department,  Noble  Hospital, 

Westfield,  Mass. 

It  was  after  considerable  hesitation  that  I  accepted  our  Secre- 
tary's invitation  to  read  a  paper  before  this  society,  knowing 
that  subjects  which  are  attractive  to  me  might  not  prove  of  the 
same  interest  to  the  majority  of  the  members.  However,  I  be- 
lieve that  a  consideration  of  one  of  the  diseases  of  the  eye  which 
we  all  frequently  meet  in  our  practices,  and  which  not  infre- 
quently results  in  partial  or  total  destruction  of  a  patient's  vision 
and  subsequent  usefulness,  may  not  be  without  benefit  to  us  all. 
I  refer  to  that  common  disease  of  the  eye  known  as  iritis,  or  in 
its  severer  form,  iridocyclitis. 

Severe  inflammation  of  the  iris  (iritis)  without  more  or  less 
involvement  of  the  ciliary  body  (cyclitis)  is  unusual,  and  many 
inflammations  designated  iritis  would  be  more  correctly  described 
by  the  term  iridocyclitis. 

This  disease  is  either  primary  or  secondary  in  its  development. 
The  primary  forms  are  in  the  main  the  manifestations  of  some 
dyscrasia  or  general  disease,  while  in  the  secondary  forms  there 
is  invariably  an  inflammation  of  neighboring  structures  with 
subsequent  involvement  of  the  iris  and  ciliary  body.  Those 
cases  now  designated  by  the  term  idiopathic,  because  we  can 
assign  no  cause  for  their  development,  must  be  classed  as 
primary. 


FREDERICK  T.  CLARK  1 3 

Following  the  classification  of  Fuchs  we  shall  find  primary 
iridocyclitis  developing  in  consequence  of  (i)  syphilis,  (2)  tuber- 
culosis, (3)  rheumatism,  (4)  gonorrhea,  (5)  diabetes  and  (6) 
the  acute  infectious  diseases.  Primary  iridocyclitis  as  an  un- 
doubted local  affection  occurs  only  as  the  traumatic  and  sympa- 
thetic inflammations,  while  the  idiopathic  variety,  now  classed 
as  a  local  inflammation  will  disappear  as  our  knowledge  of  the 
relations  of  morbid  processes  increase.  It  is  the  primary  or 
commoner  forms  that  we  wish  to  consider  at  this  time,  although 
with  some  modifications  the  same  line  of  local  treatment  outlined 
farther  on  is  applicable  to  the  secondary  forms. 

An  explanation  of  the  symptoms  of  this  disease  is  to  be  de- 
rived from  a  study  of  the  important  pathologic  changes,  viz.,  the 
congestion  of  the  iris  and  ciliary  body,  and  the  formation  of 
exudates.  The  congestion  is  evidenced  by  the  change  in  color 
of  the  iris,  causing  a  blue  or  gray  iris  to  appear  greenish  and 
a  brown  one  to  appear  of  a  lighter  shade  when  compared  with 
its  healthy  fellow  of  the  other  eye.  The  pupil  is  contracted  and 
does  not  react  readily  to  light.  The  congestion  of  the  iris  is 
accompanied  by  injection  of  the  ciliary  region,  sensitiveness  of 
the  eye  to  light  and  increase  in  the  flow  of  tears.  The  contraction 
of  the  pupil  is  the  logical  result  of  the  dilatation  of  the  vessels 
of  the  iris  together  with  spasm  of  the  pupillary  sphincter  from 
irritation.-  For  these  reasons  the  effects  of  atropin  on  the  pupil 
are  modified  or  made  ineffective  and  the  reaction  to  light  dimin- 
ished. 

Exudation  from  the  over  distended  blood  vessels  takes  place 
partly  into  the  tissues  of  the  iris  and  partly  into  the  anterior 
and  posterior  chambers.  With  exudation  into  its  tissues  the  iris 
appears  more  swollen  and  discolored  and  the  pupil  greatly  con- 
tracted. The  surface  markings  are  effaced.  Turbidity  of  the 
aqueous  is  the  first  manifestation  of  exudation  into  the  anterior 
chamber.  The  dark  background  of  the  pupil  becomes  gray  in- 
stead of  pure  black.  The  exudate  may  sink  to  the  bottom  of  the 
anterior  chamber  producing  the  condition  known  as  hypopyon, 
or  if  the  congestion  is  very  great  an  extravasation  of  blood  occurs 
which  sinks  to  the  bottom  of  the  chamber  producing  the  con- 
dition known  as  hyphemia.  A  delicate  layer  of  exudate  may  be 
found  adhering  to  the  cornea  and  capsule  of  the  lens  which  con- 
sequently appear  gray.  If  the  exudate  becomes  organized  a 
membrane  which  closes  the  pupil  is  produced.    This  condition 


4 


1  4 


IRIDOCYCLITIS 


is  called  occlusion  of  the  pupil  (occlusio  pupillae)  and  may  result 
in  great  impairment  of  the  vision. 

Exudation  into  the  posterior  chamber  manifests  itself  by  the 
formation  of  adhesions  between  the  iris  and  capsule  of  the  lens. 
These  adhesions  are  known  as  posterior  synechia  and  develop 
mainly  at  the  margin  of  the  iris  where  it  is  in  contact  with  the 
lens.  As  the  inflammation  subsides  and  the  pupil  tends  to  dilate, 
those  portions  of  the  iris  adherent  to  the  lens  capsule  cannot 
retract  and  remain  as  tags  projecting  into  the  pupillary  space. 
The  irregular  shape  of  the  pupil  and  the  extent  of  the  synechia 
are  made  more  apparent  by  the  instillation  of  atropin,  a  pro- 
cedure of  great  value  in  determining  the  presence  of  synechia 
in  old  cases.  The  traction  of  the  iris  after  the  instillation  of 
atropin  may  be  great  enough  to  rupture  the  synechia,  in  which 
event  a  brown  spot  remains  at  the  point  where  the  iris  was 
adherent  to  the  lens  capsule.  These  spots  are  derived  from  the 
pigment  layer  of  the  iris  and  never  disappear,  hence  are  a  never 
failing  evidence  of  the  previous  existence  of  an  iritis  and  may 
give  rise  to  the  subjective  symptom  of  specks  before  the  eyes. 
In  very  severe  inflammations  or  after  repeated  attacks  the  entire 
margin  of  the  iris  may  become  adherent  to  the  lens  capsule 
(annular  posterior  synechia)  thus  shutting  off  communication 
between  the  anterior  and  posterior  chambers  and  producing  the 
condition  known  as  exclusion  of  the  pupil  (seclusio  pupillae). 
These  two  dreaded  sequelae  of  this  disease,  exclusion  and  occlu- 
sion of  the  pupil,  may  occur  together  or  separately.  The  latter 
may  cause  great  reduction  in  vision  without  entailing  more 
serious  consequences  while  exclusion  of  the  pupil  though  not 
immediately  affecting  the  sight,  induces  increased  tension,  which 
results  in  blindness. 

In  severe  iridocyclitis  exudation  from  the  ciliary  body  finds 
its  way  into  the  anterior  and  posterior  chambers  and  into  the 
vitreous  where  it  becomes  apparent  in  the  form  of  opacities.  In 
these  cases  with  much  exudate  the  sight  is  almost  abolished  and 
atrophy  of  the  eyeball  is  subsequently  produced  by  shrinking 
of  the  mass.  Exudate  is  poured  out  between  the  lens  and  iris 
binding  down  its  whole  posterior  surface  to  the  lens  causing 
a  total  posterior  synechia. 

The  tension  in  the  milder  cases  remains  unchanged,  but  in  the 
severer  type  of  the  disease,  especially  in  the  early  stages,  the 
tension  may  become  so  elevated  as  to  cause  immediate  blind- 


Y 

FREDERICK  T.  CLARK  1 5 

ness,  or,  on  the  contrary,  as  the  process  subsides  diminution  of 
the  tension  is  more  frequent  because  of  a  shrinking  of  the  exu- 
date. 

The  special  characteristics  of  this  disease  when  due  to  syphilis, 
which  causes  at  least  half  of  all  cases,  are  the  formation  of 
nodules  at  the  pupillary  or  ciliary  margins  of  the  iris.  In  some 
cases  no  nodules  appear,  only  marked  swellings  of  the  pupillary 
margin  being  present  and  in  still  other  cases  no  distinguishing 
characteristics  of  the  syphilitic  disease  are  present. 

The  diagnosis  of  iridocyclitis  is  based  on  the  conditions  just 
described  and  needs  no  discussion  here. 

Sympathetic  iridocyclitis  while  included  in  the  scope  of  a 
paper  on  this  subject  needs  too  exhaustive  a  discussion  to  be 
considered  at  this  time. 

The  course  and  termination  of  this  disease  is  worthy  of  ex- 
tended discussion,  but  the  limitations  of  this  paper  forbids  more 
than  their  brief  consideration. 

Iridocyclitis  often  shows  a  great  tendency  to  relapse.  Espe- 
cially is  this  true  of  the  rheumatic  form.  The  outcome  of  an 
attack  may  be  a  perfect  cure  in  mild  cases.  The  synechia  all 
rupture  leaving  a  circular  pupil,  the  hypopyon  disappears  by 
resorption ;  and  the  exudates  even  to  considerable  opacities  of 
the  vitreous  may  all  clear  up.  In  the  majority  of  cases,  however, 
permanent  sequelae  remain.  ;  Afropr?y  of  the  iris  develops  after 
severe  or  repeated^  attacks.  The  most  freafupnt  and  important 
of  the  sequelae  at-e  die  exudates  avLu  adhesions.  .Posterior  syne- 
chia are  common,  but  unless  extensive,  cause  little  interference 
with  vision.  If  the  pupil  be  bound  down  thronghouC  iits  entire 
circumference  a  very'  serious 'conthtion  results  This  is  the  ex- 
clusion of  the  pupil  previously  mentioned,  which  unless  remedied 
by  an  iridectomy,  thus  reestablishing  communication  between  the 
anterior  and  posterior  chambers,  terminates  in  total  blindness 
from  the  resulting  increased  intra-ocular  tension.  The  organiza- 
tion of  a  pupillary  membrane  producing  occlusion  of  the  pupil 
disturbs  vision  in  proportion  to  the  thickness  of  the  membrane. 

In  some  cases  cataract  develops  because  of  the  disturbed 
nutrition  of  the  lens. 

Exudates  occur  in  severe  cases  totally  binding  the  iris  to  the 
lens  and  enveloping  the  lens  in  a  mass  of  fibrinous  material. 
This  has  a  great  tendency  to  shrink,  and  with  contraction  of  the 
vitreous  the  retina  becomes  detached  and  blindness  with  atrophied 


i6 


IRIDOCYCLITIS 


eyeball  results.  In  the  treatment  of  every  case  of  iridocyclitis 
it  is  our  duty  to  combat  the  local  symptoms  and,  to  the  best  of 
our  abilities,  search  for  and  remove  the  underlying  cause.  In 
many  cases  no  etiologic  factor  can  be  discovered  and  we  are 
dependent  to  a  great  extent  upon  symptomatic  treatment. 

In  a  case  of  even  moderate  severity  the  patient  should  be 
put  to  bed  in  a  darkened  room,  given  light  but  nutritious  diet, 
his  bowels  kept  loose,  preferably  with  salines,  and  the  urinary 
secretion  stimulated.  Atropin  is  the  most  important  remedy 
in  the  local  treatment.  It  contracts  the  iris,  reducing  the  conges- 
tion and  relaxing  the  spasm  of  the  pupillary  sphincter,  and  if 
used  early  may  rupture  the  newly  formed  synechia.  Atropin 
should  be  used  vigorously  at  first  to  obtain  its  full  cycloplegic 
action.  Drops  of  from  I  to  5  per  cent,  solutions  should  be  in- 
stilled, their  effects  of  course  being  carefully  watched.  Cocaine 
and  adrenalin  chlorid  may  be  advantageously  used  in  conjunc- 
tion with  the  atropin  if  it  alone  does  not  accomplish  the  desired 
dilatation  of  the  pupil.  In  some  few  cases  atropin  is  not  well 
borne,  cyclitis  being  intensified  and  catarrh  of  the  conjunctiva 
resulting.  In  these  cases  it  must  be  replaced  by  scopolamin  or 
duboisin,  or  even  a  miotic  should  be  used. 

Moist  hot  compresses  give  relief  from  pain  and  hasten  the 
resorptive  process. 

Extraction  of  blood. .from  the  temple-  by  means  of  five  or  six 
leeches  or  the*  artificial  leech  will  in  the  beginning  of  severe 
cases  lessen; the  pain  and  inflammatory  symptoms  and  often  after 
such  relief 'the  pupil  for  the  first  time  dilates  undei\the  action 
of  the  atropin..".  /•  J*".:S*" 

The  production  of  profuse  diaphoresis  every  second  or  third 
day  has  frequently  a  very  favorable  effect  upon  the  course  of 
the  disease.  This  should  be  produced  by  the  use  of  pilocarpin 
hypodermatically,  or  sodium  salicylate  internally  with  the  aid  of 
hot  drinks  and  the  hot  air  or  steam  baths.  In  the  syphilitic  form 
of  the  disease,  and  in  my  opinion,  in  any  form  of  iridocyclitis, 
especially  if  there  is  any  doubt  as  to  the  etiologic  factor,  mer- 
curials in  the  form  of  inunctions  should  be  used  daily.  They 
should  be  kept  up  until  the  inflammatory  symptoms  have  sub- 
sided or  until  ptyalism  appears. 

Severe  rheumatic  iridocyclitis  has  done  well  in  my  hands 
under  the  administration  of  large  doses  of  sodium  salicylate  and 


FREDERICK  T.  CLARK  1 7 

it  is  recommended  by  others  as  doing  good  service  in  some  cases 
of  the  gonorrheal  and  diabetic  forms. 

The  following  histories  of  a  few  cases  coming  under  my 
observation  within  recent  months  will  serve  to  emphasize  the 
practical  application  of  some  of  the  suggestions  made  in  this 
paper. 

Case  I.  A.  M.,  male,  aged  27,  single,  barber  by  occupation.  He  came 
to  my  office  having  been  suffering  for  thirty-six  hours  with  pain  in  the 
xight  eye  and  temple,  photophobia  and  lachrymation.  Examination 
showed  the  iris  discolored,  pupil  contracted  and  injection  of  the  ciliary 
region.  Vision  o  right  eye  20/30,  left  eye  normal.  Denied  syphilis; 
never  had  had  rheumatism  or  gonorrhea.  Pupil  dilated  slowly  and 
imperfectly  under  atropin  and  the  ophthalmoscope  showed  slight  posterior 
synechia  which  ruptured  before  he  left  the  office.  He  was  sent  home 
with  instructions  as  to  the  use  of  moist  hot  compresses  and  atropin,  and 
directed  to  call  the  following  day.  Two  days  later  he  appeared  with  the 
inflammatory  symptoms  all  increased  and  having  suffered  great  pain 
during  the  night.  Vision  was  reduced  to  20/200.  The  upper  lid  was 
edematous  and  the  pupil  irregularly  contracted.  The  fundus  could  not 
be  seen  satisfactorily  owing  to  exudation  in  the  anterior  chamber  and 
vitreous.  He  was  sent  home  and  put  to  bed  in  a  darkened  room ;  leeches 
applied  to  the  temple  and  atropin  instilled  in  the  eye  every  three  hours. 
Moist  hot  compresses  were  applied  almost  constantly  for  the  first  few 
days  for  the  relief  of  the  pain,  which  was  severe.  Inunctions  of  one 
drachm  of  20  per  cent,  oleate  of  mercury  were  given  daily,  and  he  was 
made  to  take  ten  grains  of  sodium  salicylate  every  three  hours  for  several 
days.  Pitocarpin  sweats  were  given  him  every  third  day.  At  the  end 
of  the  fourth  week  he  was  able  to  call  at  my  office.  His  vision  then 
was  20/50, ..but  subsequently  became  normal.  Posterior  synechia  were 
present.  The  subsequent  history  of  this  patient  is  interesting  in  that  it 
corroborates  what  has  been  said  in  regard  to  idiopathic  iridocyclitis, 
under  which  class  I  regarded  this  case.  He  has  had  no  return  of  his 
eye  trouble,  but  within  a  few  months  he  was  confined  to  his  home  with 
rheumatism,  and  has  had  recurring  attacks  of  this  disease,  and  finally 
journeyed  to  Mt  Clemens  for  its  relief.  Since  his  return  he  has  been 
free  from  further  attacks.  The  inunctions  were  continued  daily  for 
three  weeks  and  no  signs  of  ptyalism  developed. 

Case  II.  J.  S.,  male,  aged  40,  single,  farmer  by  occupation.  This 
patient  was  myopic  to  a  very  high  degree,  his  normal  vision  being  5/200 
with  either  eye,  as  I  had  occasion  to  know  from  having  previously  exam- 
ined for  his  refractive  error.  He  called  at  my  office,  having  suffered 
for  four  days  with  severe  pain  in  the  left  eye.  The  usual  signs  of 
iritis  were  present,  and  the  pupil  irregularly  contracted.  He  was  ad- 
mitted to  Noble  Hospital,  and  with  the  exception  of  the  leeches  and 
pilocarpin  sweats,  the  same  line  of  treatment  was  carried  out  as  in  the 
previous  case.    The  inunctions  produced  no  ptyalism  and  there  was  no 


iS 


IRIDOCYCLITIS 


other  evidence  of  syphilis.  In  four  weeks  time  he  left  the  hospital  with 
fair  vision,  although  upper  and  lower  posterior  synechia  were  present. 

Case  III.  Marie  E.,  aged  21,  single.  This  patient  called  at  my  office, 
November  28th,  complaining  of  pain  and  discomfort  in  right  eye,  which 
had  annoyed  her  for  two  days  at  her  work  as  a  paper-layer.  Her  left 
eye  had  suddenly  become  blind  five  years  before.  She  did  not  know  the 
cause  of  the  blindness,  although  she  spoke  of  having  consulted  three 
well-known  oculists  at  that  time.  Cataract  of  the  left  lens  was  undoubt- 
edly present  when  I  saw  her,  although  what  fundus  lesion  was  present 
is  a  matter  for  speculation.  That  such  lesion  was  present  is  certain, 
for  there  was  absolutely  no  light  perception.  On  examination  of  the 
right  eye  only  slight  ciliary  injection  was  present,  and  the  pain  and 
irritative  symptoms  were  slight  indeed.  Tension  was  normal  and  vision 
20/30,  but  her  accommodative  power  was  diminished  so  that  for  brief 
intervals  it  was  difficult  for  her  to  read  ordinary  print.  From  the  history 
of  sudden  blindness  of  the  left  eye,  although  she  gave  no  history  of 
traumatism,  nor  was  there  scar  to  substantiate  the  theory,  I  thought  it 
possible  that  a  traumatic  cataract  with  perhaps  a  foreign  body  in  the 
eye  was  to  be  dealt  with.  From  this  it  was  easy  to  deduce  the  theory  of 
sympathetic  iridocyclitis  just  developing  in  the  right  eye.  She  was  sent 
to  her  home  with  instructions  to  use  moist  hot  compresses  and  to  keep 
the  eye  shaded  from  the  light.  She  was  to  return  the  following  morn- 
ing, but  it  was  not  until  the  morning  of  the  second  day  that  she  put  in 
an  appearance,  accompanied  by  her  mother.  She  had  had  no  pain  to 
speak  of,  but  complained  that  she  could  see  but  dimly  as  through  a  dense 
fog.  On  examination  her  vision  was  reduced  to  counting  fingers  at  three 
feet.  She  and  her  mother  were  thoroughly  frightened,  as  indeed  they  had 
good  cause  to  be.  The  pupil  was  irregularly  dilated,  tension  was  sub- 
normal, at  least — I,  and  opacities  of  Descemet's  membrane  and  the  vitre- 
ous were  present.  I  was  still  possessed  of  the  idea  that  a  foreign  body 
was  lodged  in  the  Wind  eye,  and  that  I  had  to  deal  with  a  sympathetic 
iridocyclitis  as  the  result  of  it,  and  consequently  I  took  a  gloomy  view 
of  the  situation.  I  immediately  telephoned  to  the  late  Dr.  Prefontaine, 
asking  him  to  see  the  patient  with  me  and  to  try  what  effect  his  Haab's 
magnet  might  have  on  the  blind  eye.  He  saw  the  patient  within  an 
hour  in  his  office,  and  exposed  the  eye  to  the  magnet  with  absolutely 
negative  results.  He  examined  the  inflammed  eye,  diagnosed  iridocyclitis 
of  a  sluggish  type,  cause  unknown,  and  because  of  the  heavy  exudate  and 
minus  tension  gave  an  extremely  unfavorable  prognosis.  He  predicted 
involvement  of  the  entire  uveal  tract,  with  ultimate  blindness  and  atrophy 
of  the  eyeball. 

Right  here  I  wish  to  render  this  tribute  to  the  memory  of 
Dr.  Prefontaine.  He  was  a  good  friend,  a  gentleman  and  an 
exceptionally  able  practitioner  of  his  chosen  specialty,  whose 
opinion  I  valued  exceedingly,  and  whose  splendid  career,  cut 
off  in  its  beginning,  I  feel  as  a  deep  personal  loss. 


FREDERICK  T.  CLARK 


19 


My  patient  was  made  to  understand  the  very  serious  con- 
dition of  her  eye  and  was  told  that  the  entire  recovery  of  her 
sight  was  doubtful.  She  was  eager  to  do  all  in  her  power  in 
seconding  my  efforts  and  at  once  returned  to  Westfield  and 
to  her  bed  in  a  dark  room.  At  this  time  she  weighed  something 
over  1 60  pounds.  She  did  not  know  her  exact  weight.  Blood 
was  freely  drawn  from  the  right  temple  and  moist  compresses 
as  hot  as  could  be  borne  were  kept  on  the  eye  continuously  for 
the  first  four  or  five  days.  Atropin  solution  was  instilled  every 
three  hours  for  the  first  four  days,  then  only  nights  and  morn- 
ings as  the  pupil  was  well  dilated.  Drachm  inunctions  of  blue 
ointment  were  given  twice  daily  for  the  first  four  days  and 
then  once  daily  for  twenty-eight  days.  Pilocarpin  in  1-10  grain 
doses  were  given  every  six  hours  for  the  first  four  days  with 
hot  drinks,  hot  blankets,  etc.,  producing  a  most  thorough,  and 
I  may  add,  exhausting  diaphoresis.  She  was  given  two  drachms 
of  Rochelle  salts  every  morning  and  made  to  drink  water  freely. 
The  patient's  vision  on  the  morning  after  she  was  put  to  bed 
was  reduced  to  the  perception  of  large  objects  and  the  tension 
considerably  reduced.  She  suffered  little  or  no  pain,  but  much 
discomfort  from  her  treatment.  In  five  days'  time  she  could 
again  count  fingers  and  the  rigor  of  the  treatment  was  some- 
what relaxed.  Suffice  it  to  say  that  on  March  10th,  just  three 
months  and  twelve  days  from  the  time  she  first  presented  her- 
self at  my  office  she  again  called,  reduced  in  weight  to  130 
pounds  but  with  perfect  vision.  She  had  no  recurrence  and  is 
in  perfect  health.  She  did  not  develop  ptyalism.  She  denied 
syphilis  and  no  evidence  of  the  disease  other  than  the  eye 
trouble  could  be  found. 


20 


MALIGNANT  OVARIAN  TUMORS  IN  CHILDREN 


MALIGNANT  OVARIAN  TUMORS  IN  CHILDREN  ;  WITH 
REPORT  OF  A  CASE. 

By  J.  LEWI  DONHAUSER. 

(From  the  Bender  Laboratory,' Albany,  N.  Y.) 

The  following  case  of  a  malignant  ovarian  cyst  in  a  girl  thirteen 
years  old,  emphasizes  some  of  the  clinical  features  of  this  unusual 
condition  and  on  this  account  seems  worthy  of  reporting  in  full. 

History  of  the  Case. 

Miss  C.  P.,  a  schoolgirl,  aged  13,  was  admitted  to  the  service  of 
Dr.  Willis  G.  Macdonald,  at  the  Albany  City  Hospital,  October  20,  1904, 
complaining  of  severe  abdominal  pain. 

Family  History. — Father,  mother  and  two  sisters  living  and  well;  two 
great  aunts  and  one  aunt  and  one  uncle  on  father's  side  said  to  have 
had  cancer. 

Past  History.— Very  healthy  child;  no  sickness  before  present  illness; 
menstruated  for  the  first  time  on  September  3,  1904;  flowed  five  days 
and  menstruation  was  apparently  normal.  Leucorrhoea  present  during 
last  few  months. 

Present  Illness.— On  the  afternoon  of  September  nth,  menstruation 
having  ceased,  she  was  taken  with  severe  colicy  pains  in  abdomen,  which 
radiated  into  the  shoulder.  These  pains  soon  disappeared  and  she  be- 
came quiet  until  about  10  p.  m.,  when  she  was  again  seized  with  an 
attack  of  a  similar  character.  At  the  end  of  24  hours  she  felt  well,  and 
remained  so  for  three  weeks,  when  she  had  a  third  attack  similar  to  the 
previous  ones.  Since  the  onset  of  this  last  illness  (on  the  nth  of 
October)  she  has  been  incapacitated,  owing  to  the  frequent  and  severe 
attacks  of  pain.  For  the  past  few  days  she  has  had  fever  (1020  and 
over)  and  has  been  vomiting. 

Clinical  Diagnosis.— Ovarian  cyst  (ruptured)  with  twisted  pedicle. 

Operation. — A  median  incision  exposed  the  peritoneum  through  which 
could  be  seen  haemorrhagic  material  in  the  abdominal  cavity.  On  opening 
the  latter,  it  was  seen  to  be  filled  with  free  and  clotted  blood.  Further 
examination  revealed  an  ovarian  cyst  which  had  ruptured.  The  blood 
was  wiped  out  of  the  peritoneal  cavity  and  after  ligating  the  pedicle  of  the 
cyst,  it  was  removed.  A  glass  tube  was  inserted  and  the  abdominal  incision 
closed  with  silkworm  gut.  The  patient  was  discharged  November  12, 
1904. 

She  was  admitted  to  the  service  of  Dr.  Macdonald  again  on  November 
29,  1904,  and  gave  the  following  history.  About  five  days  after  the 
patient  left  the  hospital  she  complained  of  soreness  and  pain  in  the 
right  side  which  was  soon  followed  by  an  attack  of  sharp  pain  lasting 
from  one  afternoon  until  the  next  morning.  She  has  had  numerous 
other  attacks  since,  the  pain  extending  chiefly  down  the  right  leg.  Her 
appetite  has  been  poor  and  vomiting  has  been  more  or  less  constant. 


J.  LEWI  DONHAUSER 


21 


Her  bowels  have  moved  three  or  four  times  daily;  stools  have  been 
pencil  shaped ;  no  bloody  stools  noted.  She  has  lost  weight  and  is 
very  anaemic.  For  the  last  three  days  the  patient  has  been  kept  in 
bed,  on  a  strict  liquid  diet.  Temperature  for  the  last  two  or  three 
days  has  been  at  least  as  high  as  100.70.  A  swelling  on  the  right  side 
of  the  abdomen  was  noticed  before  coming  to  the  hospital. 

An  exploratory  operation  was  performed  on  the  29th  of  November. 
An  incision  was  made  over  the  tumor,  which  was  situated  on  the  right 
side  just  below  the  liver.  On  opening  the  abdominal  cavity  a  bloody 
fluid,  in  which  were  found  pieces  of  grayish  tissue,  escaped.  The  cavity 
was  thoroughly  irrigated  and  a  drainage  tube,  flanked  with  strips  of 
iodoform  gauze,  was  inserted.  The  patient  lived  for  nearly  a  month 
after  the  operation,  but  finally  became  delirious  and  restless,  refused 
food,  and  died  on  December  20,  1904.  An  autopsy  was  made  by  Dr.  E. 
MacD.  Stanton,  from  whose  notes  the  following  descriptions  have  been 
taken. 

Anatomical  Diagnosis. — General  sarcomatosis  of  abdominal  cavity. 
Extreme  secondary  anaemia.  Thrombus  in  right  heart.  Operation  scars 
on  abdomen. 

Abdominal  Cavity. — The  entire  left  side  of  the  abdomen  and  pelvis  is 
filled  by  a  tumor  mass  which  reaches  to  the  anterior  abdominal  wall 
and  is  for  the  most  part  covered  by  a  portion  of  the  omentum.  The  left 
border  of  this  mass  extends  from  a  point  5  cm.  to  the  left  of  the 
symphysis  pubis  upward  to  the  under  border  of  the  liver  at  a 
point  5  cm.  to  right  of  the  median  line.  The  coils  of  intestine  adja- 
cent to  the  tumor  mass  are  loosely  adherent  to  one  another  by  easily 
torn  adhesions  which  are  apparently,  for  the  most  part,  composed  of 
the  tumor  itself.  The  remainder  of  the  abdominal  cavity  contains  a 
few  cubic  centimetres  of  bloody  fluid.  The  peritoneal  surfaces  show 
a  slight  loss  of  lustre,  with  here  and  there,  small  tumors  adherent  to 
the  peritoneum.  These  smaller  masses  vary  from  a  few  millimetres 
to  4  or  5  centimetres  in  diameter.  Their  surfaces  are  smooth  with 
a  thin  peritoneum -like  covering.  Two  of  these  masses  situated  on  the 
under  surface  of  the  diaphragm  have  caused  corresponding  depressions 
in  the  right  lobe  of  the  liver.  The  head  of  the  caecum  and  appendix 
together  with  the  pelvic  organs  are  imbedded  in  the  new  growth.  The 
ascending  colon  and  small  intestines  have  been  pushed  over  the  left 
border  of  the  tumor. 

The  general  structure  of  the  large  and  smaller  tumors  is  similar. 
The  free  surface  of  the  larger  tumor  is  somewhat  lobulated  and  of  a 
mottled  grayish  and  dark  red  color.  The  cut  surface  of  the  firmer 
portions  of  the  tumor  is  also  mottled  grayish  yellow  and  dark  red,  the 
red  areas  representing  areas  of  hemorrhage  into  a  soft  succulent, 
grayish-yellow  tissue  which  in  many  places  is  necrotic.  The  entire 
center  of  the  larger  mass  is  occupied  by  an  ill-defined  area  of 
softening  which  is  filled  with  partially  clotted  blood  and  fragments  of 
necrotic  tumor  tissue.  The  tumors  do  not  infiltrate  the  tissue  beneath 
the  peritoneum,  it  being  possible  in  the  case  of  the  larger  tumor  to  strip 
the  parietal  peritoneum  from  the  abdominal  wall. 


22 


MALIGNANT  OVARIAN  TUMORS  IN  CHILDREN 


Pelvic  Organs.— All  pelvic  structures  are  imbedded  in  the  soft  tumor 
mass  described  above.  The  left  tube  and  ovary,  the  body  of  the 
uterus,  the  rectum  and  the  bladder  are  negative  except  for  the  presence 
of  tumor  metastases  or  implantations  on  their  peritoneal  surfaces.  The 
right  ovary  is  missing,  together  with  all  but  the  proximal  3.5  cm. 
of  the  right  tube.  On  the  stump  of  the  right  tube  are  seen  several 
silk  ligatures  which  show  almost  no  evidence  of  encapsulation. 

Liver—  Weight,  1560  grammes.  The  upper  surface  of  the  right  lobe 
shows  several  depressions,  the  two  larger  of  which  measure  respectively 
2  and  5  cm.  in  diameter.  These  depressions  are  caused  by  two 
tumor  masses  which  are  adherent  to  the  under  surface  of  diaphragm. 
The  under  surface  of  the  right  lobe  of  the  liver  is  in  contact  with  a 
shaggy  grayish-yellow  blood  stained  mass  representing  the  upper  and 
of  the  large  tumor  mass  described  above.  Adherent  to  the  under  sur- 
face of  the  left  lobe  of  the  liver  is  another  tumor  mass  2.5  cm.  in 
diameter.  On  section  the  liver  presents  a  pale  brownish  yellow  surface 
with  indistinct  markings. 

Gastro-intestinal  Tract. — Appendix  measures  15  cm.  in  length  and 
is  imbedded  in  the  tumor  mass.  The  remainder  of  the  gastro-intestinal 
tract  is  negative,  except  for  the  presence  of  small  new  growths  scattered 
here  and  there  over  its  peritoneal  surface. 

Pleural  cavities,  pericardial  cavity,  heart,  spleen,  kidneys,  adrenals, 
pancreas,  vagina  and  external  genitals  and  cavity  of  the  uterus  are  all 
negative. 

Gross  and  Microscopic  Appearances. — The  specimen  removed  at  the 
first  operation  was  described  by  Dr.  Stanton  as  being  a  large,  mutilated, 
haemorrhagic  and  necrotic  ruptured  unilocular  ovarian  cyst.  Its  sur- 
face was  fairly  smooth  though  in  a  few  areas  could  be  felt  fine  hard 
granules,  and  its  lining  membrane  was  covered  with  intimately  adherent 
blood  clots. 

On  microscopic  examination  isolated  groups  of  cells  suggesting  can- 
cer were  found,  but  these  were  stained  so  poorly,  owing  to  the  necrosis 
of  the  cyst  wall,  that  a  positive  diagnosis  as  to  their  character  could 
not  be  made. 

The  tissue  removed  at  the  second  operation,  on  November  27th,  and 
examined  by  Dr.  Stanton,  consisted  of  a  few  fragments  of  blood  stained 
material.  The  anatomical  diagnosis  was  then  made  of  "  multiple  malig- 
nant growths  due  to  implantation  from  a  ruptured  ovarian  cyst."  Micro- 
scopic examination  of  these  tissues  showed  a  highly  cellular  stroma  com- 
posed of  numerous  spindle  and  round  cells  of  both  the  large  and  small 
type.  These  large  spindle  and  round  cells  constituted  the  predominating 
cells  of  the  stroma.  Distributed  here  and  there  in  this  tissue  were 
numerous  masses  of  epithelial  cells  arranged  in  "  irregular  gland-like 
tubules."  This  cellular  arrangement  led  to  the  microscopic  diagnosis 
of  "  so-called  adeno-sarcoma." 

Sections  of  the  tumor  growth  removed  at  autopsy  show  a  highly  vascu- 
lar tissue,  many  of  the  blood  vessels  of  which  are  definitely  formed 
and  distinctly  show  the  three  vascular  coats.  Here  and  there  are 
large  areas  of  necrosis  and  haemorrhage  about  which  are  strands  of 


J.  LEWI  DONHAUSER 


23 


a  well  formed  granulation  tissue.  The  histologic  picture  is  somewhat 
intricate,  inasmuch  as  in  different  sections  the  character  and  arrange- 
ment of  the  cells  vary.  In  all,  however,  a  very  noticable  element  is  the 
rambling  stroma,  in  the  meshes  of  which  are  various  types  of  cells,  some 
resembling  the  spindle  and  round  cells  of  sarcoma,  others  distinctly 
epithelioid,  and  still  others  with  syncytial  arrangement  and  again  cells 
of  definite  epithelial  or  endothelial  type.  The  latter  are  often  arranged 
in  gland-like  tubules. 

Examination  of  the  smaller  peritoneal  nodules  reveals  practically  the 
same  picture  as  that  found  in  the  main  tumor  mass,  namely,  a  stroma 
of  spindle  and  round  cells  with  masses  of  epithelium  arranged  in  gland- 
like fashion.  One  section,  however,  taken  from  a  nodule  attached  to 
the  peritoneum  by  a  slight  and  slender  pedicle,  presents  an  interesting 
picture  of  a  well  formed  cyst.  The  wall  of  this  cyst  is  composed  of 
masses  of  spindle  cells  arranged  as  in  sarcoma  while  the  cavity  is  lined 
by  columnar  epithelium.  This  section  resembles  closely  the  new  growth 
known  as  cystic  adeno-sarcoma. 

From  the  histological  picture  of  the  main  tumor  growth  as  well 
as  that  of  the  smaller  nodules,  it  is  evident  that  a  microscopical 
diagnosis  is  very  difficult.  Owing  to  the  peculiar  arrangement  of 
the  epithelium  scattered  throughout  the  growth,  one  is  tempted 
to  consider  the  tumor  as  an  adeno-carcinoma.  On  the  other  hand, 
however,  the  appearance  of  the  stroma,  which  seems  to  be  an  inter- 
mediary type  between  newly  formed  connective  tissue  and  true 
ovarian  stroma  containing  as  it  does  a  vast  number  of  spindle  and 
round  cells  almost  entirely  devoid  of  intercellular  substance,  sug- 
gests a  sarcomatous  growth.  Indeed,  many  malignant  growths 
of  the  ovary  present  such  pecularities  in  their  structure  that  various 
terms  have  been  applied  to  them  in  attempts  to  combine  the  sarco- 
matous, the  carcinomatous  and  the  cystic  characteristics  in  a  single 
name  applicable  to  all.  Thus  we  have  the  terms  adeno-carcinoma, 
adeno-sarcoma,  cystic  adeno-sarcoma,  cystic  endothelioma,  sarco- 
endothelioma and  Leopold's  endothelioma  lymphaticum  and  endo- 
thelioma vascularis.  Poupinal  speaks  of  secondary  tumors  as  being 
of  the  sarco-carcinomatous  type,  although  he  does  not  state  that 
the  primary  growth  also  may  be  a  mixed  tumor.  Echardt  and 
Pomorski  have  used  simply  the  term  "  endothelioma  of  the  ovary." 

When  such  a  number  of  terms  are  applied  to  these  mixed  tumors, 
how  are  we  to  histologically  differentiate  between  them,  and  are  we 
always  justified  in  allowing  a  diagnosis  to  rest  on  a  few  sections? 
Kelly  points  out  that  "  a  thorough  sifting  of  material  from  ovarian 
tumors,  in  the  pathological  laboratory,  has  served  to  demonstrate 
the  necessity  of  a  careful  microsocopical  examination  in  every 


24 


MALIGNANT  OVARIAN  TUMORS  IN  CHILDREN 


case ;  "  and  so  an  attempt  has  been  made  to  examine  most  care- 
fully the  tumor  which  is  here  reported.  The  result,  however,  has 
Adena-carcinoma  or  "  adeno-sarcoma "  seems  to  be  the  most 
been  unsatisfactory  and  no  definite  conclusion  has  been  reached. 

plausible  term  to  apply  in  this  instance,  but  each  has  objections. 
We  must  be  satisfied  therefore  in  describing  it,  as  a  malignant 
ovarian  tumor,  the  stroma  of  which  resembles  ovarian  stroma  and 
in  places  suggests  a  sarcomatous  structure,  while  scattered 
throughout  it  are  masses  of  cells  having  the  arrangement  of  an 
adeno-carcinoma. 

The  history  of  this  case  brings  out  sharply  the  following  points : 

1  Ovarian  cysts  may  occur  in  children  and  may  be  malignant. 

2  The  pedicle  may  become  twisted  and  as  a  result  give  rise 
to  severe  abdominal  pain,  thus  leading  to  a  diagnosis  of  the  cyst. 

3  The  rupture  of  the  cyst  and  the  distribution  of  its  contents 
throughout  the  peritoneal  cavity  may  lead  to  a  general  implan- 
tation of  the  growth  and  soon  cause  death. 

4  The  histological  diagnosis  of  these  cases  is  frequently 
difficult. 

Little  is  said  in  either  the  text-books  or  the  general  literature 
concerning  malignant  ovarian  growths  in  children.  My  interest 
in  the  case  here  reported  has  prompted  me  to  examine  the  his- 
tories of  the  various  cases  heretofore  reported  in  regard  to  the 
following  points. 

1  What  are  the  principal  malignant  ovarian  tumors  in  children? 

2  What  is  the  relative  frequency  of  these  tumors? 

3  Do  malignant  ovarian  tumors  present  any  clinical  manifes- 
tations different  from  those  presented  by  the  benign  growths? 

4  How  frequently  do  accidental  conditions  such  as  twisting  of 
the  pedicle  or  rupture  of  the  cyst  give  the  first  warning  of  the 
presence  of  an  ovarian  growth? 

5  Are  seemingly  benign  growths  of  the  ovary  to  be  looked 
upon  as  harmless,  as  are  benign  growths  of  other  organs. 

Unfortunately,  I  have  not  been  able  to  obtain  much  information, 
for  the  references  are  few,  and,  in  the  majority  of  the  cases, 
meagre  in  clinical  data. 

The  cases  of  ovarian  tumors  which  have  been  reported  as 
occurring  in  children,  embrace  a  number  of  types  of  new 
growths,  which  may  conveniently  be  divided  into  the  benign 
cysts,  sarcoma  and  carcinoma ;  and  in  addition  to  these,  a  fourth 
type,  the  mixed  tumor,  which,  owing  to  the  difficulties  attending 


J.  LEWI  DONHAUSER 


25 


the  determination  of  its  structure  and  histogenesis,  affords  scope 
for  argument  as  to  its  classification. 

The  benign  cysts  may  be  divided  into  the  dermoid,  and  the 
simple  uni-  and  multilocular  cysts.  The  sarcomata  are 
usually  of  the  round  or  spindle  cell  types ;  while  the  adeno-carci- 
noma  seems  to  be  the  most  prevalent  type  of  the  epithelial  tumors. 
Th  mixed  tumors  have  been  discussed  in  the  first  part  of  this 
report. 

It  is  impossible  to  arrive  at  conclusions  regarding  the  benig- 
nancy  or  malignancy  of  new  growths  of  the  ovary  reported  in 
the  literature  as  "  cysts.''  The  fact  that  they  are  thus  reported 
does  not  in  the  least  confirm  the  idea  that  all  are  benign.  Our 
own  case  shows  the  possibilities  of  malignancy  in  an  apparently 
simple  cyst. 

Upon  careful  review  I  have  been  able  to  collect  seventy-two 
cases  of  malignant  tumors  occurring  in  girls  between  the  ages  of 
twenty-two  months  and  fifteen  years.  The  relative  frequency  of 
the  malignant  tumors  as  compared  with  the  benign  growths  of 
the  ovary  in  children  is  comparatively  small.  Whether  this  is 
due  to  the  fact  that  histological  study  has  been  neglected  in  a 
number  of  cases,  or  whether  perhaps,  the  very  small  areas  of  the 
cyst  wall  which  contain  the  malignant  cells  have  escaped  the 
examiner's  notice,  or  whether  cases  have  been  reported  too  soon 
after  the  operation,  thus  affording  little  time  for  the  observance 
of  recurrence  or  whether  surgeons  have  failed  to  report  cases 
which  have  ended  fatally,  it  is  not  my  purpose  in  this  report  to 
state  although  these  various  possibilities  have  occurred  to  me 
during  this  study  of  the  literature. 

The  fact  however  remains  that  malignant  tumors  of  the  ovary 
do  occur  in  young  children,  and  it  is  therefore  the  duty  of  the 
physician  and  the  surgeon  to  look  upon  all  ovarian  growths  as 
possessing  possibilities  of  malignancy. 

A  study  of  the  reports  of  malignant  ovarian  tumors  here  col- 
lected reveals  the  fact  that  clinically  it  is  impossible  at  first  to 
distinguish  the  benign  cyst  or  tumor  from  a  malignant  growth. 

The  symptoms  of  the  two  conditions  may  be  identical  and  to 
this  fact  is  due  the  difficulty  of  differentiating  between  the  two 
forms.  Both  may  develop  slowly  and  without  causing  the 
patient  pain,  as  the  latter  seldom  is  present  unless  a  twist  of  the 
pedicle  or  some  other  complication  occurs.  As  the  tumors  grows, 
however,  symptoms  referable  to  a  malignant  growth  may  follow, 


26 


MALIGNANT  OVARIAN  TUMORS  IN  CHILDREN 


such  as  emaciation  and  those  arising  from  metastasis  or 
implantation.  The  histories  present  little  variation  since  the 
health  of  the  individual,  in  the  majority  of  the  cases,  has  been  re- 
ported as  "  good  "  up  to  the  third,  fourth,  fifth  or  sixth  month 
before  the  detection  of  the  new  growth. 

Symptoms  calling  attention  to  the  tumor  vary. 

1  Some  cases  were  discovered  accidentally  in  operating  on 
other  organs. 

2  In  others,  symptoms  referable  to  an  abdominal  tumor,  such 
as  tightness  of  the  clothing,  dyspnoea,  or  constipation,  have  led 
to  the  diagnosis. 

3  In  some  cases  the  patient  came  under  observation  on  account 
of  pain. 

4  In  a  few  cases  the  patient  was  examined  on  account  of  an 
associated  bloody  vaginal  discharge. 

5  Symptoms  of  an  acute  abdominal  condition  arising  from 
twisting  of  the  pedicle  or  rupture  of  the  tumor,  indicated  the 
proper  diagnosis  in  several  instances. 

In  some  of  the  cases  here  tabulated,  the  diagnosis  of  sarcoma 
of  the  kidney,  hyatid  of  the  liver,  tuberculous  peritonitis,  sarcoma 
of  the  spine,  hematocele,  hydronephrosis  or  typhoid  fever  was 
made.  An  astonishingly  small  percentage  of  the  diagnoses  were 
correct,  showing  beyond  a  doubt  that  the  condition  when  it  does 
occur  in  children  is  not  readily  recognized  owing  either  to  the 
difficulty  of  interpreting  the  symptoms  or  to  the  infrequency  of 
the  disease. 

The  occurrence  of  malignant  ovarian  cysts  in  children  and  the 
impossibility  of  differentiating  them  from  benign  cysts  before 
metastases  or  implantations  occur  emphasizes  the  importance  of 
an  early  diagnosis  and  operation  in  all  cases.  The  case  re- 
ported in  this  article  supports  this  statement  as  does  also  the  ex- 
perience of  the  following  investigators.  De  Senety  states  that 
"  it  seems  impossible  to  draw  a  line  of  demarcation  between 
ovarian  cysts  and  ovarian  cancers ;"  Kelly  says  that  "  from  a 
practical  standpoint  all  ovarian  tumors  must  be  considered  as 
malignant  until  removed  and  proved  otherwise."  Pozzi  remarks 
that  "  it  is  much  better  to  always  take  the  worst  view  of  the  case 
and  always  to  fear  generalization."  Hofmeier  and  Cohn  have, 
too,  laved  much  stress  on  the  fact  that  "  glandular  cysts  may 
present  cancerous  degeneration,"  and  Leopold  fearing  this  de- 
generation has  given  it  as  a  general  rule  that  every  ovarian 


J.  LEWI  DONHAUSER 


27 


tumor  should  be  removed  as  soon  as  it  is  recognized.  Bland 
Sutton  quotes  Jessup  who  once  reported  a  case  in  which  a 
ruptured  dermoid  cyst  metastasized  to  the  liver,  the  suprarenal 
capsule  and  the  mesenteric  glands. 

As  regards  the  frequency  of  the  disease  at  the  different  periods 
of  early  life,  the  cases  which  I  have  tabulated  reveal  the  fact 
that  60  per  cent,  occur  between  the  age  of  ten  and  fifteen,  while 
the  cases  ranging  from  birth  to  five  years  form  but  about  14  per 
cent,  of  the  total  number. 

Two  tumors  simply  reported  as  malignant  ovarian  tumors 
have  not  been  included  in  the  tables  given  below  nor  are  the  four 
carcinomata  reported  in  Keating's  Encyclopaedia  of  Diseases  of 
Children  (p.  739)  since  the  records  contains  no  reference  to  age. 


Table  I* — Type  of  Tumor  According  to  Age. 


Birth  to 

5-9  yrs. 

10-15  yrs. 

Per 

5  yrs. 

incl. 

incl. 

cent. 

...  I 

6 

19 

40 

Sarcoma  

8 

10 

18 

55-4 

Endothelioma  

.  ,  .  0 

1 

2 

4-6 

13.8%  26.2%  60% 

In  the  table  below  the  result  of  the  operation  has  purposely  been 
omitted  inasmuch  as  the  majority  of  the  reports  did  not  state 
whether  the  patient  died  as  the  result  of  operation,  or  as  the 
result  of  the  occurrence  of  metastases ;  also  in  those  given  as 
recoveries'  it  was  impossible  always  to  determine  the  length  of 
time  after  operation. 

Conclusions. 

1  Malignant  ovarian  tumors  may  occur  in  children. 

2  In  the  first  stages  of  the  disease  the  clinical  symptoms  of  the 
benign  and  malignant  tumors  are  identical. 

3  The  tumor  may  be  discovered  accidentally  or  from  symp- 
toms arising  from  a  rupture  of  the  cyst  or  a  twisting  of  its  pedi- 
cle, which  may  be  the  first  evidence  of  the  presence  of  an  ovarian 
tumor. 

4  Children  of  all  ages  are  susceptible  to  the  disease  although 
it  occurs  most  frequently  in  children  between  ten  and  fourteen 
years. 


*  The  figures  here  given  cannot  be  regarded  as  conclusive  for  in  many  cases  no  micro- 
scopic examination  was  made. 


28 


MALIGNANT  OVARIAN  TUMORS  IN  CHILDREN 


5  All  ovarian  tumors  should  be  regarded  with  suspicion  be- 
cause of  the  possibilities  of  malignancy. 

6  Rupture  of  ovarian  cyst  should  be  guarded  against  because 
of  the  possibility  of  secondary  implantations  in  the  peritoneum. 

7  Accurate  classification  of  the  mixed  tumors  is  frequently 
impossible  in  the  present  state  of  our  knowledge. 


Summary  of  Reported  Cases  of  Malignant  Ovarian  Tumors. 

No.  Reporter  Age  Tumor  Reference 

1  Brown,  R   91110  Carcinoma  See  reference  to  case 

No.  35. 

2  Harris,  22.  .  .  Endoth.  Sarcoma.  .  .Am  Jour.Obst.  1904, 

L,  53°- 

3  Flatau  221110  Sarcoma  Munch.  Med.  Woch- 

enschr.  1903,  532. 

4  Hoffman  and  Keyser  331110  Cystic  sarcoma  Am.    Jour.  Obst., 

1897,  XXXVI, 
331- 

Sarcoma  St.  Louis  Courier  of 

Med.  1884. 

.  Myxo-chondro  sar- 
coma Glasgow  Med.  Jour. 

1903,  LX.  100. 

.  Sarcoma  Glasgow  Med.  Jour. 

1889  (4)  S  XXXI, 
37-4o. 

.  Sarcoma  Am. Jour.  Obst.  1896, 

XXXIII,  80. 

.  Sarcoma  Chicago  Med.  Record 

1891,  II,  434. 

.  Carcinoma  Johns  Hopkins  Hosp. 

Bulletin,  1905, 
XVI,  102. 

.  Sarcoma  See  reference  to  case 

No.  31. 

.  Sarcoma  Lancet,     1895,  II, 

1622. 

.  Sarcoma  See  reference  to  case 

No.  31. 

.  Sarcoma  Ditto. 

.  Sarcoma  Edin.    Med.  Jour. 

1892-3,  XXXVIII, 
689. 

.  Sarcoma  Presse,  Med.   2  Mai, 

1888. 

.  Endoth.  Lymphati- 

cum  Arch.     f.  Gynak, 

XLVI,  493- 

.  Carcinoma  Wiener  Med.  Woch- 

enschr.  1894,  47. 

.  Sarcoma  See  reference  to  case 

No.  31. 

.  Carcinoma  Ditto. 

.  Cystic  Sarc  Arch,  fur  Gyn.  VI, 

189. 

.  Carcinoma  See  reference  to  case 

No.  31. 


yrs. 

5  Evers   2\. 

6  Gibb   2\. 

7  Cameron   3^. 

8  Foerste   4$. 

9  Byford   4$. 

10  Wiel    5  . 

11  Viering   5  . 

12  Page   6  . 

13  Turner   6  . 

14  Cohn   6  . 

15  Croom   7  . 

16  Lucas   7 

17  Amann,  Jr   7 

18  Gussenbauer   8 

19  Stolypinski   8 

20  Chenoureth   8 

21  Leopold   8 

22  Olshausen   8 


J.  LEWI  DONHAUSER 


No.  Reporter 

23  M alius  


29 
I, 


24  Forbes   9 

25  Tanner,  J.  H   9 

26  Leopold   9 

27  McBurney  10 

28  Emmett  10 

29  Wagner  10 

30  Klebs  10 

31  Hubert  n 

32  Halliday  Croom.  ...  11 

33  Leopold   11 

34  Olshausen   11 

35  Kluge   11 

36  Kelly   12 

37  Olshausen  12 

38  Wagner  13 

39  Wells  13 

40  Martin  13 

41  Leopold  13 

42  Leopold  13 

43  Eckhardt  13 

44  Demakis  13 

45  Flaischlen  13 

46  Cohn  13 

47  Mertens  13 

48  Bode  13 

49  Schrooder  13 

50  Smith  14 

51  Leopold  14 


Age  Tumor  Reference 

9yrs  Cystic  sarc  Lancet,  1890, 

H74- 

.  Myxo-sarc  Australian  Med. 

Jour.,  1894,  XVI. 

.  Carcinoma  See  reference  to  case 

No.  35. 

.  Carcinoma  See  reference  to  case 

No.  31. 

.  Sarcoma  Annals  of  Surgery, 

1895,  XXI. 
.  Malignant  tumor. .  .Am.  jour.  Obst.  July 
1881,  XIV,  674. 

.  Sarcoma  Arch,  fur  Klin.  Chir. 

XXX,  504. 

.  Carcinoma  See  reference  to  case 

No.  35. 

.  Endothelioma  Lym- 

phaticum  L'eber  O  varial  Gesch- 

wultse  bei  Kin- 
dern,  Giessen, 
190X. 

.  Sarcoma  Obst.  Trans.  Edin. 

XIV. 

.  Carcinoma  See  reference  to  case 

No.  31. 

.  Carcinoma  See  reference  to  case 

No.  31. 

.Sarcoma  Dissertation,  Mar- 
burg, 1894. 

.  Sarcoma  Keating's  Encyclop. 

of  Diseases  of  Chil- 
dren, 739. 

.  Carcinoma  See  reference  to  case 

No.  31. 

.  Sarcoma  Arch,  fur  Klin.  Chir. 

XXX,  505. 

.  Sarcoma  Diseases  of  Ovaries, 

N.  Y.  1873,56. 

.Carcinoma  Krankheiten  der 

Eierstocke,  1899, 
369- 

.  Carcinoma  Gyn.  Ges.  Dresden, 

12  Juli,  1894. 

.  Sarcoma  Ditto. 

.  Sarcoma  Deutsche  Med.  Wo- 

chenschr.,  1895, 
Vereins  Beilage, 
14- 

.  Carcinoma  Dissertation  G5ttin- 

gen,  1895. 

.  Carcinoma  See  reference  to  case 

No.  31. 

.  Carcinoma  Ditto. 

.  Sarcoma  Deutsche  Med.  Woch- 

enschr.,  1894,  96. 
.  Sarcoma  Gyn.  Geselsch.  Dres- 
den. 12  July.  1894. 

.  Carcinoma  Zeitschr.  fur  Geb.  und 

Gyn.  1883,  9369. 

.  Sarcoma  Lancet,  1874,  vol.  II. 

.  Sarcoma  Arch,  fur  Gyn.  VI. 


3° 


MALIGNANT  OVARIAN  TUMORS  IN  CHILDREN 


No.             Reporter  Age  Tumor 

52  Solger  1 4  yrs  Carcinoma . . 


53  Kaltenbach  14 

54  Muratoff  14 

55  Vonnegut  14 

56  Amann,  Jr  14 

57  Thornton  15 

58  Dyonsten  and  Szabo .  15 

59  Koeberle  15 

60  Geyer  15 

61  Bergesio,  L  15 

62  Hanks  

63  Dembo  15 

64  Kratzenstein  15 

65  Pick  15 

66  Shatz   15 


Reference 
.  .  .  Beitrage  zur  Geburt 
shulfe  und  Gynak, 
I,  pg.  go. 

Carcinoma  See  reference  to  case 

No.  31. 

Sarcoma  See  reference  to  case 

No.  31. 

Sarcoma  Dissertation,  Mun- 

chen,  1896. 

Endoth.  Lympati- 

cum  Gesellch.  f.  Geb.  u. 

Gynak  zu  Mun- 
chen,  21  Jan. 1897. 

Carcinoma  -Med.  Times  &  Ga- 
zette, London, 
1883. 

Carcinoma  Arch.      fur  Gyn. 

XXXII.  194. 
Carcinoma  Gaz.  Med.  de  Strass- 

burg,  1875. 
Carcinoma  Dissertation ,  Wurz- 

burg,  1897. 

Cysto-sarcoma  Osservatore  Toreno, 

p.  529- 

Cystic  Carcinomatous  *&Sq 

Degeneration  Am.     Jour.  Obst., 

1891,  XXIV,  941. 

Cystic  Carcinamatous 

Degeneration  Dissertation,  Berne, 

1892, 

Sarcoma  Zeitschr.  f.  Geb.  u. 

Gyn.,  XXXVI, 93. 
Sarcoma  Centralbl.  fur  Gynak 

1894,  941- 

Carcinoma  Corresp.   Blatt.  des 

Allg.  Mecklen- 
burg, Aerzte  Ver- 
eins  No.  106. 


1.  Bigelow. 

2.  Bland  Sutton. 

3.  Cohn. 

4.  De  Senbty. 

5.  eckhardt. 

6.  Garrigues. 

7.  Holt. 

8.  Kelly. 

9.  Kelly. 

10.  Leopold. 

11.  Olshausen. 

12.  Pomorski. 

13.  poupinal. 

14.  Pozzi. 

15.  Skene. 

16.  Spencer  Wells. 

17.  Thomas  &  Mundb. 


References 

"American  Ovariotomies,"  Am.  Jour,  of  Obst.,  1882,  XV,  345_ 
373- 

Surgical  Diseases  of  Ovaries  and  Fallopian  Tubes,  Phila.,  1897. 
Zeitschr.  f.  Geb.  &  Gyn.,  XII,  7. 
Traite  prat,  de  Gynec.  758. 

Zeitschr.  fur  Geb.  und  Gyn.,  1889,  XVI.  Heft  2,  pg.  344- 
"Diseases  of  Women." 

"Diseases  of  Infancy  and  Childhood,"  Phila.,  1903. 
Keating's  Encycl.  of  Diseases  of  Children,  Phila.,  1895,  739. 
"Operative  Gynecology,"  New  York,  1898,  275-278. 
Arch.  f.  Gyn.,  VI,  189. 

Krankheiten  des  Ovaries,  Zweiten  Aufl.,  New  York,  1887,  340. 
Zeitschr.  fur  Geb.  und  Gyn.,  1890,  XVIII.  Heft  1,  92. 
Arch,  de  Phys.  norm,  et  Path.,  Paris,  1887,  3  S.  IX,  394. 
Med.  &  Surg.  Gynecology.    Publication  of  the  New  Sydenham 

Society,  London,  1898,  III,  110-119. 
"Diseases  of  Women,"  New  York,  1892. 
Diseases  of  the  Ovary,  New  York,  1873. 
"Diseases  of  Women,"  Phila.,  1891. 


BENDER  HYGIENIC  LABORATORY 


3* 


BENDER  HYGIENIC  LABORATORY. 

Annual  Report  of  the  Director,  for  the  Year  Ending  August  ji,  1905. 
By  RICHARD  M.  PEARCE,  M.  D. 

To  the  Trustees  of  the  Bender  Hygienic  Laboratory: 

I  have  the  honor  to  submit  my  report  for  the  year  ending 
August  31,  1905. 

The  Work  of  the  Laboratory.  This  may  be  conveniently 
divided  into  routine  examinations,  under-graduate  teaching, 
instruction  to  special  students  and  original  investigation. 

The  nature  of  the  routine  work  of  the  laboratory  is  shown  in 
the  accompanying  table  which  gives  the  source  of  the  material 
and  the  number  and  character  of  the  examinations,  Mr.  Wach- 
ter's  tabulation  of  his  chemical  and  bacteriological  examinations, 
made  at  the  filtration  plant,  have  been  included  in  his  annual 
statement  to  the  Water  Bureau  of  the  City  of  Albany  and  do 
not  appear  in  this  report. 


TABULATION    OF    THE    ROUTINE    EXAMINATIONS    MADE    BY  THE 
STAFF  OF  THE  BENDER  LABORATORY  FROM  SEPTEM- 
BER  I,   I9O4,  TO  AUGUST  31,  I905. 


State  Dept.  of 

Health. 

City  Board  of 

Health. 

Albany  Hospital. 

St.  Peter's 

Hospital. 

Ellis  Hospital, 
Schenectady. 

Child's  Hospital 
and  St. Margaret's 
House. 

Albany  Orphan 
Asylum. 

Coroner's 

Physicians. 

All  other  sources. 

30 
945 

3 

184 

3 
61 

21 
5 

4 
I 

28 

40 
75 

129 
1,271 
1.295 
535 
288 
408 
157 

888 
458 
143 
376 
7 

407 
45 

1 

86 

1 

2 

30 
39 
32 
68 

Widals  

17 

1 

Miscellaneous  

65 

11 

5 

I 

1,872 

45  2 

1,127 

215 

64 

34 

7 

28 

284 

4,083 

These  figures  show  a  very  satisfactory  increase  in  the  work 
in  pathology,  but  a  slight  decrease  in  the  number  of  bacterio- 
logical examinations.  There  is,  however,  an  increase  over  last 
year  of  three  per  cent,  in  the  total  number  of  examinations.  The 
greatest  increase  has  been  in  the  number  of  surgical  specimens, 


32 


BENDER  HYGIENIC  LABORATORY 


which  show  an  increase  of  26.7  per  cent,  over  last  year.  This 
is  largely  due  to  the  fact  that  the  laboratory  now  does  the  work 
of  the  St.  Peter's  Hospital,  of  Albany,  and  the  Ellis  Hospital, 
of  Schenectady. 

The  laboratory  courses  during  the  past  year  (term  of  seven 
and  a  half  months)  to  undergraduates  of  the  Albany  Medical 
School  were  as  follows : 

Pathology  and  bacteriology. — Drs.  Pearce,  Stanton,  Winne  and 
Sibley,  eight  and  a  half  hours  a  week. 

Normal  histology. — Drs.  Stanton  and  Boyd,  six  hours  a  week. 

Clinical  microscopy. — Drs.  Laird  and  Sibley,  two  and  a  half 
hours  a  week. 

Surgical  pathology— Drs.  Elting  and  Carey,  two  and  a  half 
hours  a  week. 

Histology  and  pathology,  in  connection  with  the  course  in 
obstetrics. — Drs.  Lipes  and  Boyd,  two  and  a  half  hours  a  week. 

Anatomy  and  pathology  of  the  nervous  system. — Drs.  Stanton 
and  Boyd,  one  and  a  half  hours  a  week. 

In  connection  with  the  course  in  pathology  the  most  serious 
need  is  some  arrangement  by  which  post-mortem  examinations 
may  be  made  before  the  entire  class.  At  present,  this  instruction 
can  be  given  only  to  small  sections  at  irregular  intervals.  It 
would  appear  possible,  by  combined  action  of  the  Albany  Hos- 
pital, the  faculty  of  the  Albany  Medical  College  and  the  trustees 
of  the  Bender  Laboratory,  to  arrange  for  proper  facilities  at  the 
Albany  Hospital.  I  respectfully  suggest  to  the  trustees  the 
necessity  of  immediate  action  upon  this  question. 

Physicians  who  have  availed  themselves  of  the  opportunity 
to  work  in  the  laboratory  for  considerable  periods  of  time  are 
Dr.  R.  Fletcher  Van  Heusen  of  San  Francisco,  Dr.  Ellice  Mc- 
Donald of  New  York,  Dr.  C.  G.  McMullen  and  Dr.  W.  P.  Faust 
of  Schenectady,  and  Drs.  J.  A.  Cox,  J.  A.  Lanahan,  J.  A. 
Sampson,  J.  F.  Roonev,  A.  J.  Douglas,  A.  T.  Hull  and  K.  D. 
Blackfan  of  Albany.  Undergraduates  having  similar  privileges 
were  Messrs.  J.  L.  Donnhauser,  Erastus  Corning,  Jerome  Myers, 
E.  W.  Jackson,  J.  H.  Linden,  J.  F.  Robinson,  S.  P.  Brush,  R.  A. 
Lawrence  and  F.  C.  Conway,  students  of  the  Albany  Medical 
School,  and  Mr.  Nelson  Fromm,  of  Dartmouth  Medical  College. 
These  gentlemen  have  assisted  in  the  routine  work  of  the  labora- 
tory, pursued  special  lines  of  study  or  engaged  in  research  work. 

Investigations  completed  during  the  past  year  are  as  follows: 


RICHARD  M.  PEARCE 


33 


1.  Stanton,  E.  MacD.,  The  Sequence  of  the  Pathologic 
Changes  in  Appendicitis. — Journal  of  the  American  Medical 
Association,  icjOj,  xliv,  1849. 

2.  Baldauf,  Leon  K.,  Cancer  of  the  Appendix  Vermiformis, 
with  Report  of  Three  Cases. — Albany  Medical  Annals  {in 
press). 

3.  Corning.  E.,  Retention  Cyst  and  Diverticulum  of  the  Ap- 
pendix Vermiformis. — Albany  Medical  Annals  (in  press). 

4.  Laird,  A.  T..  The  Elimination  of  Endogenous  Uric  Acid 
in  Cases  of  Chronic  Gout. — American  Medicine,  190 5.  x>  315; 
Albany  Medical  Annals,  xxvi.  742. 

5.  Pearce,  R.  M.,  Experimental  Cirrhosis  of  the  Liver. — 
Journal  of  Experimental  Medicine  (in  press). 

6.  Pearce,  R.  M.,  and  Stanton,  E.  McD.,  Experimental  Ar- 
teriosclerosis.— Journal  of  Experimental  Medicine  (in  press). 

7.  Stanton,  E.  McD.,  Actinomycosis  Limited  to  the  Urinary 
Tract. — Albany  Medical  Annals,  xxvi,  738. 

8.  Donhauser,  J.  L.,  Malignant  Ovarian  Tumors  in  Chil- 
dren with  Report  of  a  Case. — Albany  Medical  Annals  (in 
press). 

9.  McDonald,  E.,  The  Various  Forms  of  Puerperal  Sepsis 
with  Report  of  Cases. — American  Medicine  (in  press). 

Other  investigations  not  yet  completed  are: 

A  Study  of  the  Effect  of  Haemolytic  Sera  upon  the  Blood  and 
Blood-forming  Organs  by  Dr.  C.  K.  Winne,  Jr ;  A  Study  of 
the  Action  of  Toluylendiamin  upon  the  Blood  and  Blood-forming 
Organs  by  Air.  J.  L.  Donhauser;  and  a  Study  of  Sarcoma  of 
the  Uterus  by  Dr.  Ellice  McDonald. 

The  expense  of  the  experimental  work  has  been  defrayed  by 
a  grant  from  the  Rockefeller  Institute  for  Medical  Research ; 
a  similar  grant  has  been  obtained  for  the  ensuing  year. 

Laboratory  Club.  During  the  past  year  an  organization 
known  as  the  Laboratory  Review  Club  has  been  formed.  This 
includes  the  regular  staff  and  all  instructors  giving  courses  in 
the  laboratory.  Its  object  is  to  cover,  in  the  form  of  general 
reviews,  a  few  of  the  important  lines  of  work  in  scientific 
medicine.  These  reviews  are  afterwards  published  in  the 
Albany  Medical  Annals.  Physicians  and  students  doing 
special  work  in  the  laboratory  are  invited  to  attend  these  meet- 
ings so  that  an  average  attendance  of  twelve  to  fifteen  has 
been  the  rule.    This  club  has  been  so  enthusiastically  supported 


34 


BENDER  HYGIENIC  LABORATORY 


by  all  members  and  its  advantages  are  so  evident  that  it  will 
be  made  a  permanent  organization. 

Changes  in  the  Staff.  Dr.  E.  MacD.  Stanton  and  Dr. 
Chas.  K.  Winne,  Jr..  who  were  reappointed  as  regular  assistants, 
and  Dr.  E.  E.  Sibley,  who  volunteered  as  assistant  without 
salary  for  one  year,  have  constituted  the  laboratory  staff  for 
the  past  twelve  months.  To  the  conscientious  and  earnest  efforts 
of  these  gentlemen  is  due  in  large  part  the  present  efficiency 
of  the  laboratory  in  all  lines  of  work.  To  Dr.  Sibley  we  are 
especially  indebted  for  time  and  labor  given  without  substantial 
recompense.  Dr.  Stanton,  having  received  an  appointment  at 
the  St.  Mary  Hospital  of  Chicago,  resigned  in  June.  Dr.  Leon 
Kahn  Baldauf  (Johns  Hopkins  University,  A.  B.,  1901  ;  M.  D., 
1905)  has  been  appointed  his  successor.  Dr.  Winne  resigned 
September  1st  to  enter  private  practice  in  Albany  and  in  his 
stead  Dr.  Kenneth  D.  Blackfan  (Albany  Medical  College,  M.  D.. 
1905)  has  been  appointed.  On  September  1st,  Dr.  Sibley  also 
terminated  his  connection  with  the  laboratory  in  order  to  become 
an  assistant  to  Dr.  A.  W.  Elting. 

The  great  increase  in  all  departments  of  our  work  has  led 
to  the  creation  of  three  new  positions.  The  first  of  these,  an 
assistantship  in  Neuro-Pathology,  was  made  possible  through 
the  generosity  of  Dr.  Henry  Hun.  To  this  position  has  been 
appointed  Dr.  La  Salle  Archambault  (Albany  Medical  College, 
M.  D.,  1902),  who  enters  upon  his  duties  after  two  years 
special  study  of  neurology  in  the  laboratories  and  clinics  of 
Europe.  The  second  position,  that  of  assistant  in  Surgical 
Pathology,  is  the  result  of  the  generous  cooperation  of  Drs. 
Albert  Yander  Veer  and  Willis  G.  Macdonald.  To  this  position 
has  been  appointed  Dr.  Harold  Eugene  Robertson  (Carlton  Col- 
lege, A.  B..  1899;  University  of  Pennsylvania.  M.  D..  1905). 

The  third  new  position,  that  of  Pathological  House  Officer  to 
the  Albany  Hospital,  is  the  natural  result  of  the  great  increase 
in  laboratory  work  of  the  latter  institution.  Although  the  in- 
cumbent of  the  position  is  appointed  by  the  Board  of  Governors 
of  the  Albany  Hospital  at  the  recommendation  of  its  staff,  and 
is  therefore  an  officer  of  the  hospital,  it  appears  justifiable,  as 
the  greater  part  of  his  work  will  be  in  the  Bender  Laboratory, 
to  consider  him  as  an  assistant  in  the  latter  institution.  Dr. 
William  M.  Dwyer  (Albany  Medical  College,  M.  D.,  1905)  has 
been  appointed  by  the  Board  of  Governors  of  the  hospital  to 
fill  this  position  during  the  year  ending  June  1,  1906. 


RICHARD  M.  PEARCE 


35 


The  influence  which  these  changes  will  have  upon  the  work 
of  the  laboratory  cannot  be  estimated.  The  staff  for  the  past 
two  years  has  been  quite  inadequate.  The  great  variety  and 
amount  of  our  routine  work  including  as  it  does,  teaching,  exami- 
nations for  state  and  city  boards  of  health,  the  autopsy  work 
and  the  examinations  of  the  surgical  material  of  the  various 
hospitals  of  this  vicinity  and  the  prosecution  of  special  investiga- 
tions has  taxed  the  staff  to  its  utmost  and  not  infrequently  has 
caused  considerable  embarrassment.  Such  difficulties,  however, 
will  be  avoided  by  this  increase  in  the  staff. 

Through  financial  assistance  afforded  by  the  Albany  Medical 
College,  the  janitor  service  has  been  increased  and  this  very  im- 
portant service  is  now  highly  satisfactory. 

Mr.  Leonard  M.  Wachter  was  reappointed  for  the  year 
I905-'o6  as  assistant  chemist  and  bacteriologist,  in  charge  of  the 
Albany  filtration  plant. 

Improvements,  Repairs,  Etc.  These  have  been  entirely  prac- 
tical and  are  not  of  great  importance.  The  small  room  off  the 
large  class  room  has  been  transformed  into  a  museum.  Here 
has  been  formed  the  nucleus  of  a  museum  of  gross  pathology. 
On  the  first  floor  new  quarters  have  been  built  and  furnished 
for  the  janitor.  Speaking  tubes  and  call  bells  have  been  in- 
stalled, thus  obviating  much  unnecessary  confusion  and  expe- 
diting the  work.  A  set  of  framed  bacteriological  plates  have 
been  placed  in  the  class  room.  During  the  past  summer  the 
usual  amount  of  repairing,  painting  and  varnishing  of  wood- 
work has  been  done.  The  building  is  in  excellent  condition 
and  I  have  now  nothing  to  suggest  in  the  way  of  repairs  or 
improvements. 

Of  great  advantage  has  been  the  space  regained  by  the  removal 
of  the  State  Antitoxin  Laboratory.  Of  the  four  rooms  thus 
vacated  two  are  now  devoted  to  general  laboratory  purposes, 
one  has  been  fitted  up  as  an  operating  room  and  the  fourth  has 
been  reserved  for  Dr.  H.  C.  Jackson,  recently  appointed  Adjunct 
Professor  of  Physiological  Chemistry  in  the  Albany  Medical 
School.  Although  Dr.  Jackson's  classes  will  be  held  in  the  new 
laboratory  at  the  Medical  School  buildings,  it  seems  advisable, 
owing  to  the  many  advantages  offered  by  the  Bender  Laboratory 
and  also  on  account  of  the  proximity  to  the  city  and  county 
hospitals,  that  space  and  facilities  for  research  work  be  given  him 
in  this  laboratory. 


36 


EDITORIAL 


EMtortal 

I  have  scant  sympathy  with  the  plea  of  insanity 
advanced  to  save  a  man  from  the  consequences  of 
crime,  when,  unless  that  crime  had  been  committed, 
it  would  have  been  impossible  to  persuade  any  re- 
sponsible authority  to  commit  him  to  an  asylum  as 
insane.  Among  the  most  dangerous  criminals,  and 
especially  among  those  prone  to  commit  this  particular 
kind  of  offense,  there  are  plenty  of  a  temper  so  fiendish 
or  so  brutal  as  to  be  incompatible  with  any  other  than 
a  brutish  order  of  intelligence,  but  these  men  are 
nevertheless  responsible  for  their  acts,  and  nothing 
more  tends  to  encourage  crime  among  such  men  than 
the  belief  that  through  the  plea  of  insanity  or  any 
other  method  it  is  possible  for  them  to  escape  paying 
the  just  penalty  of  their  crime. 

Theodore  Roosevelt. 


Paralysis  Agi-        During  the  last  two  years  attention  has  been 
tans  and  the      directed  to  the  parathyroid  glands,  which  have 
Parathyroid       heretofore  not  been  regarded  as  of  particular 
Glands  significance.    The  discoveries  of  the  metabolizing 

functions  of  the  various  ductless  glands  have  been  of  so  great 
value  that  every  structure  of  this  kind  has  certain  possibilities 
which  merit  investigation.  In  the  Annals  of  January,  1905,  an 
abstract  was  given  from  an  article  by  Lundborg  upon  the  re- 
searches made  up  to  that  time.  He  was  especially  interested  in 
a  condition  he  described  as  hypoparathyroidisms.  He  believed 
that  the  parathyroid  glands  regulate  the  tone  of  the  muscles  or 
of  the  neuro-muscular  system,  and  bear  a  compensatory  relation 
to  the  thyroid  gland.  Among  the  diseases  in  which  a  defect  of 
the  parathyroids  might  be  assumed,  he  mentions  paralysis  agitans. 

Another  communication  upon  this  subject  has  recently  been 
made  by  Berkeley  (Medical  News,  December  2,  1905).  Dr. 
Berkeley  reports  the  results  of  some  experimental  work,  both 
upon  animals  and  in  the  use  of  the  thyroid  substance  thera- 
peutically. The  work  is  incomplete  and  only  suggestive,  but 
enough  has  been  done  to  warrant  investigation  in  this  line  in 
the  hope  that  a  way  may  be  found  for  the  relief  of  paralysis 


EDITORIAL 


37 


agitans,  which  up  to  this  time  has  been  an  utterly  intractable 
disease. 

Berkeley  found  that  the  surgical  removal  of  one,  two  or  three 
parathyroids  from  a  cat  or  a  rabbit  produces  no  signs  except 
hypertrophy  of  the  gland  or  glands  remaining.  The  subsequent 
removal  of  the  glands  left  behind,  or  the  removal  of  all  at  one 
time,  is  followed  in  twenty-four  to  forty-eight  hours  by  saliva- 
tion, trachycardia,  tremors  and  rigidity  of  the  muscles,  convul- 
sions, albuminuria,  enormously  hurried  breathing,  entire  loss 
of  appetite,  and  rapid  emaciation,  the  animal  dying  on  the  aver- 
age in  from  two  to  ten  days.  Post-mortem  there  are  no  constant 
gross  lesions. 

During  the  past  year  Berkeley  has  found  opportunity  to  ad- 
minister a  physiologically  tested  gland  to  eleven  cases  of  shaking 
palsy  in  all  grades  of  advancement. 

The  initial  dose  of  the  powdered  gland  is  one-twentieth  grain 
two  to  four  times  a  day,  preferably  in  capsule;  larger  doses 
appear  to  produce  weakness,  constipation,  "  nervousness,"  and 
even  an  exaggeration  of  the  symptoms  of  the  disease.  The  first 
good  effects  in  the  cases  treated  were  noted  as  a  rule  only  after 
fifty  to  seventy-five  capsules  had  been  taken — two  or  three  weeks 
after  beginning  treatment. 

To  sum  up  the  therapeutic  results  in  these  cases,  the  remedy 
has  been  more  or  less  fairly  tried  with  eleven  patients ;  of  these, 
nine  were  helped,  the  earlier  cases  were  greatly  helped,  and 
one  patient,  a  very  early  case,  considered  himself  nearly  entirely 
relieved  while  under  the  influence  of  the  drug.  One  patient 
reported  that  the  tremors  most  recently  appearing  in  the  course 
of  his  case  were  much  more  perfectly  relieved  than  those  of  longer 
standing. 

When  a  more  perfect  form  of  medication  has  been  devised — a 
hypodermic  extract,  or  even  a  grafting  of  the  gland  itself  from 
one  human  being  to  another — the  results  may  be  much  more 
encouraging. 


$8 


LITTLE  BIOGRAPHIES 


little  Btograpbtes 

I.    HEROPHILUS  THE  CHALCEDONIAN. 

HEROPHILUS  was  born  in  the  Bithynian  city  Chalcedon, 
situate  nearly  opposite  Constantinople  in  Asia  Minor. 
The  year  of  his  birth,  as  well  as  that  of  his  death,  is 
not  known ;  the  active  period  of  his  life  was  spent  in 
Alexandria,  during  the  reign  of  the  first  Ptolemy,  B.  C,  323"283- 
The  renown  of  Alexandria  as  a  centre  of  surpassing  intellectual 
achievement  is  imperishable.  Its  Museum  or  College  of  Philoso- 
phy, created  and  fostered  by  imperial  pride,  attracted  the  most 
famous  philosophers,  teachers,  poets  and  scientists  of  the  time,  and 
all  lands  were  searched  for  contributions  to  its  library,  zoological 
and  botanical  gardens,  observatories  and  collections  of  natural 
history.  Among  the  immortals,  the  founders  of  the  medical  school, 
Herophilus  and  Erasistratus,  were  preeminent.  That  the  Alexan- 
drian Museum  failed  to  venture  into  new  paths,  and  merely  elab- 
orated and  taught  what  was  already  known,  has  been  the  comment 
upon  its  claim  to  precedence.  In  pure  mathematics,  medicine  and 
natural  history  this  criticism  is  not  valid.  Euclid  and  Herophilus 
stood  apart  as  original  investigators;  their  work  has  borne  the 
test  of  time  and  remains  essentially  unchanged  to  the  present  day. 

The  preceptor  of  Herophilus  was  Praxagoras,  the  last  of  the 
Asclepiads.  From  him  the  pupil  may  have  had  a  touch  of  the 
semi-mystic  theories  of  his  theurgic  guild.  Herophilus,  however, 
appears  to  have  been  intensely  practical.  From  the  fragments  of 
his  writings  which  have  been  preserved,  and  from  references  by 
Galen,  Celsus,  Aretaeus,  Coelius  Aurelianus,  Pliny  and  others,  he 
is  shown  to  have  maintained  no  secrecy,  but  to  have  searched 
diligently  for  facts.  He  was  loth  to  criticize  and  occasionally  fell 
into  an  obscure  style  of  diction  rather  than  to  detract  from  the 
fame  of  his  teacher. 

Herophilus  covered  the  whole  field  of  medical  study  and 
medical  practice.  In  anatomy  his  work  is  imperishable. 
He  is  reported  to  have  dissected  over  seven  hundred  bodies, 
and  it  is  said  that  living  criminals  were  given  over  to  him  for 
experimentation.  Many  writers  pronounce  this  statement  incred- 
ible and  the  alleged  practice  inconsistent  with  the  humanity  of  the 
era.   But  Tertullian  couples  it  with  the  name  of  Herophilus  in  a 


LITTLE  BIOGRAPHIES 


39 


bitter  invective :  "  Herophilus,  that  physician,  or  rather  butcher, 
who  dissected  six  hundred  men,  in  order  to  find  out  nature ;  who 
hated  man,  in  order  to  learn  the  structure  of  his  frame ;  could  not, 
by  these  means,  come  to  a  more  perfect  knowledge  of  his  internal 
structure,  since  death  produces  a  great  change  in  all  the  parts,  so 
as  to  render  their  appearance  after  death  different  from  what  it 
was  before ;  especially,  since  they  did  not  die  a  natural  death,  but 
expired  amidst  all  the  agonies  to  which  the  curiosity  of  the  anato- 
mist was  pleased  to  subject  them." 

Herophilus  differentiated  the  cerebrum  and  cerebellum,  and 
described  the  meninges,  the  sinuses  of  the  dura,  the  ventricles, 
the  peripheral  cranial  and  spinal  nerves  and  the  coats  of  the  eye, 
two  of  which  he  designated  respectively,  the  tunica  arachnoides  and 
the  tunica  retina.  He  recognized  the  confluence  of  sinuses  which 
derived  from  him  its  name,  "  torcular  Herophili."  He  named  the 
calamus  scriptorius,  the  duodenum,  the  chorioid  plexuses,  and  he 
called  the  pulmonary  artery  the  arterial  vein.  He  analyzed  the 
various  structures  of  the  circulatory  system,  and  wrote  upon  the 
salivary  glands,  pancreas,  liver  and  generative  organs  of  both 
sexes.  He  distinguished  the  lacteals,  but  did  not  comprehend  their 
function.  He  discussed  the  pulse  and  had  an  appreciation  of  its 
variations,  and  prepared  treatises  upon  obstetrics,  diet  and  prob- 
ably upon  therapeutics  and  materia  medica,  for  which  the  oppor- 
tunities given  by  the  botanical  collections  of  the  Museum  were 
excellent.  He  also  published  commentaries  upon  the  Prognostics 
and  Aphorisms  of  Hippocrates.  He  is  believed  to  have  been  the 
first  to  extract  a  cataract.  His  remedial  measures  were  vigorous. 
He  used  heroic  doses  and  drastic  purges  ;  his  compounds  contained 
as  many  as  three  score  simples.  On  this  ground  there  existed  a 
professional,  though  probably  not  personal,  antagonism  between 
Herophilus  and  his  colleague  Erasistratus.  The  bone  of  conten- 
tion in  medicine,  it  is  interesting  to  note,  is  no  younger  than  the 
art  itself.  Erasistratus  was  gentle,  and  prescribed  abstinence,  diet, 
regimen,  bathing,  friction  and  exercise,  and  used  the  simplest 
remedies,  as  barley  water,  oil  and  cuppings.  Unfortunately  for 
posterity  a  decision  upon  the  relative  value  of  the  two  methods 
does  not  seem  to  have  been  reached. 

Herophilus  was  thus  one  of  the  greatest  physicians  of  history. 
It  may  be  questioned  whether  his  work  was  inferior  to  that  of 
Hippocrates.  Galen  called  him  a  consummate  physician,  and 
Fallopius  the  evangel  of  anatomists.  As  the  first  to  seek  the  causes 


40 


SCIENTIFIC  REVIEW 


of  disease  after  death,  he  is  justly  entitled  to  be  regarded  as  the 
father  of  pathological  anatomy.  For  centuries  students  flocked 
to  the  medical  school  he  founded,  and  it  was  sufficient  for  the 
credit  of  any  physician  to  say  that  he  had  studied  at  Alexandria. 

J.  M.  Mosher. 

Bibliography 

Dr.  K.  F.  H.  Marx.  Herophilus.    Ein  Beitrag  zur  Geschichte  der  Medicin, 

Carlsruhe  und  Baden,  1838. 
George  Jackson  Fisher,  M.  D.       Herophilus  and  Erasistratus,  Annals  of  A natomy  and 

Surgery,  Vol.  iv.  pp.  28  and  67,  1881.    (Dr.  Fisher's 

papers  include  further  bibliographical  references.) 
  Biographisches  Lexicon  der  Hervorragenden  Aerzte 

aller  Zeiten  und  Volker,  Wien  und  Leipzig,  1886. 
Benjamin  Hutchinson.  Biographia  Medica,  London,  1799. 

Rev'd  William  Burnet  Wright.    Ancient  Cities. 
J.  P.  Mahaffy.  Greek  Life  and  Thought. 

Charles  Anthon,  LL.D.  A  Classical  Dictionary. 


Scientific  IRevtew 

The  Spirochaete  Pallida  (Schaudinn)  in  Syphilis. 

Since  the  recognition  of  syphilis  as  a  disease  sui  generis  and 
the  overthrow  of  the  old  Identit'dtslehre,  the  efforts  of  many  in- 
vestigators have  been  directed  toward  the  discovery  of  its  cause. 

From  the  beginning  the  feeling  has  been  that  the  causal  factor 
was  a  parasite  of  some  sort,  a  feeling  based  on  the  small  amount 
of  infectious  material  necessary,  its  high  co-efficient  of  infection 
and  its  gradual  extension  from  the  point  infected.  During  the 
past  twenty-five  years  no  less  than  twenty-five  different  organ- 
isms have  been  reported  as  being  the  infective  agent,  which  in 
itself  testifies  to  the  constant  search  for  the  cause  of  the  disease. 
Among  all  these  organisms  the  most  important  have  been  the  ones 
described  by  Donne  and  Lustgarten.  In  1837  Donne  described 
a  spirillum  which  he  found  in  large  numbers  on  the  genitalia,  in 
the  secretions  from  mucous  surfaces  and  in  smegma.  Grace 
also  found  large  numbers  of  spirilli  in  a  chancre,  but  in  an  effort 
to  confirm  these  findings  Bordet  and  Geugon  were  not  successful. 
It  is  of  interest  to  note  here  that  in  one  of  their  old  preparations 
Metschnikoff  and  Roux  were  able  to  find  the  Spirochaete  Pallida. 

The  bacillus  of  Lustgarten  is  of  more  recent  date  and  it  is  not 
necessary  to  describe  it  in  detail.  It  has  not  generally  been 
accepted  as  the  case  of  syphilis.    Within  the  past  year  Metschni- 


SCIENTIFIC  REVIEW 


41 


koff  and  Roux,  Neisser  and  others  have  been  successful  in 
inoculating  apes  with  the  virus  of  syphilis,  experiments  which 
have  given  an  added  impetus  to  the  search  for  the  infecting 
agent. 

Early  in  the  present  year  Siegel  in  examining  the  blood  of 
patients  in  the  acute  stage  of  syphilis  described  a  flagellate 
organism.  He  was  successful  also  in  finding  the  same  organism 
in  the  blood  of  apes  inoculated  with  syphilis. 

They  are  described  as  minute  pear-shaped  flattened  bodies 
2  ^  in  length  and  0.5  ^  in  thickness.  They  are  actively  motile, 
the  motion  being  springing  like  in  character.  The  pointed  end 
appears  flagellated  and  flexes  rapidly  during  motion.  They  are 
very  hard  to  see  and  he  recommends  for  this  purpose  an  apochro- 
matic  lens  of  a  magnification  of  or  over.    In  stained  prep- 

arations Siegel  has  demonstrated  two  nuclei  in  these  bodies  and 
has  named  them  Cytoryktes  Luis. 

Merk  has  confirmed  these  findings  in  five  cases  of  acute 
syphilis;  he  observed  two  nuclei  and  determined  their  method 
of  division  by  fission.  The  presence  of  these  bodies  in  the  blood 
of  syphilitics  has  not  received  general  confirmation  and  their 
significance  must  as  yet  be  considered  sub  judice.  Schaudinn  in 
looking  for  the  Cytoryktes  Louis  of  Siegel  found  another  type 
of  parasite  which  is  apparently  of  much  greater  significance. 
Immediately  following  his  discovery  Schaudinn  began  a  system- 
atic study  of  all  acute  cases  of  syphilis  in  the  clinic  for  skin 
diseases  at  the  University  of  Berlin  in  conjunction  with  Hoff- 
man, Privatdocent  in  the  clinic.  Schaudinn's  original  communi- 
cation appeared  in  the  Arbeitcn  an  der  kaiserliches  Gesundhcit- 
samt,  Volume  XX,  page  527,  access  to  which  cannot  be  obtained. 
His  second  paper  in  collaboration  with  Hoffman  describes  the 
parasites  found  in  the  depth  of  freshly  excised  secondary  papules 
and  lymphatic  glands  in  two  cases.  They  are  very  delicate, 
spirally  curved  pointed  bodies,  of  very  low  refractive  index  and 
actively  motile.  Their  length  is  from  4-14  /x  and  Y\  /x  thick. 
The  spirals  are  corkscrew  like  and  vary  from  six  to  fourteen 
in  number.  In  fresh  specimens  it  appears  as  a  long  spirally 
twisted  thread  with  an  undulating  membrane,  and  in  moving  it 
revolves  about  its  long  axis.  The  thread-like  form  and  undulat- 
ing membrane  places  the  parasite  in  the  class  of  organisms 
known  as  spirochaete. 

Spirochaete  have  been  found  previously  in  genital  ulcers  and 


42 


SCIENTIFIC  REVIEW 


ulcerating  lesions  elsewhere.  This  form  is  known  as  the  Spiro- 
chaete  Refringens  because  of  its  high  refractive  index  and  strong 
affinity  for  the  ordinary  stains,  but  the  organism  described  by 
Schaudinn  can  be  distinguished  from  this  form  by  its  smaller 
size  and  delicate  structure,  low  index  of  refraction  and  poor 
staining  capacity.  To  distinguish  their  spirochaete  from  that 
commonly  found,  the  Spirochaete  Refringens,  Schaudinn  and 
Hoffman  suggest  the  name  Spirochaete  pallida. 

The  above  findings  have  received  wide  confirmation,  more 
particularly  in  Germany  and  France,  although  positive  results 
have  been  published  in  the  Russian,  Austrian,  Italian,  British  and 
American  journals.  Up  to  the  present  time  the  organism  has 
been  found  in  the  following  lesions  of  acute  syphilis,  chancres 
genital  and  extra-genital,  lymphatic  glands,  condylomata,  papu- 
lar and  postular  syphilides,  psoriasis  palmaris  and  mucous 
patches.  In  examining  these  lesions  care  was  used  to  avoid 
surface  contamination  as  much  as  possible.  Chancres  were  ex- 
cised, serum  expressed  and  collected  from  the  under  surface, 
so  also  with  the  papular  lesions.  Condylomata  were  curetted 
and  material  then  collected.  In  ulcerating  lesions  and  mucous 
patches  contamination  is  unavoidable,  but  here  the  spirochaete 
pallida  may  be  differentiated  from  the  spirochaete  refringens 
by  its  appearance.  The  first  positive  finding  in  congenital  syphilis 
was  reported  by  Buschke  and  Fischer ;  the  organism  was  found 
in  the  spleen  and  lymph  glands.  Babes  and  Panea  also  in  a  case 
of  congenital  syphilis  found  the  spirochaete  in  the  heart  blood, 
larynx,  lung,  thymus,  bone  marrow,  spleen,  liver,  kidney,  supra- 
renal, conjunctival  and  arachnoidal  fluid.  Salmon,  Livadite, 
Schridde  and  Bayer  have  also  published  positive  results  in  con- 
genital syphilis. 

In  tertiary  lesions  positive  results  are  very  few.  Miste  reports 
a  positive  result  in  an  ulcerating  lesion  of  the  nose — infection 
eight  years  before  and  in  an  ulcerating  gumma  of  the  scalp — in- 
fection twelve  years  before.  In  their  first  efforts  to  find  the 
spirochaete  in  apes  inoculated  with  syphilis  Metschnikoff  and 
Roux  and  Kraus  were  not  successful,  probably  because  the  ani- 
mals presented  lesions  nearly  healed  and  at  the  same  time  were 
under  specific  serum  treatment.  In  recently  inoculated  apes, 
however,  Metschnikoff  and  Roux  were  able  to  demonstrate  a 
spirochaete  in  four  of  six  cases  and  the  preparations  were  sent 


SCIENTIFIC  REVIEW 


43 


to  Schaudinn,  who  identified  the  organism  as  the  Spirochaete 
pallida. 

In  the  circulating  blood  Raubetschek  reports  one  positive 
result,  Noeggerath  and  Stachelin  three  positive  results.  The 
latter  advise  the  following  method  for  demonstrating  the  spiro- 
chaete in  the  blood:  Collect  i  cubic  centimetre  of  blood  and 
add  9  cubic  centimetres  of  .33  per  cent,  acetic  acid ;  centrifugal- 
ize  and  use  the  sediment.  Since  the  organism  does  not  stain 
readily  several  methods  have  been  advised.  Perhaps  the  method 
of  Giemsa  is  the  most  satisfactory  as  it  is  simple,  requires  very 
little  time  and  has  given  good  results  in  the  hands  of  many. 
The  staining  solution  is  prepared  according  to  the  following 
formula : 

Azur  II  Eosin   3.0 

Azur  II   0.8 

Glycerin 
methyl  Alcohol 
Stain  as  follows: 

1.  Fix  absolute  alcohol,  10  minutes. 

2.  Equal  parts  of  stain  and  distilled  water  ten  to  fifteen 

minutes. 

3.  Wash  under  tap. 

4.  Mount  in  balsam. 

Oppenheim  and  Sachs  use  a  solution  of  alcoholic  gentian  vio- 
let (5  per  cent,  carbolic  acid,  100.00,  and  concentrated  alcoholic 
gentian  violet,  10.00).  The  smear  is  covered  with  this  solution, 
steamed  over  a  flame,  washed  and  mounted.  Reitmann  fixes  the 
smear  in  absolute  alcohol  ten  minutes,  washes  in  distilled  water, 
then  into  2  per  cent,  phosphotungstic  acid,  five  minutes,  into 
70  per  cent,  alcohol  and  distilled  water.  The  smear  is  then 
steamed  in  carbol  fuchsin,  washed  in  water  and  decolorized  in 
70  per  cent,  alcohol,  distilled  water.  Of  how  much  significance 
the  presence  of  the  spirochaete  is  in  the  eitology  of  syphilis  can- 
not be  stated  positively  now. 

The  wide  confirmation  of  the  work  of  Schaudinn  and  Hoff- 
man, the  wide  distribution  of  the  spirochaete  in  acute  syphilis, 
not  only  in  the  primary  lesion  but  at  a  distance  from  it,  its 
presence  alone  in  organs  and  tissues  that  are  free  from  surface 
contamination,  in  stained  sections  of  such  tissues,  in  the  cir- 
culating blood  and  again  its  absence  in  a  great  variety  of  skin 
diseases,  all  point  to  a  causal  relationship  between  the  organism 


aa. 


250.0 


44 


SCIENTIFIC  REVIEW 


and  the  disease.  The  assumption  that  a  spirochaete  may  be  the 
cause  of  this  disease  is  within  the  range  of  possibility  and  al- 
though comparatively  little  is  known  of  the  pathogenic  role  of 
this  class  of  micro-organisms  Schaudinn  has  shown  that  the 
Spirochaete  Ziemmanni  represents  a  stage  in  the  life  history  of 
trypanosomes  and  possibly  all  spirochaete  are.  The  trvpanosoma 
Equiperdum  is  known  to  cause  pathogenic  infection  in  the  horse 
and  is  transmitted  directly  through  the  mucous  membrane,  al- 
though more  often  by  blood  sucking  flies.  Kala  Azar,  the  dis- 
ease produced  by  the  Leischmann-Donovan  bodies,  is  transmitted 
by  sexual  contact. 

The  very  character  of  these  organisms,  however,  at  present 
prevents  the  fulfillment  of  Koch's  postulates  in  proving  the 
spirochaete  the  true  etiologic  factor.  So  far  it  has  been  im- 
possible to  cultivate  any  of  the  known  spirochaete  and  so  their 
biological  characters  cannot  be  studied.  For  this  reason  too  the 
presence  of  specific  agglutinins  cannot  be  proven.  The  three 
e.  g.  the  presence  of  the  spirochaete  in  every  case  of  acute 
remaining  postulates,  however,  have  apparently  been  fulfilled, 
syphilis,  its  absence  in  other  diseases,  the  transmission  of  the 
disease  to  lower  animals  and  the  presence  of  toxins,  anti- 
toxins, etc. 

The  spirochaete  pallida  has  already  been  accepted  by  many 
individual  members  of  the  medical  profession,  particularly  in 
France.  Its  too  precipitate  acceptance  is  unwise  in  view  of 
the  facts  of  the  case.  Both  Schaudinn  and  Hoffman  have  dis- 
played a  noteworthy  conservatism  in  this  respect  and  have  not 
made  any  claims  for  their  spirochaete  beyond  asserting  its  al- 
most constant  presence  in  the  disease  and  have  maintained  this 
position  too  when  their  work  has  been  constantly  confirmed  and 
enlarged.  All  that  can  be  said  at  present  is  that  there  is  appar- 
ently good  ground  for  assuming  an  etiologic  relationship  be- 
tween the  Spirochaete  pallida  and  syphilis. 

W.  H.  Carey. 

References. 

Schaudinn  u.  Hoffmann.  Arbeiten  aus  der  kaiscrliches  Gesundheitsamt,  1905,  No 

xx,  527. 

Schaudinn  u.  Hoffmann.  Ueber  Spirochaetenbefunde  im  Lymphdrusensaft  Syphi- 

litischer,  Deutsche  medicinische  Wochenschrift,  1905, 
No.  xviii,  711. 

Schaudinn  u.  Hoffmann.  Ueber  Spirochaete  pallida  bei  Syphilis  und  die  Unter- 

schiede  dieser  Form  gegenuber  anderen  Arten  dieser 
Gattung,  Berliner  klinische  Wochenscrift,  1905,  No. 
22,  673. 


SCIENTIFIC  REVIEW 


45 


Schaudinn  u.  Hoffmann.  Nachtrag  uber  die   Spirochaete   pallida  bei  SyphilU> 

Berliner  klinische  Wochenschrift,  1905,  No.  23. 
Buschke  u.  Fischer.  Ueber  das  Vorkommen  von  Spirochaeten  in  inneren 

Organen  eines  syphilistischen  Kindes.  Deutsche  medi- 

cinische  Wochenschrift,  1905,  No.  20. 
Babes  und  Panea.  Ueber  pathologische  Veranderungen  und  Spirochaete 

pallida  bei  congenitaler  Syphilis,  Berliner  klinische 

Wochenschrift,  1905,  No.  28. 
Metschnikoff  et  Roux.  Recherches  microbiologiques  sur  la  Syphilis,  La  Presse 

Medicate,  1905,  No.  39,  312. 
Schulze.  Cytoryktes  Luis-Siegel,  Berliner  klinische  Wochenschrift, 

1905,  No.  21. 

Siegbl.  Neue  Untersuchungen  uber  die  Aetologie  der  Syphilis, 

Munchner  medicinische  Wochenschrift,  1905,  No.  28. 

McWeeney.  Spirochaetae  in  Syphilis,  British  Medical  Journal,  1905, 

June  10,  1262. 

Levaditi,  M.  Syphilis  Congenitale  et  Spirochaete  pallida  Schaudinn, 

La  Presse  Medicale,  1905,  No.  41. 

Raubetschek.  Ueber  einem  Fund  von  Spirochaete  pallida  im  kreisen- 

den  Blut,  Wiener  medicinische  Wochenschrift,  190s, 
No.  28. 

Noeggerath  u.  Staehelin.        Munchner  medicinische  Wochenschrift,  1905,  No.  31. 
Gibmsa,  G.  Bemerkungen   fur   Farbung   der    Spirochaete  pallida 

(Schaudinn),    Deutsche    medicinische  Wochenschrift, 

1905,  No.  26. 

Reitmann.  Fur  Farbung  der  Spirochaete  pallida  Schaudinn,  Deutsche 

medicinische  Wochenschrift,  1905,  No.  25. 
Salmon.  Presence  du  Spirochaete  pallida  chez  un  enfant  syphili- 

tique  herddetaire,  La  Presse  Medicale,  1905,  No.  41. 
Merk.  Ueber  den  Cytoryktes  Luis  (Siegel),  Wiener  klinische 

Wochenschrift,  1905,  No.  36,  926. 
Rille  u.  Vockerodt.  Weitere  Spirochaetenbefunde    bei    Syphilis,  Munchner 

medicinische  Wochenschrift,  1905,  No.  34. 
Flexnbr  and  Naguchi.  On  the  Occurrence  of  Spirochaeta  Pallida  Schaudinn 

in  Syphilis,  Medical  News,  1905,  page  1145. 
Oppenheim  und  Sachs.  Ein  Einfache  u.  schnelle  Methode  fur  deutichen  Dar- 

stellung  der  spirochaete  pallida,  Deutsche  medicinsche 

Wochenschrift,  190s,  No.  29.  1156. 
N.  B. — Only  the  more  important  references  are  given.    For  a  complete  bibliography 
•ee  collateral  references  in  the  above  articles. 


6 


46 


PUBLIC  HEALTH 


public  Dealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 

Department  of  Health — City  of  Albany,  N.  Y. 


Abstract  of  Vital  Statistics,  November,  1905. 


Deaths. 

1901 

1902 

1903 

1904 

1905 

Consumption   

15 

20 

18 

18 

24 

0 

6 

1 

1 

5 

Scarlet  fever  

0 

0 

1 

0 

0 

Measles   

0 

0 

0 

0 

0 

0 

1 

0 

0 

0 

9 

2 

3 

2 

0 

0 

0 

3 

0 

0 

Diarrhoeal  disease   

1 

0 

4 

3 

4- 

Pneumonia   

8 

19 

II 

10 

10 

1 

6 

2 

0 

10 

18 

23 

19 

7 

Apoplexy   

10 

6 

9 

12 

5 

8 

12 

14 

13 

4 

7 

8 

9 

9 

16 

37 

32 

32 

27 

29 

Deaths  under  one  year  

11 

14 

15 

8 

21 

124 

156 

145 

131 

I5i 

Death  rate  

1507 

18.96 

17.63 

15-93 

18.36 

Death    rate    less  non-resi- 

dents   

14. 10 

17.52 

16.66 

14  59 

15.92 

Deaths  in  Institutions. 

1902  1903           1904  1905 
Non-  Non-          Non-  Non- 
Resi-     resi-  Reei-     resi-  Resi-  resi-  Resi-  resi- 
dent,   dent  dent    dent.  dent,  dent-  dent,  dent 


Albany  Hospital  

5 

9 

8 

3 

10 

7 

5 

7 

Albany  County  Jail  

0 

0 

0 

0 

0 

0 

2 

0 

Albany  Orphan  Asylum  

0 

0 

0 

I 

0 

0 

I 

0 

County  House  

6 

0 

2 

I 

5 

0 

2 

0 

Homeopathic  Hospital  

0 

0 

3 

I 

2 

I 

I 

I 

Hospital  for  Incurables  

0 

0 

0 

I 

0 

0 

I 

0 

House  of  Good  Shepherd  

0 

0 

0 

I 

0 

0 

0 

0 

House  of  Shelter  

0 

0 

0 

0 

0 

0 

0 

0 

Home  of  the  Friendless  

0 

0 

I 

0 

0 

0 

0 

0 

Little  Sisters  of  the  Poor  

I 

0 

0 

0 

0 

0 

3 

I 

0 

0 

2 

0 

3 

I 

I 

2 

St.  Francis  de  Sayles  Orphan 

Asylum   

0 

0 

0 

0 

0 

0 

0 

c 

PUBLIC  HEALTH 


47 


1902              1903              1904  1905 t 
Non-              Non-             Non-  Non- 
Resi-    rem-  Resi-    resi-  Resi-    resi-  Resi-  resi- 
dent   dent.  dent.   dent.  dent.   dent.  dent.  dent. 

St.  Margaret's  Home   I      i      o      o      o      o      2  i 

St.  Peter's  Hospital   12402254 

St.    Vincent's    Female  Orphan 

Asylum   o      0      o      o      o      o      0  o 

Home  for  Aged  Men   0      0      o      o      1      0      o  o 

Dominican  Convent   00000000 

Penitentiary    0      o      o      o      o      0      0  o 

Sacred  Heart  Convent   00000000 

Child's  Hospital   1  1 

Births   65 

Marriages   53 

Still  births   9 

Plumbing  Inspections. 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation,  there  were  218 
inspections,  of  which  129  were  of  old  buildings  and  89  of  new  buildings. 
Forty-six  iron  drains  were  laid,  21  connections  with  street  sewers,  23  tile 
drains  laid,  2  urinals,  52  cesspools,  62  wash  basins,  64  sinks,  56  bath  tubs, 
46  wash  trays,  10  trap  hoppers  in  yard,  82  tank  closets  and  1  horse  trough. 
There  were  139  permits  issued,  of  which  105  were  for  plumbing  and  34  for 
building  purposes.  There  were  33  plans  submitted,  of  which  14  were  of 
old  buildings  and  19  for  new  buildings.  There  were  10  houses  tested  on 
complaint.  Three  with  blue-red  and  7  with  peppermint.  There  were  15 
water  tests.  Sixty-five  houses  were  examined  on  complaint  and  27  rein- 
spections.    Fifty-two  complaints  were  found  valid  and  13  without  cause. 

Bureau  of  Contagious  Diseases. 

Cases  Reported. 

1901  1902  1903  1904  1905 

Typhoid  fever   44547 

Scarlet  fever   5  5  7  17  21 

Diphtheria  and  croup   90  48  31  12  16 

Chickenpox    7  12  3  16  7 

Measles    5  1  2  1  2 

Whooping-cough    o  2  1  o  0 

Consumption    0  0  0  3  2 


Totals    in         72         49  53 

Contagious  Disease  in  Relation  of  Public  Schools. 


00 


Reported  Deaths. 
D         S.F.        D.  S.F. 


Public  School  No.  1   1 

Public  School  No.  2   1   

Public  School  No.  3   2 


48 


MEDICAL  NEWS 


Reported  Deaths. 
D.        S.  F.         D.    S.  P. 


Public  School  No.  4   1 

Public  School  No.  6   2   

Public  School  No.  9   2   

Public  School  No.  12   1  1 

Public  School  No.  21   4 

Public  School  No.  22   1   

New  York  State  Normal  College   2 

Albany  Boys'  Academy   1   

Albany  Law  School   1  1 

St.  John's  School   1   


Number  of  days  quarantine  for  diphtheria: 
Longest,  37;  shortest,  9;  Average,  21  11-15. 

Number  of  days  quarantine  for  scarlet  fever : 
Longest,  50;  Shortest,  15;  Average,  29  7-8. 

Fumigations : 

Houses,  27;  Rooms,  54. 


Caces  of  diphtheria  reported   16 

Cases  of  diphtheria  in  which  antitoxin  was  used   15 

Cases  in  which  antitoxin  was  not  used   I 

Deaths  after  use  of  antitoxin   O 


ZlDeMcal  1Rews 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick.— Statistics  for 
November,  1905. — Number  of  new  cases,  112;  classified  as  follows:  dispen- 
sary patients  receiving  home  care,  5 ;  district  cases  reported  by  health 
physicians,  10;  charity  cases  reported  by  other  physicians,  42;  patients  of 
l:mited  means,  55;  old  cases  still  under  treatment,  43;  total  number  of 
patients  under  nursing  care  during  the  month,  155.  Classification  of 
diseases  (new  cases):  medical,  31;  surgical,  6;  obstetrical  work  of  the 
Guild,  35  mothers  and  31  infants  under  professional  care;  dental,  1; 
skin,  1 ;  throat  and  nose,  5 ;  contagious  diseases  in  medical  list,  3 ;  removed 
to  hospital,  3;  deaths,  10. 

Special  Obstetrical  Department. — Number  of  obstetricians  in  charge  of 
cases,  1 ;  attending  obstetricians,  1 ;  students  in  attendance,  2 ;  Guild 
nurses,  1 ;  patients,  1 ;  visits  by  attending  obstetricians,  1 ;  by  the  medical 
students,  9;  by  the  Guild  nurses,  8;  total  number  of  visits  in  this  depart- 
ment, 24. 

Visits  of  Guild  Nurses  (all  departments)  :  number  of  visits  with  nursing 
treatment,  1,011;  for  professional  supervision  of  convalescents,  209.  Five 
graduate  nurses  and  4  assistant  nurses  were  on  duty.  Cases  were  re- 
ported to  the  Guild  by  two  of  the  health  physicians  and  by  thirty  other 
physicians  and  three  dentists. 


MEDICAL  NEWS 


49 


Union  College  Alumni  Association  of  New  York. — The  annual  re- 
union and  dinner  of  the  Union  College  Alumni  Association  of  New  York 
was  held  at  the  Hotel  Manhattan,  New  York  City,  December  14,  1905. 
President  A.  V.  V.  Raymond  announced  that  Andrew  Carnegie  had 
offered  to  dcnate  the  sum  of  $100,000  for  equipping  the  building  to  be 
devoted  to  electrical  engineering  at  Schenectady,  N.  Y.,  provided  the  col- 
lege raised  another  $100,000  to  endow  the  school. 

.  Consolidation  of  the  State  Medical  Societies. — On  December  14,  1905, 
representatives  of  the  State  Medical  Society  and  the  State  Medical  Asso- 
ciation met  in  the  Albany  Medical  College  and  effected  the  consolidation 
of  the  two  organizations,  authorized  under  the  law  passed  last  winter  by 
the  Legislature.  The  organization  will  hereafter  be  known  as  the  State 
Medical  Society,  and  will  hold  its  annual  meeting  in  Albany  on  January 
30  and  31,  and  February  1,  1906. 

Civil  Service  Examinations  for  the  State  and  County  Service. — 
The  State  Civil  Service  Commission  announces  examinations  to  be  held 
on  January  13,  1906,  for  the  following  positions  in  the  State  and  county 
service : 

Abstract  clerk,  Onondaga  county  clerk's  office;  assistant  in  microscopy, 
Cancer  Laboratory,  Buffalo,  $720 ;  carpenter,  State  Industrial  School,  Roch- 
ester, $50  a  month ;  steam  engineer  and  assistant  in  State  hospitals,  depart- 
ments and  institutions  in  the  county  service  of  Albany,  Erie,  Monroe, 
Onondaga  and  Westchester  counties;  foreman  of  fish  hatchery,  $1,080; 
inspector  of  records  and  accounts,  State  Board  of  Charities,  $1,200  to 
$1,400;  matron,  Craig  Colony,  $720  to  $900;  milk  expert,  Department  of 
Agriculture,  $800  to  $1,000;  male  officer,  State  institutions,  $540;  woman 
industrial  teacher,  State  Custodial  Asylum,  Newark,  $360  and  mainte- 
nance; physical  instructor,  State  institutions,  $540  to  $1,200;  sanitary 
agent,  Department  of  Agriculture,  $5  a  day. 

The  last  day  for  filing  applications  is  January  8th.  Application  forms 
and  detailed  information  may  be  obtained  by  addressing  the  Chief  Exam- 
iner of  the  Commission  at  Albany. 

Communications  to  the  Hospitals  of  Greater  New  York. — The  Com- 
mittee on  Hospital  Needs  and  Hospital  Finances  of  the  Association  for 
Improving  the  condition  of  the  Poor,  appointed  on  March  23,  1905,  have 
submitted  a  preliminary  report. 

This  committee  includes  John  E.  Parsons,  Seth  Low,  John  W.  Brannan, 
and  Dr.  John  A.  Wyeth. 

The  report  of  the  subcommittee  on  economy  refers  especially  to  im- 
portant items  with  regard  to  which  economy  would  in  the  average  hos- 
pital be  not  only  easy  but  would  seem  easy.  They  suggest  the  adoption 
of  less  expensive  materials  and  methods  than  those  commonly  used,  which 
we  are  assured  can  be  done  without  lessening  efficiency. 

There  should  be  one  executive  officer  of  an  institution,  with  authority 
to  enforce  methods  which,  without  in  any  way  endangering  efficiency, 
would  insure  a  minimum  of  expenditure,  and  that  where  the  best  results 
are  obtained  by  simpler  and  less  expensive  methods,  these  methods  should 
be  promptly  adopted. 


5° 


MEDICAL  NEWS 


The  sub-committee  on  accounting  and  reporting  have  made  extensive 
and  comprehensive  schedules. 

The  sub-committee  on  hospital  support  agree  that  there  is  a  general  want 
of  knowledge  in  the  public  mind  with  regard  to  the  functions  and  work 
of  the  private  hospitals,  so  called.  That  as  the  result  of  such  lack  of 
knowledge,  the  hospitals  receive  financial  support  from  only  a  very  limited 
number  of  people  in  comparison  with  other  forms  of  charitable  work. 
That  there  would  be  an  enlargement  of  the  number  now  contributing,  if 
the  facts  relative  to  the  hospital  work  were  appreciated  by  the  general 
public.  That  the  situation  is  liable  to  grow  worse  instead  of  better  by 
reason  of  the  constantly  increasing  number  of  private  hospitals,  and  that 
by  organization  and  educational  work  with  the  community,  will  prove  its 
own  right  to  financial  support. 

This  committee  also  publish  a  complete  report  of  all  the  hospitals  in 
Manhattan  and  the  Bronx. 

Epilepsy  Prize. — At  the  fifth  annual  meeting  of  the  National  Association 
for  the  Study  of  Epilepsy,  held  in  the  Academy  of  Medicine,  New  York 
City,  on  November  29,  last,  Dr.  W.  P.  Spratling,  President,  announced  that 
the  association  offered  a  prize  of  $300  for  the  best  essay  on  the  etiology  of 
epilepsy. 

Physicians  in  any  country  may  compete  for  this  prize.  The  award  will 
be  made  in  November,  1906,  but  all  essays  submitted  must  be  sent  in  by 
September  1st  of  that  year. 

Details  as  to  conditions  governing  the  award  may  be  obtained  from  Dr. 
Spratling,  Superintendent  of  the  Craig  Colony  for  Epileptics,  Sonyea, 
Livingston  county,  N.  Y. 

Food  in  Health  and  Disease. — Messrs.  Lea  Brothers  &  Co.  announce 
publication  early  in  January,  1906,  of  a  work  with  this  title,  by  Robert  F. 
Williams,  M.  A.,  M.  D.,  Professor  of  Principles  and  Practice  of  Medicine 
in  the  Medical  College  of  Virginia,  Richmond. 

American  Journal  of  Clinical  Medicine. — With  the  January  issue  of 
the  Alkaloidal  Clinic  the  name  is  changed  to  the  American  Journal  of 
Clinical  Medicine.  The  present  editorial  force  and  management  continues 
with  the  addition  of  Dr.  Wm.  J.  Robinson  of  New  York  City,  who  will 
conduct  a  department  of  Dermatology  and  Genitourinary  Diseases ;  and 
Dr.  Emory  Lamphear  of  St.  Louis,  who  will  conduct  a  department  of 
Surgery,  Obstetrics  and  Gynecology,  and  other  departments  will  be  added 
as  arrangements  can  be  made  therefor. 

Saunders'  Catalogue. — The  Annals  has  received  from  W.  B.  Saunders 
&  Co.,  of  Philadelphia,  an  unusually  attractive  illustrated  catalogue  of 
their  complete  list  of  publications.  A  copy  will  be  sent  free  upon  request 
to  the  publishers. 

Engagement. — Shaw-Burrell — Mr.  and  Mrs.  E.  J.  Burrell  announce 
the  engagement  of  their  daughter,  Miss  Susanne  S.,  to  Dr.  Henry  Larned 
Keith  Shaw  (A.  M.  C,  1896)  of  Albany,  N.  Y. 


IN  MEMORIAM 


Personal. — Dr.  Jesse  M.  W.  Scott  (A.  M.  C,  '96)  after  serving  eight 
years  in  the  Matteawan  State  Hospital,  the  last  three  years  as  assistant 
superintendent,  has  started  in  private  practice  at  No.  602  Union  street, 
Schenectady,  N.  Y. 


Deaths. — Dr.  Levi  Wood  (A.  M.  C,  '65)  died  recently  at  Ephratah, 
Fulton  County,  N.  Y.,  aged  62.  He  is  survived  by  one  son  and  two 
daughters. 

— Dr.  J.  A.  Smeallie  (A.  M.  C.  '79)  died  at  Cass  Lake,  November  25, 
1905,  aged  52  years. 


IN  MEMORIAM 

Levi  Wood,  M.  D. 

Dr.  Levi  Wood,  aged  62  years,  died  recently  at  his  home  at  Ephratah. 
For  the  past  two  years  he  had  suffered  with  Brighr/s  disease,  but  had  been 
able  to  attend  to  his  practice  until  September,  when  his  condition  became 
such  that  he  was  confined  to  his  house.  He  gradually  failed  until  death 
came. 

Dr.  Wood  was  born  at  Ephratah,  the  son  of  Dr.  Henry  Wood,  a  prac- 
ticing physician  of  that  place.  After  obtaining  a  preparatory  education, 
he  entered  the  medical  academy  at  Pittsfield,  Mass.,  but  completed  his 
-course  and  graduated  at  the  Albany  Medical  College  in  1865.  He  practiced 
for  a  time  at  Fonda,  but  later  formed  a  partnership  with  his  father  and 
removed  to  Ephratah,  where  he  has  practiced  continuously  since.  He  was 
a  physician  of  skill  and  ability,  and  enjoyed  a  large  practice  throughout 
the  vicinity  where  he  resided.  He  was  a  man  of  keen  intellectuality  and 
deeply  interested  in  all  that  was  for  the  public  advantage.  He  was  a  life 
long  Republican,  and  although  he  never  filled  a  public  office,  he  was  eager 
that  the  best  men  should  be  selected  to  serve  the  township.  In  private 
life  he  was  genial  and  sociable,  and  numbered  among  his  friends  a  very 
large  circle  of  acquaintances.  He  was  a  member  of  Caroga  Lodge,  F.  & 
A.  M. 

In  1871  he  married  Miss  Elmira  Keith,  who  died  in  1901. 

He  is  survived  by  a  son,  Charles  Wood,  of  Ephratah,  two  daughters, 
Mrs.  Everett  Stephenson,  of  Schenectady,  and  Mrs.  John  Rickard,  of 
Ephratah,  and  one  sister,  Mrs.  Oliver  Getman,  of  Johnstown. 


5* 


CURRENT   MEDICAL  LITERATURE 


Current  fl&eMcal  Xiterature 

REVIEWS  AND  NOTICES  OF  BOOKS 

Handbook  of  Anatomy.  Being  a  Complete  Compend  of  Anatomy,  Includ- 
ing the  Anatomy  of  the  Viscera  and  Numerous  Tables.  By 
James  K.  Young,  M.  D.  Second  edition,  revised  and  enlarged, 
with  171  engravings,  some  in  colors.  Philadelphia:  F.  A.  Davis 
Company,  Publishers,  1905. 

This  volume  is  an  abridged  "  Gray's  Anatomy,"  with  addition  of  illus- 
trations, charts  and  tables  from  other  recognized  anatomists.  It  is  a  little 
larger  in  size  than  the  ordinary  "  compends,"  has  larger  type,  larger  cuts 
and  charts  and  very  good  illustrations  of  the  arteries  (in  red). 

The  chapters  on  the  14  Organs  of  Special  Sense "  are  more  thorough 
than  those  usually  in  compends;  the  concluding  chapter  is  devoted  to 
"  Surgical  Anatomy "  and  considers  the  anatomical  structures  met  with 
in  operations  in  the  neck  triangles,  elbow,  upper  thigh,  axilla,  popliteal 
space,  inguinal,  ischio-rectal  regions  and  perineum. 

The  medical  student  usually  wants  a  complete  anatomy,  such  as  a 
"  Gray  "  or  a  "  Morris."  If  he  uses  a  compend  at  all,  he  wants  a  small- 
sized  edition  [which  mentions  important  details]  to  be  used  to  reinforce 
his  memory.  Young's  volume  admirably  fills  the  field  for  which  he 
intends  it,  but  the  book  will  not  supplant  the  complete  anatomy  or  the 
quiz-compend.  a.  h. 


The  Surgical  Assistant.  A  Manual  for  Students,  Practitioners,  Hospital 
Internes  and  Nurses.  By  Walter  M.  Brickner,  B.  S.,  M.  D. 
Published  by  the  International  Journal  of  Surgery  Co.,  Medical 
Publishers,  100  William  street,  New  York  City. 

This  is  an  octavo  volume  of  363  pages,  with  many  appropriate  original 
illustrations.  The  paper,  printing  and  workmanship  are  good.  Dr.  Brick- 
ner  has  been  associated  with  several  of  the  best  New  York  surgeons  at 
the  Mt.  Sinai  Hospital  and  has  designed  this  book  as  "  a  helpful  guide — 
to  the  student  preparing  for  hospital  examinations ;  to  the  hospital  interne 
who,  early  in  his  service,  unfamiliar  as  yet  with  surgical  technique  or  even 
with  the  names  and  forms  of  many  surgical  instruments,  is,  for  a  time, 
embarrassed  by  the  awkwardness  of  his  untutored  hands  and  the  slowness 
of  his  untrained  eye ;  to  the  trained  nurse  who  finds  herself  in  private 
practice  confronted  with  preparing  a  room  for  an  operation  and  very 
often  with  assisting  in  the  operation  itself ;  and  to  the  general  practitioner, 
as  a  volume  of  reference  to  aid  him  in  maintaining  a  large  share  in  the 
treatment  of  those  of  his  patients  who  otherwise  would  pass  from  him 
entirely  into  other  hands."  The  writer  has  succeeded  admirably  in  giving 
many  lucid,  concise  and  helpful  suggestions ;  his  style  is  not  labored  and 
his  diction  is  refreshing. 

Part  I  treats  of  the  relations  of  surgeon,  assistant  and  nurse;  the  hos- 
pital interne;  assistance  in  examinations  and  dressings;  preparations  for 
an  operation ;  the  room,  the  patient,  the  anaesthetist ;  preparation  and 


CURRENT  MEDICAL  LITERATURE 


53 


preservation  of  surgical  instruments  and  accessories;  "handing  of  instru- 
ments;"' assistance  at  the  wound,  and  the  immediate  post-operative  care 
of  the  patient. 

Part  II  treats  of  the  different  operations  regionally.  Appendix  I 
describes  the  preliminary  and  routine  after-treatment  of  operative  cases, 
also  the  preparation  of  surgical  materials.  Appendix  II  gives  illustra- 
tions of  surgical  instruments. 

The  remarks  on  the  conduct  of  the  assistant  are  particularly  appropriate. 
The  chapter  on  the  immediate  post-operative  care  of  the  patient  contains 
besides  many  helpful  suggestions,  the  enumeration,  diagnosis  and  treat- 
ment of  emergencies,  giving  in  detail  the  methods  of  controlling  hemor- 
rhages in  every  region  of  the  body. 

We  would  suggest  that  a  short,  clear  history  outline  should  be  added 
to  Chapter  II ;  that  in  Chapter  III  the  spica  bandage  illustrated  would  be 
too  short  to  prevent  motion  at  the  hip  joint.  (This  is  frequently  an 
important  indication  for  the  use  of  this  dressing.)  In  such  cases  the 
spica  should  extend  as  high  on  the  thorax  as  the  ninth  or  tenth  rib;  that 
if  very  hot  water  is  used  in  wetting  plaster  of  Paris  bandages,  instead  of 
"lukewarm  water,"  the  plasters  will  set  quicker  and  firmer;  that  the  new 
plaster  cutting  forceps  is  the  best  instrument  for  removing  plaster  of 
Paris  dressings;  that  it  is  poor  technic  for  any  operator  or  assistant  to 
put  on  a  rubber  blanket,  cover  this  with  a  sterile  gown,  don  a  mouth 
mask  and  a  sterile  cap,  draw  on  sterile  rubber  gloves  and  start  to  operate 
with  his  bare  arms  exposed  from  the  top  of  his  gloves  to  the  edge  of  his 
gown  sleeves,  which  end  above  the  elbow,  as  pictured  in  figure  22.  It 
would  be  better  to  have  these  sleeves  long  enough  to  be  tucked  into  the 
top  of  the  glove.  The  subcutaneous  method  of  suturing  the  skin  deserves 
mention  and  illustration. 

As  a  whole  this  little  work  is  highly  commendable  and  should  be 
accessible  to-every  interne  or  member  of  a  resident  house  staff.        a.  h. 


A  Text-Book  of  Physiology.  By  Winfield  S.  Hall,  M.  D.  Second  edi- 
tion, revised  and  enlarged.  Philadelphia  and  New  York :  Lea 
Brothers  &  Co.,  1905. 

The  second  edition  of  this  work,  which  appears  six  years  after  the 
first,  has  been  carefully  revised  and  considerably  enlarged.  The  author, 
as  in  the  first  edition,  closely  associates  the  physics,  chemistry  and 
biology  of  each  subject  considered.  The  details  of  histological  structure 
are  more  complete  than  is  the  rule  in  text-books  of  physiology.  A  new 
departure,  and  one  which  we  do  not  remember  having  seen  in  any  work 
on  physiology,  except  Professor  Landois'  u  Lehrbuch  der  Physiologie  des 
Menschen,"  is  the  addition  of  sub-chapters  on  pathologic  physiology. 
This  is  a  very  laudable  effort  to  form  a  bridge  between  physiology  and 
the  practice  of  medicine  and  in  this  work  is  more  methodically  planned 
than  in  Landois'  treatise. 

Such  treatment  of  a  subject  is  of  great  value  in  explaining  the  symptom- 
atology of  a  disease,  but  as  it  necessitates  also  a  discussion  of  etiology 
and  pathological  anatomy,  it  places  an  unusually  heavy  burden  on  those 


54 


CURRENT   MEDICAL  LITERATURE 


students  who  study  physiology  in  the  first  year  of  the  medical  course. 
For  students  farther  advanced  and  for  practitioners  it  is  a  most  excellent 
arrangement  and  by  such  will  undoubtedly  be  greatly  appreciated.  The 
work  is  freely  illustrated,  340  engravings  and  three  colored  plates  in  a 
volume  of  795  pages,  and  is  arranged  in  a  methodical  manner,  with  very 
complete  summaries  preceding  each  section. 

It  is  the  most  interesting  of  American  text-books  of  physiology  and 
should,  for  this  reason  and  because  of  its  comprehensive  scope  and  prac- 
tical character,  become  most  popular.  r.  m.  p. 


A  Manual  of  Practical  Hygiene.  By  Charles  Harrington,  M.  D.  Third 
edition,  revised  and  enlarged.  Philadelphia  and  New  York:  Lea 
Brothers  &  Co.,  1905. 

In  the  preparation  of  the  third  edition  of  this  well-known  book,  the 
author  has  replaced  obsolete  matter  with  material  in  accordance  with 
present  knowledge  in  a  most  satisfactory  manner.  Indeed,  so  excellent 
was  the  character  of  the  first  edition  of  this  treatise  when  it  appeared 
in  1901  that  few  changes,  other  than  those  demanded  by  new  investiga- 
tions, have  been  necessary  in  the  succeeding  editions.  The  most  import- 
ant change  in  the  present  volume  is  the  addition  of  a  very  excellent 
chapter  devoted  to  Infection,  Susceptibility  and  Immunity. 

The  work  remains  the  best  presentation  which  we  have,  in  the  English 
language  at  least,  of  general  hygiene. 

Although  the  volume  contains  793  pages  and  several  new  illustrations, 
it  is  by  some  magic  of  type  or  paper  of  less  bulk  than  the  first  edition  of 
729  pages.  The  able  and  amiable  Secretary  of  the  Massachusetts  State 
Board  of  Health  is  apparently  as  capable  of  "  squeezing "  information  as 
he  is  of  "  squeezing "  adulterators  of  food  and  drink,  and  with  as  little 
ostentation.  R.  m.  p. 


A  System  of  Physiologic  Therapeutics.  A  Practical  Exposition  of  the 
Methods,  other  than  Drug-giving,  Useful  in  the  Treatment  of  the 
Sick  and  in  the  Prevention  of  Disease.  Edited  by  Solomon 
Solis  Cohen,  A.  M.,  M.  D.  Volume  XI.  Serum  Therapy,  by 
Joseph  McFarland,  M.  D.  Organotherapy,  by  Oliver  T. 
Osborne,  M.  A.,  M.  D.  Radium,  Thorium  and  Radio- 
Activity,  by  Samuel  G.  Tracy,  B.  S.  C,  M.  D.  Counterirrita- 
Hon,  External  Applications,  Bloodletting,  by  Frederick  A. 
Packard,  M.  D.  An  Outline  of  the  Principles  of  Therapeutics, 
with  Especial  Reference  to  Physiologic  Therapeutics,  by  the 
Editor.  With  Addendum  on  X-Ray  Therapy  and  an  Index- 
digest  of  the  Complete  System  of  Eleven  Volumes.  Illustrated. 
Philadelphia:  P.  Blakiston's  Son  &  Co.,  1012  Walnut  street,  1905. 

This  volume  completes  the  "  System,"  begun  in  1901,  which  may  be 
said  to  have  fulfilled  its  mission.  In  the  series  are  included  discussions 
for  practical  instruction  in  electrotherapy,  climatology,  hygiene  and  nurs- 
ing, dietetics,  mechanotherapy,  mental  therapeutics,  suggestion  and  rest, 
hydrotherapy  and  phototherapy,  pneumotherapy  and  the  topics  of  the 


CURRENT  MEDICAL  LITERATURE 


55 


present  volume.  There  are  thus  described  numerous  methods  of  present- 
day  practice,  some  of  which  may  be  regarded  as  fashions  of  medicine,  to 
undergo  modification  or  to  be  abandoned  as  experience  grows.  The 
authors  have  each  exploited  their  special  fields,  and  the  papers  are  com- 
prehensive. A  generous  index  in  this  volume  facilitates  reference.  The 
therapeutic  skeptic  may  wonder  whether  the  "  physiological "  alternatives 
offer  more  attractive  and  more  rational  promise  of  success  than  the  drugs 
so  often  regarded  with  contempt. 


Diseases  of  the  Heart  and  Aorta.  By  Thomas  E.  Satterthwaite,  M.  D., 
Professor  of  Medicine  in  the  New  York  Post-Graduate  Medical 
School ;  Consulting  Physician  to  the  Post-Graduate  Orthopedic  and 
Babies'  Hospitals;  President  of  the  Medical  Association  of  the 
Greater  City  of  New  York.  E.  R.  Pelton,  19  East  Sixteenth  Street, 
New  York  City. 

This  volume  is  based  on  a  series  of  articles  that  originally  appeared 
in  various  medical  periodicals.  One  of  the  chapters,  "  Pulsus  Infrequens," 
was  published  in  the  Annals  for  March,  1903.  These  papers  have  been 
carefully  revised  and  with  the  addition  of  new  chapters  form  a  fairly 
complete  work  on  the  diseases  of  the  heart  and  aorta. 

The  author  has  had  unusual  opportunities  for  seeing  the  clinical  and 
pathological  aspects  of  these  diseases,  and  especially  for  studying  the 
relation  of  clinical  signs  to  post-mortem  appearances.  Abstracts  of  the 
clinical  histories  and  autopsy  protocols  of  illustrative  cases  are  freely  used. 

In  the  chapter  on  diagnosis  the  author  refers  to  the  use  of  the  X-ray 
as  a  means  for  accurately  determining  the  outline  of  the  heart,  and  sug- 
gests a  convenient  method  for  representing  by  diagram  the  borders  of 
the  heart  as  determined  by  percussion.  The  discussion  of  the  various 
valvular  lesions  is  quite  complete.  Special  attention  is  called  to  the  relation 
of  the  strong  cardiac  impulse  to  a  weak  radial  pulse  as  a  sign  of  mitral 
obstruction.  The  heart  of  mitral  regurgitation  is  characterized  as  the 
"  large  and  the  long  heart."  In  the  discussion  of  myocardial  affections  a 
plea  is  made  for  the  retention  of  the  term  "  Carditis,"  introduced  by 
Corvisart,  which  included  diseases  of  the  heart  muscle,  interstitial  tissue 
and  vessels,  and  is  now  quite  generally  replaced  by  the  term  "  myocarditis," 
a  term  that  actually  refers  only  to  muscle  inflammation. 

The  question  of  treatment  receives  careful  attention.  Beside  the  thera- 
peutic measures  given  in  the  chapters  describing  the  various  diseases, 
there  is  a  special  chapter  on  the  general  management  of  heart  diseases 
and  one  on  "  Nauheim  Methods  in  Chronic  Heart  Diseases  with  American 
Adaptations." 

Features  of  the  book  that  make  it  specially  pleasant  to  read  and  con- 
venient for  reference,  are  the  author's  historical  notes  regarding  the 
various  affections,  and  the  numerous  footnotes  indicating  careful  study 
of  the  modern  literature. 

While  the  book  is  not,  nor  is  intended  by  its  author  to  be,  an  exhaustive 
treatise,  it  will  be  found  a  useful  addition  to  the  library  of  the  general 
practitioner,  and  will  undoubtedly  afford  him  much  help  in  the  manage- 
ment of  heart  cases.  a.  t.  l. 


56 


CURRENT   MEDICAL  LITERATURE 


A  Manual  of  Diseases  of  Infants  and  Children.  By  John  Ruhrah,  M.  D. 
Clinical  Professor  of  Diseases  of  Children,  College  of  Physicians 
and  Surgeons,  Baltimore.  i2mo  volume  of  404  pages,  fully  illus- 
trated. Philadelphia  and  London :  W.  B.  Saunders  &  Company, 
1905.    Flexible  leather;  $2  net. 

This  manual  is  compiled  especially  for  the  medical  student  to  enable 
him  to  quickly  review  at  night  the  subjects  considered  in  the  classroom 
and  clinic  during  the  day.  In  other  words,  it  is  a  condensed  reference 
book  for  clinical  use. 

In  the  preface  the  author  calls  attention  to  the  part  that  this  manual 
is  not  intended  to  supplant  the  larger  and  necessary  textbook. 

The  arrangement  of  the  topics  is  similar  to  that  employed  by  Holt. 
The  essential  features  of  each  disease  are  included  in  a  condensed  form 
under  the  following  subdivisions :  Definition,  etiology,  lesions,  symptoms, 
prognosis,  diagnosis,  treatment.  The  author  has  shown  excellent  judg- 
ment in  separating  the  chaff  from  the  wheat. 

The  topic  of  infant  feeding  has  received  a  good  deal  of  attention,  but 
here  the  author  has  not  shown  the  same  discriminating  skill.  Several 
pages  are  devoted  to  modification  tables  and  formulas,  which  perhaps 
have  their  place  in  the  larger  works,  but  in  a  student's  handbook  are  more 
confusing  and  discouraging  than  helpful.  No  adequate  mention  is  made 
of  the  importance  of  a  clean  sanitary  milk  supply.  Illustrations  are  shown 
of  the  Freeman  pasteurizer  and  the  Arnold  sterilizer,  but  no  description 
of  the  methods  is  given. 

The  book  is  a  very  convenient  size,  of  405  pages  and  attractively  bound 
with  flexible  leather  covers.  There  are  numerous  illustrations  throughout 
the  book,  most  of  which  are  excellent. 

While,  as  the  author  himself  states,  this  manual  should  not  take  the 
place  of  the  larger  text  books,  yet  it  is  superior  to  many  of  them,  and 
will  be  a  useful  and  serviceable  book,  not  only  to  the  medical  student,  but 
to  the  general  practitioner  as  well.  h.  l.  k.  s. 


Physical  Diagnosis,  Including  Diseases  of  the  Thoracic  and  Abdominal 
Organs.  A  Manual  for  Students  and  Physicians.  By  Egbert 
Le  Fevre.  M.  D.  Second  edition,  thoroughly  revised  and  enlarged. 
Illustrated  with  102  engravings  and  16  plates.  Lea  Brothers  &  Co. 
Philadelphia  and  New  York,  1905. 

In  the  second  edition  of  Le  Fevre's  Physical  Diagnosis  the  author  has 
preserved  the  general  plan  of  the  original  work,  keeping  the  scope  of  the 
work  within  the  subjects  of  Inspection,  Palpation,  Percussion  and  Auscul- 
tation. Some  sections  have  been  entirely  rewritten,  the  illustrations  have 
been  increased,  and  special  attention  has  been  called  to  recent  modifications 
in  methods  of  examination,  including  X-ray  diagnosis.  Respiratory  and 
cardiac  sounds  are  discussed  more  fully  than  in  most  manuals  of  this 
sort.  The  chapter  on  percussion  is  especially  good,  and  with  the  excellent 
illustrations  should  aid  the  student  greatly  in  acquiring  proficiency  in  this 
diagnostic  method.  The  application  of  each  of  the  four  classical  methods 
of  physical  diagnosis  to  diseases  of  the  respiratory  system  is  system- 


CURRENT  MEDICAL  LITERATURE 


57 


atically  discussed,  and  is  followed  by  similar  treatment  of  the  diagnosis 
of  diseases  of  the  circulatory  system  and  of  the  abdominal  organs. 

Medical  students,  for  whom  the  work  appears  to  be  especially  designed, 
will  find  it  a  clear  and  concise  summary  of  the  essentials  of  physical 
diagnosis.  Physicians  in  practice  will  probably  also  find  it  a  valuable 
though  somewhat  brief  discussion  of  the  subject.  a.  t.  l. 


A  Manual  of  Diseases  of  the  Nose  and  Throat.    By  Cornelius  G.  Coak- 
ley,  A.  M.,  M.  D.,  Professor  of  Laryngology  in  the  University  and 
Bellevue  Hospital  Medical  College ;  Laryngologist  to  Columbus  Hos- 
pital, etc.,  New  York.    New  (3d)  edition,  revised  and  enlarged. 
In  one  i2mo.  volume  of  594  pages,  with  118  engravings  and  5 
colored  plates.    Cloth,  $2.75  net.    Lea  Brothers  &  Co.,  Publishers, 
Philadelphia  and  New  York,  1905. 
The  well  known  author  has  certainly  succeeded  in  writing  a  book  on 
the  diseases  of  the  nose  and  throat,  which  is  particularly  valuable  for 
students  because  it  does  not  go  too  deeply  into  details. 

General  practitioners  and  specialists  can  also  get  many  valuable  points 
by  carefully  reading  the  book. 

The  chapter  devoted  to  the  diseases  of  the  accessory  sinuses  of  the 
nose  may  be  specially  commended. 

The  author  has  done  so  much  good  work  along  this  line,  that  he  is  in 
a  position  to  speak  with  authority.  There  are  many  other  good  special 
features  in  the  book,  among  them  the  chapter  devoted  to  therapeutics  may 
be  mentioned.  Drugs  are  classified  according  to  their  local  actions,  and 
a  number  of  useful  prescriptions  together  with  indications  for  their  em- 
ployment are  given.  c.  f.  t. 


Biographic  Clinics.  Volume  III.  Essays  Concerning  the  Influence  of 
Visual  - Function,  Pathologic  and  Physiologic,  upon  the  Health  of 
Patients.  By  George  M.  Gould,  M.  D.  Philadelphia :  P.  Blakiston's 
Son  &  Co.,  1905. 

This  is  a  continuation  of  Dr.  Gould's  two  former  volumes  on  this  sub- 
ject, and  an  extension  of  them,  in  that  it  contains  not  only  the  usual 
biographic  studies,  but  also  papers  of  a  more  general  character  dealing 
with  various  problems  in  ophthalmology.  The  more  important  of  these 
relate  to  migraine,  the  relation  of  optic  defects  to  the  scoliosis  of  school 
children,  dextrality  and  sinistrality,  and  certain  problems  in  presbyopia. 
There  Is  also  a  chapter  on  the  reception  of  medical  discoveries.  Besides 
Dr.  Gould's  own  articles  the  book  also  contains  two  excellent  articles  on 
Eyestrain  by  Snell  and  Pronger. 

The  purely  biographic  studies  are  in  the  same  vein  as  the  previous  ones, 
and  consist  in  a  series  of  quotations,  culled  from  the  biographies  of 
Symonds  and  Taine,  which  give  support  to  Dr.  Gould's  hypothesis  that  eye- 
strain was  at  the  bottom  of  the  multifarious  ills  from  which  the  gentlemen 
mentioned  suffered.  The  chapter  on  migraine  contains  an  interesting 
historical  review  of  the  subject,  and  brings  further  evidence,  if  any  were 
needed,  to  show  that  in  a  good  many  cases  errors  of  refraction  are 


CURRENT  MEDICAL  LITERATURE 


intimately  associated  with  this  trouble.  The  chapters  dealing  with  the 
relation  of  ocular  troubles  tc  scoliosis  in  school  children,  and  to  other 
aspects  of  school  hygiene  contain  much  interesting  food  for  thought,  and 
should  be  read  by  all  discriminating  people  interested  in  this  important 
subject.  The  remaining  chapters  concern  subjects  which  are  of  interest 
to  the  ophthalmologist  rather  than  to  the  general  practitioner. 

Unfortunately  the  same  faults  disfigure  this  book  that  marred  its  pre- 
decessors, and  the  most  important  of  these  is  the  unfortunate  spirit  in 
which  it  is  written.  Dr.  Gould  starts  with  the  assumption  that  the 
medical  profession  is  mainly  composed  of  intolerant,  and  incidentally 
rather  obtuse,  individuals  who  are  opposed  to  all  new  ideas,  and  he  rubs 
the  assumption  in  all  through  the  book.  He  further  holds  as  one  of  his 
main  premises  that  the  medical  profession  has  persisted  and  continues 
to  persist  in  deliberately  scouting  the  role  of  eyestrain  in  causing  various 
ills.  So  far  as  the  first  proposition  is  concerned,  it  is  of  course  true  that 
the  medical  profession  is  not  entirely  composed  of  brilliant  geniuses  like 
George  M.  Gould,  but  it  is  likewise  true  that,  taking  the  average  doctor 
bye  and  large  he  is  a  pretty  commonsense  sort  of  fellow.  The  charge 
that  the  profession  have  disregarded  plain  evidence  as  to  the  relation  of 
eyestrain  in  disease  is  disproved  by  Dr.  Gould's  own  book  in  which  he 
mentions  numerous  American  publications  on  the  subject,  and  speaks  of 
thousands  (italics  ours)  of  patients  who  are  being  cured  by  quiet,  almost 
unknown,  oculists  all  over  the  United  States.  Dr.  Gould  evidently  does 
not  yet  appreciate  that  if  one  wishes  to  convince  a  man  of  the  truth  of 
any  proposition  it  is  best  not  to  begin  by  calling  him  a  fool  and  a  knave. 
Like  many  reformers,  the  doctor  is  suffering  from  too  much  Ego  in 
his  Cosmos,  and  he  lacks  the  patience  and  the  balance  which  are  neces- 
sary to  enable  him  to  place  his  views  before  the  profession  without 
exciting  antagonism.  The  articles  of  Dr.  Snell  and  Dr.  Pronger  are  in 
strong  contrast  to  those  of  Dr.  Gould,  and  we  would  suggest  that  in 
future  Dr.  Gould  should  model  his  work  on  theirs.  G.  b. 


Neurotic  Disorders  of  Childhood,  Including  a  Study  of  Auto  and  Intes- 
tinal Intoxications,  Chronic  Anaemia,  Fever,  Eclampsia,  Epilepsy, 
Migraine,  Chorea,  Hysteria,  Asthma,  etc.  By  B.  K.  Rachford, 
M.  D.,  Professor  of  Diseases  of  Children,  Medical  College  of  Ohio, 
•University  of  Cincinnati;  Pediatrist  to  the  Cincinnati,  Good  Samari- 
tan and  Jewish  Hospitals ;  Member  of  American  Pediatric  Society, 
Association  of  American  Physicians,  etc.  New  York:  E.  B.  Treat 
&  Co.,  1905. 

This  book  is  a  thesis.  The  author  has  addressed  himself  to  the  task  of 
establishing  a  relation  between  certain  toxic  states  or  defects  of  metabolism 
and  the  nervous  diseases  of  childhood.  The  line  of  argument  is  much 
the  same  as  that  of  Haig,  except  that  the  term  uric  acid  exploited  by  Haig 
is  here  replaced  by  a  discussion  of  the  purin  bodies.  The  work  is  divided 
into  two  parts.  Part  I,  comprising  nine  chapters,  describes,  first,  the 
functions  of  the  nervous  system  in  health,  the  nervous  changes  incident 
upon  febrile  conditions,  and  the  toxic  states  (gastro-intestinal  toxaemia, 


CURRENT   MEDICAL  LITERATURE 


59 


auto-intoxications,  chronic  systemic  bacterial  toxaemias)  which  influence 
the  thermogenetic  centers  of  the  brain.  As  having  analogus  effects  chronic 
anaemia,  reflex  irritation  and  excessive  nerve  activity  are  given  a  place. 

Part  II  consists  of  eighteen  chapters  descriptive  of  diseases  or  symptoms 
alleged  to  be  due  to  toxic  states.  These  are  fevers,  eclampsia,  laryngismus 
stridulus,  tetany,  enuresis,  migraine,  recurrent  vomiting,  epilepsy,  recurrent 
coryza,  chorea,  hysteria,  headaches  and  earache,  asthma,  disorders  of  sleep, 
nystagmus,  habit  spasm  and  pica. 

.  The  purpose  of  the  author  is  the  exploitation  of  methods  of  treatment 
for  the  prevention  or  cure  of  these  conditions.  It  is  possible  to  go  to 
an  extreme  in  this  theory,  and  to  attribute  as  causes  a  series  of  events 
which  are  only  incidental.  The  seizures  of  epilepsy,  for  instance,  are 
often  regarded  as  due  to  an  accumulation  of  poisons  in  unstable  nerve 
cells,  and  yet  attempts  at  cure  by  removal  of  this  hypothetical  state  have 
been  exasperatingly  discouraging.  It  can  only  be  said  that  the  condition 
of  a  true  epileptic  is  frequently  made  more  bearable  by  the  adoption  of 
strict  rules  of  personal  hygiene.  Anomalies  of  nervous  function  are  too- 
deeply  seated  to  be  so  easily  removed.  The  author,  however,  has  ex- 
pressed his  ideas  plainly  and  forcibly.  His  descriptions  are  good,  and 
he  displays  ample  evidence  of  careful  clinical  scrutiny.  His  book  is  valu- 
able, not  too  technical,  and  should  prove  suggestive  to  every  practitioner 
who  deals  with  the  ailments  of  children. 


Saunders'  Medical  Hand-Atlases. — Atlas  and  Epitome  of  Diseases  of  the 
Skin.    By  Professor  Dr.  Franz  Mracek,  of  Vienna.    Edited,  with 
additions,  by  Henry  W.  Stelwagon,  M.  D.,  Professor  of  Derma- 
tology, Jefferson  Medical  College,  Philadelphia.    Second  edition, 
revised,  enlarged,  and  entirely  reset.    With  77  colored  lithographic 
plates,  50  half-tone  illustrations,  and  272  pages  of  text.  Philadelphia 
and  London :   W.  B.  Saunders  &  Company,  1905.    Cloth,  $4  net. 
The  second  edition  of  this  book,  which  appeared  recently,  is  consider- 
ably improved  and  enlarged.    The  text  is  clear  and  concise,  and  the 
nomenclature  is  simple,  a  point  of  considerable  importance  to  any  one 
familiar  with  the  many  and  confusing  synonymous  terms  of  dermatology. 
Theoretical  discussions  are  conspicuous  by  their  absence,  and  only  the 
more  advanced  facts  are  stated. 

This  edition  contains  27  new  plates,  each  plate  has  opposite  it  a  short 
clinical  history  of  the  case  illustrated.  The  illustrations  are  excellent  and 
instructive,  the  colored  plates  particularly.  One  must  remember,  however, 
that  the  text  is  written  from  the  German  standpoint,  and  in  this  country, 
at  any  rate,  dermatitis  herpetiformis  (Duhring)  is  not  considered  a  form 
of  chronic  pemphigus. 

The  terms  pityriasis  rubra  pilaris  and  pityriasis  rubra  as  used  in  this 
text  may  lead  to  confusion,  for  it  is  not  always  clear  to  which  disease  the 
author  refers.   Lupus  vulgaria  is  probably  a  typographical  error. 

The  book  will  recommend  itself  both  to  practitioners  and  students.  As 
a  textbook  for  students  it  is  admirably  adapted,  particularly  to  schools 
where  clinical  material  is  not  abundant.  The  colored  plates  are  an  ever- 
ready  clinic  for  the  student.  h.  w.  c. 


6o 


CURRENT   MEDICAL  LITERATURE 


The  Physician's  Visiting  List  (Lindsay  &  Blakiston's) .  For  1906.  Fifty- 
fifth  Year  of  its  Publication.  The  Dose-Table  herein  has  been 
revised  in  accordance  with  the  new  United  States  Pharmacopeia 
(1900).  Philadelphia:  P.  Blakiston's  Son  &  Co.,  successors  to 
Lindsay  and  Blakiston,  1012  Walnut  street.  Sold  by  all  Book- 
sellers and  Druggists. 

The  new  edition  of  Lindsay  &  Blakiston's  Visiting  List  contains,  in 
addition  to  the  regular  pages  in  which  to  record  visits,  a  dose-table,  re- 
vised in  accordance  with  the  new  United  States  Pharmacopeia  (1900), 
blank  pages  for  addresses,  memoranda  and  accounts,  etc.,  as  well  as  much 
valuable  information  regarding  incompatibilities,  treatment  of  poisons,  etc. 
The  regular  edition  is  published  in  various  sizes,  for  25,  50,  75,  100  patients 
weekly.  Beside  this  there  is  a  monthly  and  a  perpetual  edition.  This 
visiting  list  will  undoubtedly  be  as  popular  as  its  predecessors.      a.  t.  l. 


International  Clinics.  A  Quarterly  of  Illustrated  Clinical  Lectures  and 
Especially  Prepared  Original  Articles  on  Treatment,  Medicine, 
Surgery,  etc.,  by  Leading  Members  of  the  Medical  Profession 
throughout  the  World.  Edited  by  A.  O.  J.  Kelly,  A.  M.,  M.  D., 
Philadelphia,  U.  S.  A.,  with  the  collaboration  of  Osier,  Musser, 
and  others.  Volume  II,  Fifteenth  Series,  1905.  J.  B.  Lippincott 
Co.,  Philadelphia  and  London. 

Of  the  many  excellent  articles  which  this  volume  contain,  perhaps  none 
is  of  greater  interest  to  the  rank  and  file  of  the  medical  profession  than 
the  one  entitled  "  The  Diagnosis  of  Incipient  Thoracic  Tuberculosis." 
Robert  W.  Willson,  in  an  exhaustive  monograph,  reviews  in  detail  fifteen 
cases,  drawing  therefrom  a  symptom  complex  for  incipient  phthisis, 
emphasizing  the  necessity  of  a  careful  examination  of  the  bared  chest  in 
all  cases  of  simple  "  cold  "  or  cough  and  elaborating  in  detail  upon  the 
physical  signs  and  clinical  features  of  the  malady. 

John  Lovett  Morse,  of  Boston,  in  a  readable  article  on  "  The  Treatment 
of  Acute  Nephritis  in  Childhood,"  compares  the  caloric  needs  of  the  child 
and  adult.  He  disfavors  an  exclusive  skim-milk  diet,  large  quantities  of 
water  and  diuretics  in  the  first  stages  of  actue  nephritis,  but  advises  milk 
and  cream  mixtures,  free  catharsis  and  diaphoretics. 

"The  Rational  Therapy  of  Uterine  Displacements,"  by  C.  D.  Palmer, 
of  Cincinnati,  gives  a  resume  of  the  various  methods,  both  mechanical  and 
surgical,  for  relieving  this  condition.  He  believes  engorgement  to  be  the 
chief  underlying  factor  of  the  symptomatology  of  uterine  displacement, 
and  that  a  fruitful  cause  of  this  condition  is  prolonged  dorsal  decubitus 
following  confinement. 

"  Plague."  J.  Ruter  Williamson,  of  India,  furnishes  a  very  entertaining 
article.  He  considers  the  cardinal  points  in  the  clinical  diagnosis  of  plague 
to  be  the  presence  of  buboes  (extremely  tender  after  the  first  day)  ;  the 
very  rapid  pulse  (130  to  140  or  more);  the  injected  eyes;  the  fierce  or 
dazed  expression,  and  the  staggering  gait.  Regarding  treatment,  the 
main  axiom  throughout  is  fearlessly  and  persistently  to  push  cardiac 
stimulation. 


CURRENT   MEDICAL  LITERATURE 


6l 


D.  Baity  King,  of  London,  gives  "  Some  Observations  on  the  Treatment 
of  Pulmonary  Hemorrhage  by  Adrenalin  Chloride."  He  believes  the  drug 
to  be  contra-indicated  in  this  condition,  as  it  neither  hastens  coagulation 
nor  reduces  the  pressure  in  the  pulmonary  blood  vessels. 

G.  Hayem,  of  Paris,  in  a  clinical  lecture,  lauds  the  virtues  of  Keplin, 
cows'  milk  which  has  undergone  a  special  mode  of  fermentation,  and  is 
used  largely  by  Russian  physicians.  He  believes  it  to  be  especially  adapted 
for  patients  suffering  from  insufficient  gastric  functions  and  particularly 
from  insufficient  secretion. 

The  above  is  but  a  passing  mention  of  a  few  of  the  readable  articles  the 
editor  has  served  up  in  this  volume,  having  well  accomplished  his  purpose 
in  keeping  the  reader  in  touch  with  the  latest  thought  of  the  medical 
world.  H.  d.  c. 


NEW  YORK  STATE  MEDICAL  LIBRARY. 
Edited  by  Miss  Ada  Bunnell,  B.  L.  S. 

Hours  of  opening.  The  library  is  open  for  readers  and  borrowers  each 
week  day  from  8  a.  m.  to  10  p.  m.,  including  Saturdays  and  holidays,  except 
during  July  and  August,  when  it  closes  at  6  p.  m. 

Loans.  Books  can  be  lent  to  any  registered  physician,  but  will  be  deliv- 
ered only  on  personal  application  or  on  a  written  order,  by  which  full 
responsibility  for  books  so  delivered  is  assumed. 

Loans  outside  Albany.  Books  will  be  lent  by  the  medical  library  to  any 
registered  physician  outside  Albany,  provided : 

1.  That  such  precautions  be  taken  in  packing  as  to  guard  against 
any  probability  of  injury  in  transportation. 

2.  That  the  medical  library  shall  not  pay  postage  or  express  either 
way. 

The  library  is  collecting  articles  on  minute  subjects  and  will  be  glad  to 
receive  gifts  of  reprints  of  articles  in  magazines  from  authors  or  publishers. 

RECENT  ACCESSIONS  TO  THE  LIBRARY 
General  Works 

Magnus,  Hugo.   Superstition  in  Medicine.    N.  Y.  1905. 
Keen,  W.  W.    Addresses  and  other  Papers.    Phil.  1905. 
Osier,  William.    Aequanimitas,  with  other  Addresses  to  Medical  Stu- 
dents, Nurses  and  Practitioners  of  Medicine.    Phil.  1905. 

Nursing 

Beck,  A.  K.    Reference  Handbook  for  Nurses.    Phil.  1905. 
Connecticut  Training  School  for  Nurses.    Handbook  of  Nursing,  re- 
vised ed.  for  Hospital  and  General  Use.    Phil.  1905. 
Dock,  L.  L.    Short  Papers  on  Nursing  Subjects.    N.  Y.  1900. 


7 


62 


CURRENT   MEDICAL  LITERATURE 


Anatomy.    Physiology.  Hygiene. 

Schultze,  O.  M.  S.  Atlas  and  Textbook  of  Topographic  and  Applied 
Anatomy,  ed.  with  Additions  by  G.  D.  Stewart.    Phil.  1905. 

Pawlow,  J.  P.  The  Work  of  the  Digestive  Glands,  tr.  into  English  by 
W.  H.  Thompson.    London,  1902. 

Association  international  pour  la  protection  legale  des  travailleurs. 
Les  industries  insalubres;  rapports  sur  leurs  dangers  et  les  moyens  de  les 
prevenir,  particulierement  dans  l'industrie  des  allumettes  et  celles  qui 
fabriquent  ou  emploient  des  couleurs  de  plomb,  precedes  d'une  preface 
par  Etienne  Bauer.    Jena,  1903. 

Brandt,  Lilian,  comp.  (A)  Directory  of  Institutions  and  Societies 
dealing  with  Tuberculosis  in  the  United  States  and  Canada.  N.  Y.  The 
Committee  on  the  Prevention  of  Tuberculosis  of  the  Charity  Organiza- 
tion Society  of  the  City  of  New  York  and  the  National  Association  for 
the  Study  and  Prevention  of  Tuberculosis,  1904. 

Pathology.    Diseases.  Treatment 

Hare,  H.  A.    Textbook  of  the  Practice  of  Medicine.    Phil.  1905. 

Nothnagel,  Hermann,  ed.  Encyclopedia  of  Practical  Medicine.  Au- 
thorized Translation  from  the  German,  under  the  Editorial  Supervision 
of  Alfred  Stengel.    I2v.    Phil.  1902-05. 

Vaughan,  V.  C,  and  Novy,  F.  G.    Cellular  Toxins;  or,  the  Chemical 
Factors  in  the  Causation  of  Diseases.    Ed.  4.    Phil.  1902. 
.  Cabot,  R.  C.    Physical  Diagnosis.    Ed.  3.    N.  Y.  1905. 

Da  Costa,  J.  C.  Clinical  Hematology,  a  Practical  Guide  to  the  Exam- 
ination of  the  Blood  with  Reference  to  Diagnosis.    Ed.  2.    Phil.  1905. 

Hensel,  Otto,  Weil,  Richard  and  Jelliffe,  S.  E.  Urine  and  Feces  in 
Diagnosis.    Phil.  1905. 

Turk,  Wilhelm.  Klinische  Untersuchungen  iiber  das  Verhalten  des 
Blutes  bei  acuten  Infectionskrankheiten.    Wien,  1898. 

Deaver,  J.  B.  Appendicitis ;  its  History,  Anatomy,  Clinical  Aetiology, 
Pathology,  Symtomatology,  Diagnosis,  Prognosis,  Treatment,  Technique 
of  Operations,  Complications  and  Sequels.    Ed.  3.    Phil.  1905. 

Kelly,  H.  A.,  and  Hurdon,  E.  The  Vermiform  Appendix  and  its  Dis- 
eases.   Phil.  1905. 

Richardson,  Hubert.    The  Thyroid  and  Parathyroid  Glands.    Phil.  1905. 

Mracek,  Franz.  Atlas  and  Epitome  of  Diseases  of  the  Skin,  authorized 
tr.  fr.  the  German.    Ed.  2,  ed.  by  H.  W.  Stelwagon.    Phil.  1905. 

Deaver,  J.  B.,  and  Ashurst,  A.  P.  C.  Enlargement  of  the  Prostate;  its 
History,  Anatomy,  Aetiology,  Pathology,  Clinical  Causes,  Symptoms, 
Diagnosis,  Prognosis,  Treatment,  Technique  of  Operations  and  after 
Treatment.    Phil.  1905. 

Taylor,  R.  W.  Practical  Treatise  on  Sexual  Disorders  of  the  Male  and 
Female.    Ed.  3.    N.  Y.  1905. 

Dubois,  Paul.  Psychic  Treatment  of  Nervous  Disorders;  the  Psycho- 
neuroses  and  their  Moral  Treatment,  tr.  and  ed.  by  S.  E.  Jelliffe  and  W. 
A.  White.    N.  Y.  1905. 


CURRENT   MEDICAL  LITERATURE 


63 


Krafft-Ebing,  R.  von.  Text-Book  of  Insanity,  tr.  by  C.  G.  Chaddock, 
with  introduction  by  Frederick  Peterson.    Phil.  1904. 

Councilman,  W.  T.,  Mallory,  F.  B.,  and  Wright,  J.  H.  Epidemic 
Cerebro-Spinal  Meningitis  and  its  Relation  to  other  forms  of  Meningitis. 
Boston,  1898.    A  Report  of  the  State  Board  of  Health  of  Massachusetts. 

Surgery.    Obstetrics.  Pediatrics 

Moynihan,  B.  G.  A.    Abdominal  Operations.    Phil.  1905. 

Whiting,  Frederick.    Modern  Mastoid  Operation.    Phil.  1905. 

Keyes,  E.  L.,  and  Keyes,  E.  L.,  Jr.  Surgical  Diseases  of  the  Genito- 
urinary Organs.    Ed.  2.    N.  Y.  1905. 

Savage,  G.  C.  Ophthalmic  Neuro-Myology,  a  Study  of  the  Normal 
and  Abnormal  Actions  of  the  Ocular  Muscles  from  the  Brain  side  of  the 
Question.    Nashville,  Tenn.,  1905. 

Wright,  A.  H.    Text-Book  of  Obstetrics.    N.  Y.  1905. 

Graetzer,  E.  Practical  Pediatrics,  a  Manual  of  the  Medical  and  Sur- 
gical Diseases  of  Infancy  and  Childhood,  tr.  by  H.  B.  Sheffield.  Phil. 
1905. 

New  Periodicals 

Archives  of  Physiological  Therapy.  Boston. 
Journal  of  Biological  Chemistry.    N.  Y. 
Surgery,  Gynecology  and  Obstetrics.  Chicago. 


MEDICINE 

Edited  by  Samuel  B.  Ward,  M.  D.,  and  Hermon  C.  Gordinier,  M.  D. 

An  Enquiry  Anio  the  Etiology  and  Pathology  of  Beri-beri. 
Hamilton  Wright.    Journal  of  Tropical  Medicine,  1905,  viii,  161,  180. 

The  theories  most  often  advanced  as  to  the  cause  of  beri-beri  are: 

(1)  Gelpke's  theory  that  it  is  due  to  dried  fish  infected  with  a  trichina. 

(2)  Miura's  theory  that  it  is  due  to  the  ingestion  of  certain  kinds  of 
raw  fish. 

(3)  Grimm's  theory  that  it  is  due  to  the  ingestion  of  infected  fish. 

(4)  The  theory  of  Takaki  and  others  that  it  is  due  to  a  pathogenic 
diet  in  which  the  proportion  of  nitrogen  to  carbon  is  too  small. 

(5)  Ross's  theory  that  it  is 'due  to  arsenical  poisoning. 

(6)  The  theory  that  it  is  due  to  the  ingestion  of  mouldy  rice. 

(7)  Braddon's  theory  that  it  is  due  to  the  ingestion  of  a  specific  organ- 
ism which  develops  on  growing  rice. 

(8)  Manson's  theory  that  it  is  due  to  a  place  germ  (earth,  floor  or 
house),  which  distils  a  toxin,  volatile  or  otherwise,  that  being  inhaled  or 
ingested  produces  the  disease. 

(9)  Glogner's  theory  that  it  is  due  to  a  hemic  Plasmodium. 

(10)  The  author's  own  conclusion  is  that  it  is  due  to  a  specific  organ- 
ism that  remains  dormant  in  certain  localities,  but  having  gained  entrance 


64 


CURRENT   MEDICAL  LITERATURE 


to  the  body  by  the  mouth,  it  multiplies  locally  (in  the  stomach  or  duo- 
denum), gives  rise  to  a  local  lesion  and  produces  a  toxin  that,  gaining 
entrance  to  the  general  circulation,  acts  on  the  peripheral  terminations 
of  both  afferent  and  efferent  neurones.  Finally  the  organism  escapes  in 
the  faeces  and  again  lies  dormant  in  various  places.  Unfortunately  the 
specific  organism  has  to  be  assumed. 

For  the  elimination  of  the  other  theories  the  author  relies  on  the  results 
of  his  observations  of  prisoners  and  of  experiments  on  monkeys  in  a 
jail  in  Kwala  Lumpor  in  the  Federated  Malay  States. 

The  prisoners  were  divided  into  separate  parties ;  party  No.  I  con- 
sisted of  those  who  had  had  beri-beri ;  party  No.  2,  of  prisoners  who  had 
never  had  beri-beri.  This  party  was  kept  separate  from  party  No.  1,  and 
at  different  work,  but  were  yet  in  the  same  building.  Party  No.  3  con- 
sisted also  of  those  who  had  not  had  beri-beri,  but  they  were  kept  at 
work  outside  the  building  and  slept  in  different  cells  from  the  other  par- 
ties. Party  No.  4  consisted  of  certain  prisoners  who  had  had  more  or 
less  severe  beri-beri.  They  were  kept  at  work  in  the  kitchens  and  laun- 
dries. Conditions  as  to  clothing,  sleep,  water  supply,  personal  hygiene, 
etc.,  were  uniform  as  possible.  The  water  was  from  a  supply  above  sus- 
picion. The  rice  used  was  steamed  for  two  and  a  half  hours  under  two 
atmospheres  of  pressure  or  boiled,  and  afterward  examinated  bacterio- 
logically.  The  other  articles  of  diet  were  regularly  inspected.  The  prison- 
ers received  no  fish  of  any  kind.  The  proportion  of  nitrogen  to  carbon 
averaged  about  one  in  twelve.  This  is  a  higher  proportion  of  nitrogen  than 
is  normally  required.  The  bad  feature  of  the  prison  routine  was  the 
disposition  of  the  excreta.  This  seemed  to  be  the  main  source  of  infec- 
tion. From  the  cases  that  developed  it  appeared  that  the  incubation 
period  of  beri-beri  might  be  as  short  as  ten  days.  In  the  jail  it  was  no 
respecter  of  nationality.  The  Chinese,  however,  furnished  the  majority 
of  cases.  Most  of  the  cases  originated  during  the  northeast  monsoon, 
i.  e.,  from  September  to  April.  Rainfall  seemed  to  provide  the  moisture 
necessary  for  the  virile  development  of  the  organism. 

As  the  result  of  eleven  months'  observation  of  the  prisoners  the  author 
concludes  that  beri-beri  is  independent  of  diet,  considered  as  diet;  that 
the  jail  itself  was  a  focus  in  which  the  virus  of  beri-beri  was  generated; 
that  beri-beri  is,  broadly  speaking,  an  infectious  disease. 


On  the  Classification  and  Pathology  of  Beri-beri. 

Hamilton  Wright.    Journal  of  Tropical  Medicine,  1905,  viii,  197. 

The  author  classifies  beri-beri  as  follows : 
Acute  pernicious  beri-beri. 
Acute  beri-beri. 
Subacute  beri-beri. 

Beri-beric  residual  paralysis  or  neuritis. 

Acute  pernicious  beri-beri  has  a  sudden  onset.  Those  attacked  are 
frequently  among  the  lustiest  of  their  fellows.  A  complaint  is  made  of 
loss  of  appetite  and  dislike  of  solid  food.    Within  a  few  hours  there  is 


CURRENT  MEDICAL  LITERATURE 


65 


dull  pain  in  the  epigastrium.  Almost  immediately  the  epigastrium  begins 
to  bulge  more  or  less  distinctly.  The  throat  is  moderately  congested. 
There  are  generally  found  even  at  this  period  areas  of  anaesthesia  or 
hyperesthesia  over  the  distribution  of  the  cutaneous  branches  of  the 
anterior  tibial  and  the  musculo-cutaneous  nerves  in  the  legs.  In  all  cases 
of  this  class  there  are  early  sudden  intimations  which  declare  the  action 
of  the  beri-beric  virus  on  the  cardiac  nervous  system.  Even  within 
-twelve  hours  the  heart  proclaims  its  release  from  nervous  control.  The 
vessels  throb  violently,  various  hemic  murmurs  become  audible.  The 
slightest  exertion  on  the  part  of  the  patient  causes  the  pulse  to  rise 
rapidly  in  rate  and  to  become  irregular.  The  heart,  especially  on  the 
right  side,  becomes  greatly  dilated.  The  lungs  give  signs  of  engorge- 
ment, shortness  of  breath  follows  and  the  patient  dies.  The  mind  is 
clear  up  to  within  a  few  moments  of  death.  At  the  post-mortem  examina- 
tion the  throat  is  generally  found  reddened.  In  the  abdominal,  pleural 
and  peri-cardial  cavities  a  varying  amount  of  clear  fluid  is  found.  The 
pyloric  end  of  the  stomach  and  the  valvule  conniventes  of  the  duodenum 
are  the  seat  of  discrete  or  more  or  less  confluent  hemorrhagic  extrava- 
sions.  The  inflammation  may  extend  to  the  jejunum  or  even  to  the 
caecum,  but  as  a  rule  the  changes  are  confined  to  the  duodenum,  the 
upper  few  feet  of  the  jejunum  and  the  pyloric  end  of  the  stomach.  Micro- 
scopically the  affected  parts  exhibit  the  main  features  of  an  acute  inflam- 
matory process.  There  is  active  congestion,  round-cell  infiltration, 
cloudy  degeneration  and  necrosis  of  the  epithelium.  Mast  cells  are  pres- 
ent in  unusually  large  numbers.  Nerve  cells  in  the  plexuses  and  fibers 
show  beginning  degeneration.  The  entire  cardiac  nervous  system  shows 
the  effect  of  the  virus.  The  kidneys,  lungs,  spleen  and  liver  may  show 
congestion.  The  muscles,  if  their  nerves  have  been  affected,  are  flabby. 
No  interstitial  changes  are  noticeable.  If  there  has  been  oedema  the 
nervi  vasorum  in  the  ©edematous  areas  show  the  first  stage  of  change.  So 
also  do  the  nerve  cells  in  the  solar  and  other  sympathetic  plexuses. 

Acute  Beri-beri. — The  onset  in  this  form  is  similar,  but  differs  in  degree 
from  the  class  just  described.  The  premonitory  syndrome  of  gastro- 
intestinal disturbance  is  perhaps  not  so  marked.  By  the  end  of  ten  days 
a  patient  may  be  robbed  of  all  voluntary  movements  in  the  limbs  and 
trunk,  the  intercostals  and  the  diaphragm  alone  escaping.  The  various 
forms  of  sensation  may  be  widely  disturbed.  Even  the  fifth  and  seventh 
cranials  may  be  involved.  On  the  other  hand  the  paralysis  may  not 
extend  beyond  the  lower  limbs.  The  heart  is  not  involved  to  as  great  a 
degree  as  in  the  acute  pernicious  variety.  Any  degree  of  oedema  may  be 
present.  Cases  of  this  class  seldom  die  in  the  acute  stage  of  the  disease, 
but  may  die  later  when  the  gasto-intestinal  symptoms  have  disappeared 
and  paralysis  has  developed. 

Subacute  Beri-beri. — In  this  class  the  gastro-intestinal  symptoms  are 
slight.  The  knee-jerk  is  lost  in  a  few  days.  As  a  rule  the  paralysis  of 
sensation  and  motion  is  confined  to  the  legs,  though  there  may  be  numb- 
ness of  the  hands  and  slight  paresis  of  the  movements  of  extension  at 
the  wrist.  Various  grades  of  oedema  may  develop.  It  is  only  rarely  that 
signs  of  poisoning  of  the  cardiac  nervous  system  are  demonstrable.  The 


66 


CURRENT    MEDICAL  LITERATURE 


chief  defect  which  appears  is  a  tendency  for  the  heart  to  beat  more 
rapidly  than  it  should  on  slight  exertion. 

Bcri-beric  residual  paralysis  may  persist  for  almost  any  length  of  time, 
depending  upon  the  extent  of  the  original  lesion  in  the  cardiac  nervous 
system,  or  the  ability  of  those  affected  to  withstand  the  effects  of  inter- 
current maladies.  I  have  notes  of  a  case  which  had  endured  paralysis  of 
extension  of  the  ankles  and  loss  of  sensation  in  the  legs  for  sixteen  years. 

The  usual  course  is  for  such  cases  to  succumb  in  from  one  to  five  years 
from  heart  failure,  as  the  result  of  over-taxation  of  the  diseased  organ 
or  from  intercurrent  affections,  such  as  dysentery,  Bright's  disease,  phthsis, 
pneumonia,  or  repeated  attacks  of  malignant  malaria. 

During  life  the  symptoms  are  those  of  any  chronic  neuritis,  the  amount 
of  paralysis  of  a  given  movement  or  quality  of  sensation  depending  upon 
the  extent  of  the  initial  poisoning  of  the  neurones  involved. 

Pathological  Summary. — It  is  of  great  importance  to  remember  that  the 
large  majority  of  cases  of  beri-beri  which  come  to  the  post-mortem  table 
are  cases  of  beri-beric  residual  paralysis  or  neuritis.  These  cases  have  been 
searched  by  many  to  discover  the  active  agent  of  the  disease.  The  beri- 
beric  residual  paralytic  is  simply  a  nervous  wreck,  the  active  cause  having 
long  since  accomplished  its  work  and  departed.  A  gastro-duodenitis  is 
never  seen.  Mesenteric  glands  are  never  found  swollen ;  petechiae  are 
not  to  be  observed  in  the  serous  membranes ;  granular  degeneration  of  the 
kidney  epithelium  is  rarely  found ;  foci  of  small  cells  are  not  present  in 
heart  or  kidneys.  In  fact,  there  are  no  positive  signs  of  an  acute  process 
in  any  organ  of  the  body. 

The  author  concludes  the  article  by  giving  a  detailed  discussion  of  the 
microscopic  changes  taking  place  in  the  neurones  in  beri-beri. 


Experimental  Tuberculosis  of  the  Heart  and  Aorta.    (Tubcrculose  experi- 
mental du  Coeur  et  de  VAorte.) 

L.  Bernard  and  M.  Salomon.    Revue  de  Medicine,  LV ,  I,  January,  1903. 

Though  the  existence  of  tuberculous  lesions  of  the  endocardium  was 
denied  for  a  long  time  the  condition  is  now  recognized  by  all  pathologists 
as  occasionally  found.  When  first  seen  at  autopsy  upon  tuberculous  indi- 
viduals they  were  attributed  to  secondary  infection  with  pyogenic  cocci, 
a  view  which  was  strengthened  by  the  isolation  of  such  organisms  from 
the  lesions  in  a  few  cases,  but  later  and  more  extensive  investigations 
failed  to  reveal  any  such  etiological  factor,  and  still  more  recent  work 
has  shown,  both  by  microscopical  examination  and  by  animal  inoculation, 
that  tubercle  bacilli  may  be  here  present.  Michaelis  and  Blum  have  given 
experimental  confirmation  of  these  latter  findings;  they  injected  rabbits 
intravenously  with  tubercle  bacilli,  having  previously  injured  the  aortic 
valves  of  the  animals,  and  found  later  at  autopsy  typical  vegetative 
endocarditis  in  which  histological  tubercles  and  tubercle  bacilli  were 
present. 


CURRENT   MEDICAL  LITERATURE 


67 


These  lesions  however,  and  those  found  at  human  autopsy,  represent 
only  a  secondary  localization  of  bacilli  in  the  heart,  in  the  course,  or  at 
the  end  of  a  general  miliary  tuberculosis.  Primary  tuberculosis  of  the 
endocardium  has  no  independent  clinical  existence  and  has  only  very  lately 
been  demonstrated  as  a  pathological  possibility.  Braillon  (and  others) 
have  recently  reported  such  cases,  and  he  believes  that  there  is  no  essential 
difference  in  the  structure  of  such  vegetations  and  of  those  due  to  the 
ordinary  pyogenic  micro-organisms. 

The  work  here  reviewed  is  entirely  confirmatory  of  his  findings  in  this 
respect.  Bernard  and  Salomon  used  in  their  experiments  two  dogs  and 
six  rabbits,  and  upon  five  of  these  animals  the  results  were  positive,  i.  e. 
tuberculous  lesions  were  produced. 

The  rabbits  received  direct  intracardiac  injections  of  tubercle  bacilli, 
the  needle  being  inserted  through  the  thoracic  wall;  in  the  case  of  the 
dogs  the  injections  were  made  through  a  cannula  inserted  in  the  left 
carotid  artery  and  passed  down  to  a  point  just  within  the  left  ventricle. 
The  rabbits  received  two  cubic  centimeters  of  an  emulsion  of  tubercle 
bacilli,  but  the  dose  given  to  the  dogs  is  not  mentioned.  The  animals 
were  killed  at  periods  varying  from  twenty  to  fifty  days  after  the  injections, 
and  showed  in  addition  to  a  generalized  tuberculosis,  lesions  in  the  heart 
and  aorta,  which  were  in  all  the  animals  exactly  similar,  though  more 
advanced  in  those  in  whom  the  condition  had  existed  for  the  longest  time, 
as  was,  of  course,  to  be  expected. 

Tuberculous  lesions  were  found  in  the  endocardium,  in  the  myocardium, 
and  in  the  pericardium.  They  appeared  macroscopically  as  typical  tuber- 
cles scattered  over  the  internal  surface  of  the  left  ventricle  without 
apparent  predilection  as  to  location,  and  occurred  in  two  forms,  one  as 
definitely  projecting  nodules  situated  apparently  on  the  endocardium  and 
the  other  as  sub-endocardial  nodules  with  very  slight  projection  but  an 
increased  development  apparently  in  the  muscle  beneath.  In  addition  to 
the  left  ventricle,  they  were  found  in  the  right  ventricle  and  upon  the 
ventricular  surface  of  the  auriculo-ventricular  valves,  and  in  the  case  of 
the  animal  injected  through  the  carotid  upon  the  endocardial  surface 
of  the  left  auricle,  the  aortic  valves,  and  upon  the  intima  of  the  aorta. 
In  no  instance  had  these  lesions  the  appearance  of  ordinary  endocarditic 
vegetations,  but  had  macroscopically  all  the  characteristics  of  typical 
tubercles. 

On  this  account  their  microscopical  (histological)  structure  was  very 
interesting  and  equally  surprising.  The  projecting  nodules  were  com- 
posed of  a  deposit  of  fibrin  upon  the  elastic  layer  of  the  endocardium, 
and  were  covered  by  the  endothelial  layer.  Many  lymphocytes  were  found 
in  the  meshes  of  the  fibrin,  and  here  and  there  in  the  deeper  layers  a 
few  tubercle  bacilli.  The  second  form  of  endocardial  lesion  which  has 
been  mentioned  was  found  to  be  composed  of  lymphocytes  and  epithelioid 
cells,  and  to  be  subendocardial  as  had  been  suspected,  the  slight  projec- 
tion being  caused  by  the  elevation  of  this  membrane  from  the  muscle 
beneath.  The  lesions  in  the  aorta  were  formed  of  a  network  of  fibrin, 
which  enclosed  numerous  lymphocytes,  and  were  situated  on  the  internal 
elastic  coat  just  beneath  the  endothelial  layer  of  the  intima.  The  valvular 
nodules  were  also  of  two  forms,  exactly  corresponding  with  the  endo- 


08 


CURRENT  MEDICAL  LITERATURE 


cardial  and  subendocardial  forms  already  described.  These  lesions  were 
found  at  the  attached  margin  of  the  valves  or  extending  from  this  point 
into  the  valve  substance,  but  were  not  found  upon  the  free  margin. 

Bernard  and  Salomon  offer  the  following  explanation  for  the  two  forms 
of  lesions  (endocardial  and  subendocardial),  agreeing  with  the  conclusions 
of  Peron  in  regard  to  similar  forms  of  pleural  tubercles,  that  the  endo- 
cardial form  is  due  to  direct  inoculation  with  the  bacilli,  while  the  sub- 
endocardial form  arises  from  bacillary  emboli. 

They  explain  the  fact  that  the  macroscopic  appearances  are  not  those 
of  vegetative  endocarditis  and  that  the  lesions  are  more  widespread  in 
their  localization  than  in  human  cases  by  two  facts,  first  an  infection 
of  shorter  duration  and  secondly,  an  infection  of  greater  intensity.  They 
consider  it  is  not  only  possible  but  very  probable  that  with  a  gradual 
progressive  development  of  the  lesion  over  a  longer  period  of  time  a 
true  vegetation  might  be  found.  In  this  case  the  macroscopical  appear- 
ance would  be  very  misleading  as  to  the  true  nature  of  the  condition, 
and  as  it  has  been  seen  that  the  histological  picture  cannot  usually  be 
distinguished  from  that  of  ordinary  endocarditis  of  nontuberculous  origin, 
the  confusion  as  to  the  true  etiological  factor  in  such  cases  can  be  very 
easily  explained,  especially  when  we  remember  how  difficult  it  often  is 
to  demonstate  tubercle  bacilli  in  such  lesions. 

The  writers  also  point  out  that  such  considerations  compel  us,  at  least 
partially,  to  give  up  the  classical  specificity  of  the  histological  tubercle, 
as  other  agents  can  produce  tubercles,  and  tubercle  bacilli  under  certain 
conditions  can  produce  ordinary  inflammatory  processes.  It  would  seem 
as  though  perhaps  the  nature  of  the  inflammatory  reaction  depends  in 
part  upon  the  nature  of  the  tissue  involved. 


Primary  Ulcerative  Aortitis  of  Probable  Tuberculous  Origin.  (Aortite 
Septique  Ulcero-V  egetante  de  Nature  Probablement  1 uberculeuse.) 

M.  M.  Rome  and  Bombes  de  Villiers,  Lyon  Medical,  CV.  No.  34,  August 
20,  1905. 

Ulcerative  aortitis  occurs  under  two  conditions:  first,  as  an  accompani- 
ment of  infectious  ulcerative  endocarditis  and  resulting  from  a  direct 
extension  of  this  process  from  the  aortic  valves  along  or  into  the  aortic 
wall;  second,  as  a  primary  lesion  entirely  independent  of  any  cardiac 
affection.  The  first  condition  is  much  more  common  and  the  aortic 
lesion  passes  unrecognized  until  it  is  discovered  at  autopsy.  The  second 
condition  also  passes  unrecognized  clinically,  and  is  usually  thought  to 
be  an  affection  simply  of  the  aortic  valves  until  post-mortem  examination 
shows  the  endocardium  clear  and  the  whole  trouble  to  be  in  the  aorta. 

The  writers  report  a  case  falling  under  the  latter  classification.  The 
clinical  history  was  briefly  as  follows :  A  woman,  aged  40,  complained 
of  a  cough,  a  sense  of  thoracic  oppression  and  fever,  all  of  which  had 
lasted  about  three  months.  Family  history  negative  for  tuberculosis. 
Personal  history  negative  for  syphilis,  though  she  had  had  two  mis- 
carriages, cause  unknown ;  she  had  had  six  living  children.    At  the  age  of 


CURRENT  MEDICAL  LITERATURE 


69 


20  she  had  had  an  acute  monarticular  arthropathy  which  persisted  for  a 
long  time.  Since  that  time  she  had  been  well  until  three  months 
before  when  she  had  had  a  short  attack  of  polyarticular  pain.  Following 
that  she  had  had  constant  cough,  attacks  of  dyspnoea,  especially  at  night 
and  on  exertion,  fatigue,  asthenia,  headache,  chills.  Recently  her  symptoms 
had  been  worse.  When  first  seen  her  cardiac  condition  was  as  follows : 
Dyspnoea  present,  heart  slightly  enlarged  to  left,  thrill  in  2d  left  interspace, 
systolic  in  time;  systolic  murmur  over  whole  heart,  but  more  intense 
at  apex  and  base,  in  the  latter  situation  being  remarkably  rough  and 
grating  in  quality.  No  diastolic  murmur  heard.  Pulse  120,  regular,  feeble. 
The  lungs  gave  numerous  rales  throughout,  liver  and  spleen  enlarged, 
albuminuria.  For  two  months  her  condition  persisted  with  no  improve- 
ment; her  temperature  was  continually  elevated,  but  very  irregular;  heart 
signs  grew  worse,  increased  thrill  and  intensity  of  murmur,  especially  at 
the  base,  with  transmission  into  the  carotids.    Death  sudden. 

At  autopsy  the  heart  was  found  to  be  greatly  enlarged,  especially  the 
left  side;  mitral  valve  and  entire  right  heart  normal.  Aortic  valves 
thickened,  retracted,  partially  adherent,  causing  marked  occlusion  of  the 
orifice.  There  was  however  no  trace  of  recent  lesions  and  no  vegetations. 
The  aorta  in  its  transverse  and  descending  portions  was  normal.  In  the 
ascending  portion  about  four  centimeters  from  the  aortic  valves  there  was 
a  ragged  irregular  ulcer  about  two  centimeters  in  diameter,  its  edges 
nearly  hidden  with  friable  fibrinous  vegetations.  This  ulcer  opened  into 
a  small  pocket  in  the  posterior  wall  of  the  aorta,  which  was  partially 
filled  with  blood  clot,  and  proved  to  be  a  small  dissecting  aneurysm 
between  the  media  and  adventitia.  Nowhere  was  the  least  trace  of 
atheroma. 

Further  than  these  heart  findings  the  autopsy  disclosed  bilateral  chronic 
fibrous  pleurisy,  healed  tuberculosis  of  the  right  lung,  bilateral  pulmonary 
oedema,  chronic  passive  congestion  of  liver,  spleen  and  kidneys,  cerebral 
oedema. 

The  microscopic  examination  of  the  aorta  showed  a  necrotic  inflamma- 
tion of  the  middle  coat  of  the  vessel  with  considerable  infiltration  of 
the  surrounding  tissues.  There  was  no  evidence  of  syphilis,  of  atheroma, 
or  of  tuberculosis. 

Inflammatory  conditions  of  the  aorta  are  divided  into  three  main 
classes : 

(a)  Atheroma  of  old  age,  the  lesions  of  which  are  chronic  and  of 
slow  development  and  produce  no  symptoms  referable  to  the  aorta ; 

(b)  Syphilitic;  producing  typical  gelatiniform  plaques  upon  the  intima; 

(c)  That  occurring  in  the  course  of  grave  septicaemia  or  pyaemia,  and 
in  which  one  finds  at  autopsy  either  ulcerative  or  vegetative  aortitis  or 
true  abscess  of  the  vessel  walls.  Such  lesions  are  usually  accidentally 
found  at  autopsy,  as  in  the  above  case. 

The  writers  review  the  reported  cases  of  the  latter  condition,  many 
of  which  were  merely  extensions  inward  of  ulcerative  endocarditis.  Their 
case  was  purely  and  absolutely  primary,  as  no  fresh  lesions  of  the  valve 
were  found  and  there  was  no  atheroma.  The  etiological  factor  in  most 
of  these  cases  is  very  hard  to  determine,  though  those  cases  which  occur 


7° 


CURRENT  MEDICAL  LITERATURE 


in  the  course  of  septicaemia  or  pyaemia  or  in  which  metastatic  abscesses 
are  found  at  autopsy  are  very  definitely  pyogenic  in  origin. 

They  offer  the  following  reasons  for  considering  their  case  as  probably 
due  to  tuberculosis  though  no  positive  evidence  of  this  was  found  at 
autopsy. 

There  was  no  evidence  of  syphilis  or  atheroma,  and  as  blood  cultures 
made  during  life  were  sterile  the  possibility  of  a  pyogenic  causative  factor 
was  practically  ruled  out.  The  history  of  previous  articular  troubles  was 
of  course  suggestive  of  rheumatism,  but  the  attacks  were  not  at  all  typical 
of  this  disease,  and  rheumatism  never  produces  the  severe  aortic  con- 
ditions which  were  here  present;  it  might  have  accounted  for  the  valvular 
lesion,  though  this  is  more  frequent  of  the  mitral  valve,  and  in  this  case 
the  mitral  valves  were  clear.  The  patient  showed  signs  of  healed  tuber- 
culosis of  one  lung,  and  the  serum  test  for  tuberculosis  in  the  course  of 
her  acute  terminal  attack  was  positive.  They  consider  the  joint  condi- 
tion, the  pulmonary  lesions,  the  valvular  and  aortic  troubles  as  all  due 
probably  to  tuberculosis. 

DERMATOLOGY 

Edited  by  Frederic  C.  Curtis,  M.  D.  and  Harry  W.  Carey,  M.  D. 

Observations  Concerning  Some  Palmar  Eruptions. 
Stelwagen.    Journal  of  Cutaneous  Diseases,  January,  1905. 

The  paper  includes  a  discussion  of  eczema,  eczema  seborrhoicum  and 
syphilis  palmaris,  in  which  the  lesions  are  chronic,  dry  and  scaly  in  char- 
acter, exclusive  of  those  due  to  occupation.  Common  predisposing 
factors  are  age,  seldom  under  thirty  years,  sex,  males  more  often  that 
females,  sedentary  occupation,  anaemia  and  circulatory  disturbances 
due  to  renal  or  cardiac  disease.  The  diagnosis  is  often  difficult, for  be- 
tween the  diffuse,  thickened  scaly  eruption  of  eczema  and  the  sharply 
defined  serpiginous  palmar  syphilide  are  many  gradations  which  are 
confusing.  Itching  when  present  is  characteristic  of  eczema.  Marginate 
and  crescentic  lesions  occur  in  eczema  seborrhoicum,  but  are  more  super- 
ficial, vary  more  from  month  to  month  and  are  less  infiltrated  than  in 
syphilis. 

For  eczema  palmaris,  ten  to  twenty  per  cent,  salicylic  ointment  or 
plaster  with  washings  of  sapo  viridis  or  weak  solutions  of  caustic  potash 
are  recommended  at  intervals.  Between  the  periods  when  the  above 
treatments  are  used,  a  mild  ointment,  such  as  Unna's  diachylon  salve 
may  be  used.  Some  of  these  cases  respond  promptly  to  the  Roentgen 
ray.'I£         - ' 

T  In  eczema  seborrhoicum  palmaris,  occasional  painting  with  ten  to  fifty 
per  cent,  resorcin  alcohol,  sulphur  five  to  twenty-five  per  cent.,  or  chrysal 
robin' two  to  ten  per  cent,  with  lard  or  Lassar's  paste  has  yielded  the 
best'^results. 

In  syphilis  palmaris,  the  writer  is  of  the  opinion  that  mercury  alone  is 
indicated  in  the  form  of  inunctions  or  hypodermic  injections,  as  these 
patients  seem  to  be  specially  tolerant  of  mercury  when  given  by  the 
mouth.  Potassium  iodide  has  not  yielded  good  results.  Attention  should 
also  be  given  to  improving  the  circulation  and  to  regulating  the  general 
hygiene  of  the  patient. 


CURRENT  MEDICAL  LITERATURE 


7* 


The  Diagnosis  of  Urinary  and  Genital  Tuberculosis. 

Young  and  Churchman.    American  Journal  of  the  Medical  Sciences, 
July,  1905. 

The  habitat  of  the  smegma  bacillus  is  such  a  wide  one  that  it  may  be 
present  in  any  urine.  It  is  frequently  found  in  the  fossa  navicularis  of 
the  anterior  urethra,  but  not  in  the  posterior  urethra  or  bladder.  Catheter- 
ized  urines,  therefore,  are  not  necessarily  free  from  the  smegma  bacillus. 
The  various  methods  employed  to  differentiate  the  smegma  from  the 
tubercle  bacillus  are  reviewed,  viz.,  those  based  upon  morphology,  staining 
peculiarities  and  animal  inoculation.  The  two  former  methods  are  proven 
to  be  uncertain  and  the  latter  requires  too  much  time. 

The  object  of  the  method  outlined  is  to  eliminate  the  smegma  bacillus 
completely  by: 

(1)  Careful  washing  of  the  external  genitalia,  specially  the  foreskin  and 
glans; 

(2)  Irrigation  of  the  whole  anterior  urethra  through  a  small  glass  tube 
introduced  into  the  urethra  as  far  as  the  triangular  ligament; 

(3)  The  urine  is  collected  into  three  glasses  and  the  contents  of  the 
third  glass  are  centrifugalized  and  stained  after  Gabbet's  method. 


The  Etiology  and  Pathogenesis  of  Erythema  Nodosum. 

Hoffman.    Deutsche  medicinische  Wochenschrift,  p.  1877,  No.  51,  1904. 

The  writer  believes  that  the  skin  lesions  and  general  symptoms  of  fever, 
arthropathy  and  gastric  disturbance  point  to  an  acute  infection  or  a 
toxaemia. 

It  should  not  be  classed  with  erythema  exudativum  multiforme  or  acute 
articular  rheumatism. 

Three  forms  are  distinguished:  (a)  idiopathic,  (fr)  symtomatic 
[typhoid,  scarlet  fever,  gonorrhea,  etc.],  (c)  toxic — iodoform,  etc.  It  is  to 
the  idiopathic  form  the  article  refers. 

The  erythematous  nodules  excised  and  studied  microscopically  show  a 
swelling  of  the  intima  of  the  small  veins  and  particularly  of  the  endo- 
thelial lining;  the  media  is  also  involved,  but  to  a  lesser  extent.  Within 
the  lumen  are  found  accumulations  of  leucocytes,  a  partial  thrombosis. 
The  staphylococcus  albus  and  the  streptococcus  have  been  grown  in  cul- 
tures from  the  nodules,  but  in  not  enough  cases  to  warrant  any  positive 
conclusions  as  to  their  importance.  The  author  believes  the  condition  is 
an  acute  phebitis  in  the  small  veins  of  the  extremities. 


The  Combined  Quinine-Iodine  Treatment  of  Lupus  Erythematosus  after 
the  Method  of  Hollander  and  its  Explanation. 

Oppenheim.    Wiener  klinische  Wochenschrift,  p.  53,  No.  3,  1905. 

Quinine  and  iodine  have  long  been  used  in  the  treatment  of  this  disease, 
the  former  internally,  the  latter  applied  externally.    Hollander  advised 


72 


CURRENT  MEDICAL  LITERATURE 


their  combined  use  in  1902.  The  author  suggests  a  modification  of  Hol- 
lander's method,  as  follows: 

(1)  A  preliminary  dose  of  quinine  bisulphate  or  hydrochlorate,  grams 
0.5,  to  determine  any  idiosyncrasy ; 

(2)  Quinine,  grams  0.5,  morning  and  evening,  increasing  the  dose 
grams  0.5  every  third  day  until  grams  4.0  pro  diem  is  reached ; 

(3)  Clean  lupus  area  with  alcohol  and  ether,  then  paint  with  tincture 
of  iodine  twice  each  day; 

(4)  Maintain  this  treatment  until  skin  becomes  smooth  and  erythema 
disappears,  then  diminish  quinine  grams  0.5  every  third  day. 

He  reports  no  bad  effects  from  the  high  doses  of  quinine.  The  gradual 
increase  in  the  dose  is  for  two  reasons:  (a)  the  patient  develops  a 
tolerance  for  the  drug,  and  (6)  it  exerts  a  more  marked  beneficial  effect 
on  the  lesions.  He  cites  six  cases  treated  in  Finger's  clinic,  two  com- 
pletely cured  and  four  much  improved. 

By  experiment  the  author  has  proven  that  the  iodine  increases  the 
quinine  in  the  lupus  lesions  by  attraction  [positive  chemotaxis],  and 
probably  forms  a  compound  there  which  acts  favorably  on  the  diseased 
skin.    He  urges  this  method  in  all  chronic  cases  of  lupus  erythematosus. 


Ethyl  Chloride  in  the  Treatment  of  Zoster. 

Morrow.    Journal  of  Cutaneous  Diseases,  April,  1905. 

The  application  of  ethyl  chloride  is  recommended  only  in  those  cases  in 
which  the  pain  is  severe  and  counter-irritation  is  indicated.  It  is  applied 
at  the  spinal  origin  of  the  affected  nerve  and  also  over  the  area  where 
the  pain  is  located.  A  spot  about  the  size  of  a  dollar  is  frozen  and  this 
can  be  repeated  frequently  with  good  results.  A  period  of  relief  follows, 
varying  from  a  few  hours  to  a  day. 


CLINICAL  MICROSCOPY 

Edited  by  Arthur  T.  Laird,  M.  D. 

The  Vitality  of  the  Typhoid  Bacillus  in  Shell-Fish. 
E.  Klein.    Lancet,  1905,  Vol.  CLXVlll,  p.  1133. 

This  investigator  endeavored  to  determine  the  viability  of  typhoid  and 
colon  bacilli  in  oysters,  cockles  and  mussels  under  the  usual  variety  of 
conditions  and  processes  to  which  these  shell-fish  are  subjected  before 
consumption. 

Healthy  oysters  free  from  contamination  by  these  bacteria  were  found 
to  be  capable  of  ingesting  such  bacilli  when  the  latter  were  introduced 
into  the  shells,  or  were  merely  introduced  into  the  water  in  which  the 
oysters  were  placed.  Such  infected  oysters  if  placed  in  frequent  changes 
of  clear  sea  water  would  free  themselves  from  these  bacteria.    The  dis- 


CURRENT  MEDICAL  LITERATURE 


73 


position  of  the  bacteria  by  the  infected  oysters  was  carried  on  to  a  less 
extent  and  more  slowly  if  the  oysters  were  not  placed  in  sea  water  but 
kept  in  the  air. 

Oysters  coining  from  sources  where  the  sea  water  was  regularly  pol- 
luted would,  after  infection  with  the  typhoid  bacillus,  clear  themselves 
of  these  bacteria  to  a  lesser  extent  and  at  a  slower  rate  when  placed  in 
clean  sea  water  than  those  clean  when  infected.  If  such  oysters  were 
kept  in  the  air  they  cleared  themselves  much  more  slowly,  and  to  a  far 
less  extent  than  when  kept  in  clean  water.  In  the  same  way,  if  infected 
oysters,  which  having  once  cleared  themselves  of  typhoid  bacilli  while 
kept  in  the  air,  were  again  subjected  to  reinfection,  they  were  very  slow 
in  again  clearing  themselves  even  if  kept  in  clean  water. 

That  the  disposition  of  the  infecting  bacilli  was  not  merely  a  passing 
out  of  them  into  the  surrounding  water  was  shown  by  the  results  of  the 
tests  on  the  oysters  kept  in  the  air,  and  also  by  the  lack  of  increase  of 
typhoid  bacilli  in  such  surrounding  water  as  compared  with  the  decrease 
in  the  oyster. 

The  conclusion  is  drawn  that  the  disposition  of  the  bacteria  must  be 
due  in  large  part  to  the  direct  devitalizing  power  of  the  oyster  upon  them. 
Therefore,  any  condition  which  decreases  the  vitality  of  the  oyster  tends 
to  increase  the  viability  of  the  typhoid  bacilli  infecting  them. 

Microscopically  the  oysters  showed  no  indications  of  infection  even 
when  kept  out  of  water  for  a  few  days. 

Oysters  lived  quite  well  in  sterile  sea  water  if  the  latter  was  frequently 
changed.  Mussels  and  cockles  in  this  order  showed  a  much  less  power  of 
clearing  themselves  of  typhoid  bacilli  than  did  oysters,  in  fact,  in  cockles 
there  was  an  increase  in  the  number  of  typhoid  bacilli  after  a  preliminary 
decrease,  but  this  was  followed  by  a  gradual  decline  in  numbers. 


Clinical  Examination  of  the  Urine.    A  Critical  Study  of  the  Commoner 
Methods. 

Richard  C.  Cabot.    The  Journal  of  the  American  Medical  Association, 
1905,  XLIV,  837,  943. 

The  author  has  compared  systematically  the  urinary  records  and  post 
mortem  findings  in  all  the  cases  of  acute  and  chronic  nephritis  that  have 
come  to  autopsy  at  the  Massachusetts  General  Hospital  since  1893.  The 
cases  were  classified  according  to  Councilman's  method  of  classification. 
Of  cases  of  acute  glomerular  nephritis  five  were  diagnosed  during  life, 
out  of  twenty-one  recorded  in  the  table  but  not  one  was  recognized  as 
acute  nephritis.  The  amount  of  albumin  was  five-tenths  per  cent,  or  more 
in  six  cases.  From  these  figures  it  varied  to  only  a  trace  in  eight  cases. 
Casts  were  absent  in  three  cases,  scanty  in  nine,  and  abundant  in  eight. 
No  single  type  predominated  except  the  hyaline  variety.  Blood  in  con- 
siderable quantity  was  present  in  but  two  cases.  Uremic  symptoms  were 
present  in  none  of  the  unrecognized  cases.  Dropsy  was  present  only  in 
the  five  cases  rightly  diagnosed. 


74 


CURRENT  MEDICAL  LITERATURE 


Of  the  cases  classified  post  mortem,  as  "subacute  glomerular  nephritis," 
five  out  of  ten  cases  were  recognized  ante-mortem,  as  being  cases  of  some 
form  of  nephritis.  The  five  unrecognized  cases  were  diagnosed  as  fol- 
lows: gallstones,  actinomycosis  (ribs),  sloughing  uterine  fibroid,  acute 
endocarditis,  and  pneumonia  with  alcoholism.  The  condition  of  the  urine 
in  these  cases  was  not  normal  but  the  abnormality  was  not  greater  in  de- 
gree or  different  in  kind  from  that  often  found  in  fever  urines;  that  is, 
in  febrile  diseases  such  as  were  present  in  these  cases. 

Of  the  seventeen  cases  of  chronic  glomerular  nephritis,  in  only  two 
was  the  nephritis  unsuspected,  and  in  thirteen  of  the  remaining  fifteen 
cases  the  type  of  the  disease  was  correctly  stated  as  well.  How  much  the 
diagnosis  may  have  depended  on  other  clinical  features  than  the  result 
of  the  urinary  examination  is  a  question.  Urines  as  highly  albuminous, 
as  lacking  in  urea,  as  thickly  sown  with  fatty  elements  have  occurred  in 
various  other  conditions  mentioned  in  the  paper.  In  these  cases  the 
albumin  varied  from  a  trace  to  one  and  five-tenths  per  cent,  hyaline  granu- 
lar fatty  blood,  epithelial,  and  waxy  casts  were  present  in  varying  numbers. 
In  some  of  the  cases  at  times  no  casts  were  found. 

Of  the  thirty-five  cases  classified  as  chronic  interstitial  nephritis  at 
autopsy  nineteen  were  recognized  as  nephritis  of  some  type.  In  the 
sixteen  unrecognized  cases  the  diagnoses  were  varied.  In  regard  to  the 
urine  in  the  cases  proved  at  autopsy  to  be  cases  of  the  chronic  inter- 
stitial type:  albumin  was  absent  in  three  cases,  very  scanty  in  thirteen 
cases  and  present  in  varying  amounts  in  the  remaining  cases.  Casts  were 
absent  in  nine  cases,  very  scanty  in  eighteen,  but  in  the  remaining  cases, 
about  one- fourth  of  the  total,  they  were  abundant.  The  specific  gravity 
was  persistently  low  in  twenty-four  cases. 

Of  six  cases  of  amyloid  kidney  none  were  diagnosed  during  life.  The 
urine  was  not  characteristic  and  varied  greatly  in  the  different  cases; 
one  case  showed  no  casts  and  but  a  small  amount  of  albumin. 

Thirty-five  cases  of  chronic  passive  congestion  of  the  kidney  were 
studied.  The  specific  gravity  was  low  or  within  normal  limits  in  seventeen 
cases.  The  total  amount  of  urine  was  diminished  in  all  cases  but  one. 
The  albumin  varied  from  the  slightest  possible  trace  in  five  cases  to  four 
per  cent,  casts  were  abundant  in  twelve  cases  and  included  the  hyaline, 
granular,  epithelial  varieties,  and  in  certain  cases  blood  cells  and  fat 
droplets  were  also  found  on  the  casts. 

Ninety-three  cases  in  which  the  kidneys  were  found  in  the  post- 
mortem examination  to  show  acute  degenerative  changes  were  studied. 
By  this  term  the  author  means  only  such  a  degree  of  granular  or  fatty- 
change  in  the  epithelium  of  the  tubules  as  is  to  be  found  post-mortem  in 
almost  every  fatal  case  of  typhoid,  pneumonia,  or  other  infectious  dis- 
ease. The  condition  was  diagnosed  in  all  but  three  cases.  If  we  said  that 
all  these  cases  had  nephritis  we  should  be  forced  to  the  paradox  that 
almost  everybody  has  a  certain  amount  of  nephritis  when  he  dies. 

In  a  group  of  these  cases  Bright's  disease  in  the  ordinary  sense  of  the 
term  was  diagnosed  during  life  and  after  death  only  acute  degenerative 
changes  were  found.  In  one  of  these  cases  the  24-hour  urine  was  re- 
duced to  300  c.c.  with  one  and  seven  tenths  per  cent,  of  urea  and  one- 


CURRENT  MEDICAL  LITERATURE 


75 


half  per  cent,  of  albumin,  while  the  sediment  contained  hyaline  and 
granular  casts.  These  findings  would  seem  to  indicate  nephritis,  but  none 
was  found  post-mortem.  Yet  in  many  of  the  cases  of  acute  glomerular 
nephritis  already  mentioned  the  urinary  picture  was  no  more  alarming. 

In  another  series  of  ten  cases  marked  urinary  anomalies  were  found 
without  discoverable  lesion  post-mortem. 

Cases  of  arterio  sclerotic  atrophy  involving  only  a  part  of  the  kidney, 
and  cases  of  extensive  fatty  degeneration  did  not  show  any  characteristic 
urinary  findings. 

The  author  does  not  believe  that  urea  estimations  are  of  much  value. 
The  amount  excreted  depends  on  the.  amount  of  nitrogenous  food  ab- 
sorbed and  on  the  catabolism  of  the  entire  body.  Exercise  and  a  free 
ingestion  of  water  increase  it.  Disturbances  of  assimilation  or  digestion 
cause  the  appearance  in  the  feces  of  part  of  the  nitrogen  taken  in  with  the 
food.  The  circulation  through  the  kidney  also  influences  the  amount  of 
urea  excreted,  and  there  may  be  spontaneous  nitrogen  retention.  In  the 
vast  majority  of  cases  we  cannot  spend  the  time  necessary,  even  to  de- 
termine the  food  nitrogen,  the  fecal  nitrogen  and  the  urea  of  a  24-hour 
specimen,  to  say  nothing  of  accounting  for  the  disturbing  factors  men- 
tioned. 

The  quantitative  estimation  of  the  other  urinary  solids — uric  acid, 
phosphates,  chlorids  and  sulphates  the  author  believes  to  be  equally  use- 
less. 

Supplementary  methods  for  the  examination  of  the  renal  functions  are 
discussed.  The  methylene  blue  test  is  not  considered  of  clinical  value 
since  we  cannot  judge  of  the  permeability  of  the  kidney  for  other  solids 
from  its  permeability  for  a  single  substance  like  methylene  blue.  The 
phloridzin  test  is  one  in  which  the  glucocide  phloridzin,  injected  sub- 
cutaneously,  produces  glycosuria  by  direct  action  on  the  renal  epithelium. 
Assuming  that  the  amount  of  sugar  drawn  from  the  blood  under  these 
conditions  by  the  kidney  is  in  proportion  to  the  number  of  functionally 
active  cells,  we  may  attempt  to  estimate  the  functional  power  of  the 
kidney  by  testing  the  amount  of  sugar  excreted  in  the  urine  after  a 
standard  dose  of  phloridzin  and  the  rate  of  its  excretion.  The  test  seems 
to  be  of  some  value  in  testing  the  functional  power  of  one  kidney,  for 
then  we  have  the  sound  kidney  as  a  control,  but  in  nephritis  affecting 
both  kidneys  the  test  is  of  little  value  because  the  normal  quantity  of 
sugar  and  the  rate  of  excretion  following  the  injection  of  phloridzin  vary. 
Cryoscopy,  the  determination  of  the  freezing  point  of  a  liquid  is  not  a 
difficult  process,  and  is  supposed  to  give  us  an  idea  of  the  functional 
activity  of  the  kidney  in  accordance  with  Raoult's  law.  According  to 
this  rule  the  greater  the  number  of  monocules  dissolved  in  a  liquid,  the 
lower  the  freezing  point.  It  is,  however,  necessary  to  determine  the 
amount  of  chlorin  in  the  urine  first  in  order  to  make  an  allowance  for  the 
effect  of  the  sodium  chlorid  that  passes  unchanged  into  the  urine.  By 
subtracting  this  we  get  an  idea  of  the  amount  of  lowering  due  to  sub- 
stances concerned  with  metabolism.  The  various  factors  influencing 
metabolism  enumerated  in  the  discussion  of  urea  determinations  must 
also  be  taken  into  account.    Cryoscopy  is,  however,  of  more  value  in 


70 


CURRENT  MEDICAL  LITERATURE 


determining  the  functional  power  of  one  kidney  when  the  other  is  affected 
by  some  surgical  condition  demanding  operation. 

The  author  sums  up  the  results  of  his  investigation  as  follows: 

1.  There  are  many  cases  of  acute  glomerular  nephritis  which  cannot 
be  recognized  by  any  of  the  methods  of  examination  known  to  us. 

2.  In  some  cases  of  subacute  and  chronic  glomerular  nephritis,  our 
diagnostic  resources  are  likewise  at  fault,  but  in  the  great  majority  of 
cases  here  studied,  the  condition  of  the  urine  taken  in  connection  with 
other  features  of  the  clinical  picture,  enabled  us  to  anticipate  the  autopsy 
findings.  Our  success  in  the  diagnosis  of  chronic  nephritis  is  almost  as 
constant  as  our  failure  in  the  acute  cases. 

3.  When  we  face  the  group  of  chronic  interstitial  cases,  our  diagnostic 
resources  appear  to  be  neither  as  sufficient  as  in  chronic  glomerular 
nephritis,  nor  as  inadequate  as  they  were  shown  to  be  in  the  acute 
cases. 

In  about  one-third  of  the  cases  the  diagnosis  was  correctly  made  before 
death. 

4.  Among  other  conditions  mistaken  for  nephritis,  owing  to  the  im- 
plicit reliance  in  the  urinary  findings,  we  find  that  the  senile  and 
arteriosclerotic  degenerations  are  not  infrequently  the  cause  of  mistaken 
diagnoses  of  chronic  nephritis,  while  in  conditions  involving  passive  con- 
gestion or  acute  degeneration  of  the  kidney,  the  urine  occasionally  simu- 
lates that  of  acute  nephritis.  Even  in  cases  where  no  lesions  are  to  be 
found  at  autopsy,  the  urine  is  occasionally  highly  albuminous  and  full 
of  casts. 

5.  In  our  ordinary  urinary  examinations,  common  errors  are:  (a)  The 
attempt  to  estimate  urea  without  any  accurate  knowledge  of  the  patient's 
metabolism;  (b)  the  statement  that  renal  cells  are  present  when  all 
that  we  know  is  that  we  have  seen  small  mononuclear  cells,  perhaps  be- 
longing to  the  renal  tubules,  perhaps  not. 

6.  Cryoscopy  and  other  attempts  to  test  more  directly  the  renal  per- 
meability are  not  as  yet  capable  of  supplementing  in  clinical  work  the 
older  methods  of  examination  in  the  diagnosis  of  nephritis. 

The  vast  majority  of  estimations  of  urinary  solids,  including  urea,  are, 
in  my  opinion,  a  waste  of  time,  since  they  are  not,  and  in  most  cases 
cannot  be  made,  part  of  a  general  metabolism  experiment. 

The  attempt  to  estimate  the  anatomic  condition  of  the  kidney  by  the 
measurement  of  albumin  and  the  search  for  casts  is  fallacious  in  the 
extreme. 

The  most  reliable  data  about  the  urine  are  those  most  simply  and 
quickly  obtained,  the  twenty-four  hour  quantity,  the  specific  gravity  and 
the  color. 

In  the  body  of  the  paper  the  author  states  that  the  increase  in  the 
relative  amount  of  the  night  urine,  nocturnal  polyuria  has  been  found  to 
be  one  of  the  most  reliable  manifestations  of  a  chronic  nephritis. 


Vol.  xxvii 


FEBRUARY,  1906 


No.  2 


ALBANY 

MEDICAL  ANNALS 

Original  Communications 

EXPERIMENTAL  ARTERIOSCLEROSIS.1 
By  RICHARD  M.  PEARCE,  M.  D.,  and  E.  MacD.  STANTON,  M.  D. 

(From  the  Bender  Laboratory,  Albany,  N.  Y.) 

(Plates  I  and  II) 

The  complexity  of  the  pathologic  picture  in  the  arterioscle- 
rosis of  man  and  the  difficulty  of  determining  the  nature  and 
sequence  of  the  early  changes  have  led  many  investigators  to 
attempt  the  experimental  production  of  the  disease  in  the  hope 
of  thus  solving  some  of  its  many  confusing  problems.  Until 
within  the  last  two  years  all  such  efforts  have  been  unsuccessful. 
It  is  true  that  Thoma  described  a  diffuse  arteriosclerosis  in  the 
dog  as  the  result  of  a  chronic  experimental  aortic  insufficiency 
and  that  Gilbert  and  Lion1  produced  scattered  sclerotic  and 
calcareous  changes  in  the  vessels  of  animals  by  injecting  bacteria 
and  their  toxins.  Thickening  of  the  vascular  walls  has  been 
described  also  as  the  result  of  poisoning  animals  with  lead. 
These  results,  however,  have  been  inconstant  and  lack  confirma- 
tion. Jores,2  in  his  excellent  monograph  on  arteriosclerosis  pub- 
lished in  1903,  reached  the  conclusion,  based  on  a  critical  review 
of  the  literature,  that  all  experimental  methods  fail  to  cause 
lesions  similar  to  those  occurring  in  man.  Various  endarterial 
lesions,  obliterative  or  otherwise,  as  well  as  diffuse  inflammation 
and  atrophy,  have  been  produced  by  injections  of  bacteria  or 
their  toxins  by  the  application  of  irritating  substances  to  the 
perivascular  tissues  and  by  ligation  and  other  forms  of  mechani- 
cal injury ;  but  none  of  these  lesions  is  analogous  to  true  arterio- 
sclerosis. 


*This  investigation  was  conducted  under  a  grant  from  the  Rockefeller  Institute  for 
Medical  Research.  Read  before  the  Association  of  American  Physicians,  at  Washington. 
May  17,  1905.    Published  also  in  Journal  of  Experimental  Medicine,  1906,  viii,  no.  1. 


78 


EXPERIMENTAL  ARTERIOSCLEROSIS 


It  is  a  curious  coincidence  that  in  the  same  year  in  which 
Jores  reached  this  conclusion  Josue3  described  experimental 
lesions  in  the  aorta  of  rabbits,  somewhat  similar  to  those  of 
human  arteriosclerosis.  These  were  caused  by  frequent  intra- 
venous injections  of  adrenalin.  With  the  exception  of  a  few 
inconclusive  experiments  of  Jores,  who  gave  dogs  adrenal  tablets 
in  their  food  in  the  hope  of  obtaining  lesions  due  to  heightened 
blood  pressure,  Josue  appears  to  be  the  first  investigator  to 
attempt  the  experimental  production  of  arteriosclerosis  by  the 
use  of  the  principle  of  the  adrenal  gland.  His  results  have  been 
confirmed  by  Erb,4  Rzentkowski,5  Fisher,6  and  others.  Their 
reports  include  but  a  small  group  of  experiments,  and  deal  for 
the  most  part  with  the  late  changes,  which  they  describe  variously 
as  arteriosclerosis,  atheroma,  and  calcification.  The  principal 
histologic  changes  to  which  they  call  attention  are  alteration  in 
the  elastica  and  the  infiltration  of  lime  salts. 

The  importance  of  a  method  capable  of  producing  an  experi- 
mental lesion  so  closely  resembling  human  arteriosclerosis  is 
apparent.  It  allows  an  opportunity  to  study  many  of  the  obscure 
problems  of  the  disease,  as  the  nature  of  the  primary  changes, 
the  sequence  of  these  changes,  and  the  combinations  which  con- 
stitute the  fully-developed  lesion.  It  was  with  the  hope  of  eluci- 
dating some  of  these  problems  that  the  present  investigation  was 
undertaken.  The  results  have  been  satisfactory  beyond  all  expec- 
tation. Vascular  changes,  capable  of  throwing  much  light  upon 
the  pathology  of  arteriosclerosis,  and  also  that  of  aneurysm  for- 
mation, have  been  readily  produced.  Only  a  general  outline 
of  these  will  be  given  at  this  time,  for  many  of  the  details  of  the 
histologic  changes,  especially  of  the  process  of  repair,  are  so 
important  that  they  require  a  more  extended  study.  A  consid- 
eration of  these  details  is  therefore  reserved  for  a  future  publica- 
tion, based  on  a  second  series  of  experiments  now  in  progress. 

Methods.  Rabbits  have  received  in  the  veins  of  the  ear 
repeated  injections  of  a  1:1000  solution  of  adrenalin.  The  solu- 
tion was  prepared  by  a  chemist,  with  due  regard  to  asepsis  and 
chemical  purity.  Physiologic  salt  solution  was  used  as  a  medium. 
In  addition  to  adrenalin  (Parke,  Davis  &  Co.)  it  contained 
chloretone  in  the  proportion  of  one-half  of  one  per  cent,  and 
a  sufficient  amount  of  hydrochloric  acid  to  make  the  solution 
faintly  acid. 


[^[RICHARD  If.   PEARCE  AND   E.   MAC  D.   STANTON  79 

An  initial  dose  of  three  minims1  and  the  repetition  of  the  same 
amount  every  other  day  has  been  the  usual  procedure,  though  in 
some  experiments  the  dose  has  been  gradually  increased.  Not 
infrequently  the  early  injections  cause  death  from  acute  dilatation 
of  the  heart  and  pulmonary  edema.  Such  accidents  usually  occur 
after  any  one  of  the  first  seven  or  eight  injections.  If  the  animal 
survives  this  period  it  appears  to  gain  a  certain  amount  of  immu- 
nity, or,  at  least,  tolerance  to  adrenalin,  so  that  the  dose  may  be 
gradually  increased  during  several  weeks,  until  twenty  to  twenty- 
five  minims  may  be  given  every  day.  This  increased  resistance 
to  adrenalin  has  been  noted  also  by  Erb  and  Fisher.  The  animals 
have  been  killed  after  periods  varying  from  a  few  days  to  eight 
and  a  half  weeks. 

For  histologic  study  tissues  have  been  preserved  in  Zenker's 
fluid,  alcohol  and  six  per  cent,  formalin;  imbedded  in  celloklin ; 
and  stained  with  hematoxylin  and  eosin,  and  by  Weigert's  elastica 
and  Mallory's  connective-tissue  methods.  The  scharlach  R.  and 
Osmic  acid  methods  have  been  employed  for  the  demonstration 
of  fat.  Sections  hardened  in  Flemming's  solution  and  stained  by 
hematoxylin  have  been  found  to  be  most  satisfactory  for  purposes 
of  general  study.  By  this  method  the  nuclei  and  areas  of  calcifi- 
cation stain  blue ;  fat,  if  present,  black.  The  elastic  fibres  stand 
out  prominently  as  light,  greenish-yellow,  glistening  lines,  while 
all  other  structures  are  of  a  faint  gray  color. 

Results.  Of  twenty  animals  receiving  adrenalin  nine  suc- 
cumbed to  the  acute  effects  of  the  drug  within  fifteen  days. 
These  nine  represent  animals  receiving  one,  three,  four,  five, 
seven,  and  eight  injections  of  adrenalin  on  alternate  days.  In 
some  instances  death  resulted  within  a  few  minutes  after  the 
injection,  in  others,  after  a  few  hours.  The  immediate  effect  of 
the  intravenous  administration  of  adrenalin  is  collapse  with  diffi- 
cult and  rapid  respiration.  The  animal  lies  on  its  abdomen,  with 
legs  outstretched,  and  head  resting  on  the  table  or  raised  in  spas- 
modic respiratory  effort.  Death,  preceded  by  severe  convulsive 
movements,  may  occur  immediately.  Other  animals  recover  from 
the  immediate  manifestations  only  to  succumb  after  a  few  hours. 
Upon  postmortem  examination  the  usual  picture  is  acute  dilata- 
tion of  the  heart  and  edema  of  the  lungs,  with,  not  infrequently, 


1  Throughout  this  report  the  dose  will  be  given  in  minims.  It  would  be  better,  perhaps, 
to  use  the  values  of  the  metric  system,  but  as  Josue"  and  others  give  the  dose  in  minims  or 
drops,  we  have  for  purposes  of  control  used  the  same  system  of  measurement 


So 


EXPERIMENTAL  ARTERIOSCLEROSIS 


small  hemorrhages  beneath  the  pleura  and  pericardium.  In  one 
animal  hemorrhages  were  also  found  in  the  adrenal.  These 
acute  lesions  indicate  a  very  serious  disturbance  in  the  terminal 
vascular  territories,  and  are  worthy,  perhaps,  of  further  investi- 
gation ;  but  as  our  problem  has  to  do  only  with  the  histologic 
changes  in  the  larger  vessels,  its  scope  has  been  limited  to  that 
extent.  The  theoretic  conclusions  to  be  drawn  from  experi- 
mental adrenalin  edema  and  their  possible  application  to  acute 
edema  of  the  lung  in  man  have  recently  been  discussed  by  Josue.7 

In  but  two  of  this  group  of  nine  animals  were  changes  in  the 
vessels  demonstrable.    These  will  be  discussed  later. 

The  second  group  of  eleven  animals  represents  those  receiving 
from  eight  to  twenty-eight  injections  during  periods  varying  from 
sixteen  to  fifty-nine  days.  One  of  these  died  on  the  twenty-fifth 
day  from  spinal  hemorrhage ;  another  on  the  forty-sixth  day, 
from  unknown  cause,  three  weeks  after  the  cessation  of  injec- 
tions ;  the  remaining  ten  were  chloroformed.  The  aorta  in  six 
of  these  showed  marked  gross  lesions ;  in  the  other  five  it  was 
negative,  both  macroscopically  and  microscopically.  It  is  of  in- 
terest that  these  five  animals  were  all  from  the  same  litter,  and 
each  weighed  about  750  grams  at  the  time  of  the  first  injection. 
Pic  and  Bonnamour8  have  come  to  the  conclusion  that  it  is  im- 
possible to  produce  vascular  lesions  by  adrenalin  in  rabbits  weigh- 
ing less  than  2000  grams,  and  quote  in  support  of  this  opinion 
their  negative  experiments  with  animals  weighing  about  1200 
grams.  That  this  is  not  an  absolute  rule  is  shown  by  the  fact 
that  the  most  characteristic  and  advanced  lesions  in  our  series 
occurred  in  an  animal  weighing  870  grams  at  the  beginning  and 
1020  at  the  end  of  the  experiment.  Otherwise,  however,  our 
experience  with  small  animals  supports  the  contention  of  Pic 
and  Bonnamour. 

Attempts  to  produce  lesions  in  dogs  have  been  unsuccessful. 
Both  old  and  young  dogs  have  been  used.  One  of  the  latter,  a 
puppy  2120  grams  in  weight,  received  in  the  ear  vein  in  one 
month  one  hundred  thirty  minims  of  adrenalin  in  doses  rising 
gradually  from  four  to  twenty  minims.  Although  respiratory 
and  cardiac  disturbances  frequently  occurred  immediately  after 
injection,  thus  indicating  a  definite  physiologic  action  of  the 
adrenalin,  no  evidence  of  vascular  lesions  could  be  found  at 
autopsy  or  upon  microscopic  examination. 

Gross  Lesions.    These  appear  to  be  limited  to  the  aorta.  The 


RICHARD   M     PEARCE  AND   E.   MAC  D.   STANTON  8l 


involvement  of  other  arteries,  as  the  brachial,  carotid,  and  renal, 
which  Erb  describes,  we  have  not  found.  These  lesions  in  the 
aorta  are  most  marked  in  the  thoracic  portion,  and  are  seldom 
found  below  the  coeliac  axis  or  in  the  first  portion  of  the  arch. 
The  earliest  change  in  the  vessel  wall  manifest  to  the  naked  eye 
is  a  faint  longitudinal  or  irregular  grayish  streak  of  the  intima 
without  thickening.  This  appearance  was  seen  as  early  as  the 
ninth  day  in  a  rabbit  which  had  received  five  injections.  After 
eight  to  fifteen  injections,  especially  if  the  animal  is  allowed  to 
live  for  a  week  or  longer  after  the  last  injection,  very  definite 
lesions  are  apparent.  These  consist  of  irregular,  isolated,  or  con- 
fluent areas,  usually  slightly  depressed,  of  a  pearly  gray  color  and 
almost  constantly  calcified.  The  following  protocol  illustrates 
this  condition : 

Rabbit  No.  n.  Weight,  2,300  grams.  Killed  May  2d  after  injection  as 
follows:  March  29th  and  31st,  4  minims;  April  2d  and  4th,  5  minims; 
April  6th  and  8th,  7  minims;  April  10th,  10  minims;  April  12th,  12  min- 
ims; April  14th,  15th  and  16th,  15  minims.  Autopsy:  The  aorta  is  dis- 
tinctly dilated,  measuring  twelve  millimeters  in  circumference  at  the  arch. 
Beginning  at  the  origin  of  the  left  carotid  artery  is  an  irregular  patch 
thirty-seven  millimeters  long,  averaging  two  and  a  half  millimeters  in 
width,  and  extending  in  a  spiral  course  along  the  aorta  for  a  distance  of 
thirty  millimeters  so  as  to  completely  encircle  it.  Along  this  patch  the 
wall  of  the  aorta  is  slightly  dilated.  The  media  is  firm,  parchment-like 
and  so  distinctly  calcified  that  the  vessel  cracks  in  several  places  when  the 
arch  of  the  aorta  is  straightened.  At  one  side  of  this  large  patch  are  two 
very  small  oval  areas  of  similar  structure.  There  is  no  atheroma  or 
ulceration.    All  the  other  organs  are  entirely  negative. 

The  late  lesions  occurring  after  from  twenty  to  twenty-five 
injections  are  very  well  marked.  The  aorta  is  more  or  less  dis- 
torted, rigid  and  non-elastic.  Irregular  dilations  alternate  with 
elevated  brittle  areas  of  calcification.  Distinct  ulceration  with 
atheroma  is  not  readily  demonstrable.  Diffuse  calcification  is 
not  infrequent  and  small  aneurysmal  dilations  may  be  present. 
The  following  protocol  illustrates  the  advanced  lesions  occurring 
in  animals  receiving  large  doses  during  a  considerable  period 
of  time. 

Rabbit  No.  3.  Weight,  870  grams.  Received  first  injection  of  3  min- 
ims in  ear  vein  on  November  30,  1904.  Similar  injections  were  repeated 
on  alternate  days  until  December  30th,  after  which  date  the  dose  was 
rapidly  increased  until  it  reached  20  minims  daily.  The  animal  was  killed 
on  January  20,  1005.    Autopsy:  Weight,  1,150  grams.    The  thoracic  aorta 


82 


EXPERIMENTAL  ARTERIOSCLEROSIS 


measures  six  millimeters  in  diameter,  is  distinctly  dilated,  irregular  in 
outline,  stiff  and  brittle,  although  the  wall  is  apparently  thinned.  This 
condition  extends  as  far  as  the  coelic  axis,  beyond  which  point  the  abdom- 
inal aorta  is  apparently  normal.  On  opening  the  aorta  the  inner  surface 
of  the  abdominal  aorta  above  the  coelic  axis  shows  numerous  yellowish, 
slightly  raised,  calcified  patches  one  to  one  and  five-tenths  millimeters  in 
diameter,  which  in  the  upper  portion  of  the  thoracic  aorta  become  con- 
fluent. Except  in  one  of  the  small  patches  situated  in  the  upper  portion 
of  the  abdominal  aorta  there  is  no  evidence  of  ulceration.  All  other 
organs  are  negative. 

The  following  description  from  the  protocol  of  a  parallel  ex- 
periment illustrates  the  tendency  to  the  formation  of  small 
aneurysms : 

Rabbit  No.  2.  The  aorta  averages  three  millimeters  in  diameter  except 
at  three  places  where  distinct  dilations  occur.  The  first  of  these  begins 
three  centimeters  below  the  origin  of  the  aorta  and  involves  the  right 
anterior  wall  of  the  aorta  for  a  distance  of  two  centimeters,  giving  the 
appearance  of  a  fusiform  aneurysm;  the  diameter  of  the  aorta  at  this 
point  is  four  millimeters.  A  second  dilation,  two  and  five-tenths  centi- 
meters in  length,  occurs  in  the  distal  portion  of  the  thoracic  aorta  and 
a  third  involves  the  abdominal  aorta  for  a  distance  of  one  centimeter 
immediately  below  the  coelic  axis.  On  section  the  inner  surface  of  the 
aorta  shows  sharply  circumscribed  saccular  dilations,  varying  from  one  to 
two  millimeters  in  depth,  and  corresponding  to  the  protrusions  described 
above.  The  walls  of  these  aneurysms  contain  firm  placques  of  calcareous 
material.  The  intervening  aorta  shows  a  number  of  yellowish-white  ele- 
vated areas  one  to  three  millimeters  in  diameter.  The  aorta  below  the 
dilation  at  the  coelic  axis  is  macroscopically  negative. 

Histology.  In  the  group  presented  by  the  nine  rabbits  which 
died  during  the  first  two  weeks,  the  vessels  of  but  two  showed 
histologic  changes.  These  were  animals  which  had  received  four 
and  five  injections,  respectively.  The  first  died  on  the  fifth  day 
and  the  second  on  the  ninth  day.  Scattered  through  the  middle 
coat  of  the  aorta  in  each  of  these  are  small  longitudinal  or  occa- 
sionally irregular,  finely  granular  foci  of  degeneration.  In  these 
areas  no  nuclei  are  visible,  and  the  muscle  fibres  are  transformed 
into  a  finely  granular,  almost  hyaline  material,  which  stains 
deeply  with  eosin.  The  exact  nature  of  this  change  is  not  readily 
determined,  but  as  the  various  methods  of  demonstrating  fatty 
transformation  are  negative,  and  those  which  differentiate  elastic 
fibres  show  no  change  in  the  staining  reaction  of  the  latter,  the 
condition  would  appear  to  be  a  simple  necrosis  limited  to  the 
muscle  fibres.    The  elastic  tissue  has,  however,  undergone  very 


RICHARD   M.    PEARCE   AND    E.    MAC  D.    STANTON  83 

characteristic  morphologic  changes,  which  are  found  only  in  the 
degenerate  areas,  and  are  due,  presumably,  to  mechanical  influ- 
ences. In  the  normal  aorta  the  elastic  fibres  have  a  distinctly 
wavy  or  curled  appearance,  and  are  definitely  separated  from  one 
another.  In  the  areas  described  the  fibres  lose  this  appearance 
and  become  straightened  and  closely  approximated.  They  are 
also  swollen  and  occasionally  appear  to  be  fused  together.  Frac- 
ture of  the  fibres  is  seldom  seen  at  this  stage  of  the  process. 

A  more  diffuse  lesion  of  this  character  was  found  in  an  animal 
killed  on  the  twenty-fourth  day  after  receiving  eleven  injections. 
The  changes  involve  the  entire  circumference  of  the  vessel,  spar- 
ing to  a  certain  extent,  the  innermost  and  outermost  portions  of 
the  media.  In  this  central  zone  few  or  no  nuclei  can  be  found, 
and  the  altered  tissue  presents  a  uniform,  finely  granular  appear- 
ance, relieved  only  by  the  glistening  lines  of  the  elastic  fibres. 
The  latter,  by  selective  stain,  are  seen  to  be  so  closely  massed 
together  that  individual  fibres  can  be  distinguished  only  with 
great  difficulty.  On  either  side  of  this  zone  the  less  degenerated 
portions  of  the  media  show  irregular  areas,  which  take  the  hema- 
toxylin stain  in  a  manner  very  suggestive  of  early  infiltration  with 
lime  salts.  There  is,  however,  no  distinct  calcification  and  no 
fracture  of  elastic  fibres. 

Lesions  of  great  interest  in  comparison  with  the  above  were 
observed  in  two  rabbits  which  had  received  the  same  number  of 
injections,  but  which  were  allowed  to  live  for  ten  and  eighteen 
days,  respectively,  after  the  last  injection.  In  the  aorta  of  each 
are  found  a  few  areas  of  granular  necrosis,  but  for  the  most  part 
these  areas  have  been  altered  by  infiltration  with  lime  salts.  From 
the  topography  of  the  areas  of  calcification  and  their  relation  to 
the  necrotic  foci  it  is  evident  that  the  deposition  of  lime  salts 
follows  the  necrosis.  It  would  appear,  therefore,  that  the  primary 
degenerative  lesions  are  well  advanced  by  the  end  of  the  third 
week,  and  that,  after  this,  but  one  or  two  weeks'  time  is  sufficient 
for  advanced  calcification.  The  latter  may,  however,  occur  much 
earlier,  for  in  one  rabbit,  killed  on  the  sixteenth  day,  small  but 
very  definite  foci  of  lime  infiltration  were  present. 

In  the  areas  of  lighter  deposition  of  lime  it  is  seen  that  these 
salts  are  first  deposited  between  the  elastic  fibres,  an  observation 
which  indicates  that  the  destruction  of  the  muscle  fibre  is  the 
older,  and  therefore  in  all  probability  the  primary  lesion.  In  the 
areas  of  advanced  calcification,  although  the  elastic  fibres  appear 


84 


EXPERIMENTAL  ARTERIOSCLEROSIS 


to  be  completely  destroyed  by  the  calcareous  transformation, 
Weigert's  stain  shows  them  to  be  still  present,  though  they  stain 
poorly  and  are  frequently  fractured.  Not  uncommonly  at  a  point 
of  fracture  one  bundle  of  fibres  overlaps  another,  the  ends  being 
splinted  together  by  an  encapsulating  mass  of  lime  salts.  These 
fibres  are  always  perfectly  straight,  except  at  angles  formed  by 
fracture.  A  definite  relation  appears  to  exist  between  calcifica- 
tion and  fracture  of  the  elastic  fibres.  In  areas  of  the  most 
extensive  calcification  few  breaks  in  the  elastic  fibres  have  been 
observed,  while,  on  the  other  hand,  they  are  constantly  present 
in  the  aneurysmal  dilations  which  show  comparatively  little 
calcification. 

Lesions  of  this  stage  show  the  first  evidence  of  repair.  This  is 
indicated  by  the  collection  of  newly  formed  cells  about  the  foci  of 
calcification.  These  cells  are  closely  massed,  surrounded  by  but 
a  slight  ring  of  protoplasm,  and  appear  to  be  of  connective-tissue 
origin,  though  it  has  been  impossible  to  always  distinguish  be- 
tween such  and  the  nuclei  of  smooth  muscle  fibres.  No  accu- 
mulation of  polymorphonuclear  leukocytes,  or  lymphoid  cells, 
has  been  seen.  Of  greater  interest  are  the  proliferative  changes 
in  the  intima.  These  occur  only  opposite  distinct  breaks  of  con- 
siderable depressions  in  the  media,  and  include  proliferation  of 
the  lining  endothelium  and,  to  a  greater  extent,  the  subendothelial 
tissues.  The  endothelial  cells  proliferate  to  form  two  or  three 
layers  of  cells  longitudinally  arranged,  while  the  subendothelial 
space,  barely  visible  in  the  normal  aorta,  becomes  very  prominent 
owing  to  the  presence  of  closely  packed  oval  nuclei  arranged 
vertically  to  the  lining  endothelium.  Between  the  nuclei  are 
delicate,  newly  formed  connective  tissue  and  elastic  fibrils.  In 
the  late  stages  the  newly  formed  elastic  fibrils  are  very  prominent. 
In  the  angle  of  fracture  the  nuclei  of  the  media  assume  a  perpen- 
dicular arrangement,  very  striking  in  contrast  to  their  longitudinal 
arrangement  elsewhere.  The  entire  picture  is  distinctly  that  of 
a  compensatory  proliferation — an  effort  to  strengthen  the  weak- 
ened point  in  the  vessel  wall. 

Such  are  the  essential  phases  of  this  lesion  in  the  order  of  their 
sequence.  The  more  prolonged  experiments  offer  no  funda- 
mentally new  features,  but  the  combinations  of  these  primary 
changes  in  the  course  of  the  more  extensive  involvement  of  the 
vessel  wall,  lead  to  a  complex  histologic  picture  closely  resembling 
advanced  human  arteriosclerosis.    This  is  seen  only  in  animals 


RICHARD   M.    PEARCE    AND   E.    MAC  D.    STANTON  85 

which  have  received  gradually  increasing  doses  during  a  period 
of  seven  or  eight  weeks.  The  vessel  wall  becomes  greatly  thick- 
ened, not  only  by  infiltration  of  lime  salts,  but  also  by  an  exten- 
sive repair  process,  which  involves  the  intima  as  well  as  the  media. 
Small  foci  of  complete  necrosis,  analogous  to  atheroma  and 
entirely  different  from  the  primary  degeneration,  are  also  seen 
in  areas  in  which  the  elastic  fibres  are  completely  destroyed. 
These  present  a  uniform,  finely  granular  appearance,  and  stain 
deeply  with  eosin.  The  osmic  acid  method  for  fat  is  negative, 
but  a  few  fine  droplets  are  evident  after  treatment  with  scharlach 
R.  About  such  areas  repair  takes  place,  but  it  is  not  as  active  as 
it  is  about  the  masses  of  lime  salts. 

The  most  striking  feature  of  the  late  histologic  picture  is  the 
extent  of  repair  in  the  intima.  The  latter,  with  its  newly  formed 
connective  tissue  and  elastic  fibrils,  becomes  so  greatly  thickened 
that  it  constitutes  in  some  places  a  quarter  to  a  third  of  the  entire 
vessel  wall,  and  offers  convincing  evidence  of  the  compensatory 
nature  of  the  repair  process. 

It  is  in  these  late  lesions  that  the  small  aneurysms  are  seen. 
They  occur  at  points  where  the  elastica  is  so  completely  destroyed 
as  to  be  transformed  into  an  indistinct  mass  of  fractured  granular 
and  fused  fibres.  The  transition  from  normal  to  necrotic  fibres 
is  always  sharp  and  distinct,  and  marked  by  complete  fracture  of 
all  elastic  tissue.  It  is  worthy  of  note  that  in  the  thinned  wall 
of  these  aneurysms  the  degree  of  calcification  is,  as  a  rule,  less 
marked  than  eleswhere.  The  adentitia  is  compressed,  but  other- 
wise unaffected. 

The  changes  in  other  organs  include  enlargement  of  the  heart, 
edema,  and  congestion  of  the  lungs,  and  occasionally  degenera- 
tive changes  in  the  heart  and  skeletal  muscles.  In  one  case  de- 
generative lesions  were  found  in  a  nerve  ganglion  adherent  to 
the  aorta.  It  was  thought  that  these  changes  might  have  some 
etiologic  relation  to  the  vascular  lesion,  but  a  thorough  study 
of  all  our  material  failed  to  reveal  lesions  in  other  animals  or  in 
other  ganglion  of  the  same  animal.  The  affected  ganglion  was 
in  the  adventitial  tissue  of  an  aneurysmal  dilation,  and  the  effects 
of  pressure  and  disturbed  blood  supply  were  sufficient,  appar- 
ently, to  account  for  the  changes  observed. 

The  Mode  of  Action  of  Adrenalin.  The  manner  in  which  ad- 
renalin produces  these  lesions  is  a  matter  of  widely  varying 
opinion,  and,  unfortunately,  one  which  cannot  readily  be  deter- 


86 


EXPERIMENTAL  ARTERIOSCLEROSIS 


mined  by  our  method  of  experimentation.  Until  we  know  more 
about  the  toxic  action  of  adrenalin  and  can  distinguish  between 
the  lesions  due  to  this  action  and  those  due  to  increased  blood 
pressure,  and  especially  between  its  direct  and  secondary  effect 
on  the  blood-vessels,  we  can  hope  for  no  elucidation  of  this  prob- 
lem. Drummond,9  who  has  recently  made  a  thorough  study  of 
the  histologic  lesions  caused  by  adrenalin,  divides  all  into  those 
due  to  toxic  action  and  those  due  to  increased  blood  pressure.  It 
is  obvious  that  such  a  classification  is  difficult,  for  it  is  impossible 
to  determine  to  what  extent  degenerative  lesions  are  due  to  inter- 
ference with  the  circulation  through  action  on  the  blood  vessels. 

A  discussion  of  the  variety  of  ways  in  which  adrenalin  might 
act,  directly  or  indirectly,  to  cause  degenerative  changes  in  the 
media  of  the  aorta  would,  in  the  present  state  of  our  knowledge, 
be  of  little  value.  The  difficulty  of  reaching  definite  conclusions 
is  illustrated  by  the  diversity  of  opinion  expressed  by  those  who 
have  previously  produced  the  lesions  here  described.  Josue  be- 
lieves them  to  be  due  to  a  combination  of  a  specific  toxic  influence 
and  the  increased  blood  pressure.  Rzentkowski  believes  in  the 
latter  influence  only.  Erb  ascribes  an  important  influence  to 
disturbance  of  the  vasa  vasorum.  Fisher  thinks  that,  aside  from 
the  increased  blood  pressure,  disturbances  of  metabolism  play 
an  important  part.  Lissauer10  believes  that  the  toxic  influence 
is  the  most  important  factor,  but  offers  no  explanation  of  its 
mode  of  action. 

No  definite  conclusion  can  be  drawn  from  our  own  experi- 
ments. The  observation  that  the  earliest  changes  occur  in  the 
media  and  are  apparently  primary  in  the  smooth  muscle  fibres 
suggests,  in  view  of  the  well-known  physiologic  action  of  adre- 
nalin on  this  tissue,  a  direct  and  selective  toxic  action ;  but  the 
absence  of  similar  lesions  in  vessels  other  than  the  aorta  does  not 
support  this  view.  For  the  same  reason,  and  also  because  of 
the  absence  of  changes  in  the  adventitia,  the  vasa  vasorum  theory 
appears  to  be  untenable.  On  the  other  hand,  if  we  assume,  as 
is  very  probable,  that  the  changes  in  form  and  arrangement  of 
the  elastic  fibres  are  due  to  the  same  factor  or  factors  which 
causes  the  destruction  of  the  muscle  cells,  and  are  not  secondary 
to  the  latter,  we  have  a  strong  argument  in  favor  of  the  influence 
of  a  greatly-heightened  blood  pressure  at  the  time  of  the  ischaemia 
due  to  the  primary  action  of  the  adrenalin.  In  other  words  it 
is  possible  that  at  the  period  of  vascular  spasm  produced  by  the 


RICHARD  M.  PEARCE  AND  E.  MAC  D.  STANTON.  Sj 

adrenalin  the  nutrition  of  the  vessel  wall  is  altered.  This  would 
not  explain  the  limitation  of  the  lesion  to  the  aorta  but  the  added 
mechanical  disturbance  due  to  the  extreme  distention  of  the  ves- 
sel wall  would  appear  to  be  sufficient  to  bring  about  a  condition 
analogous  to  anaemic  necrosis.  These  problems,  however,  must 
be  settled  by  other  methods  of  experimentation.  Although  it  is 
impossible  to  determine  to  what  extent  the  primary  changes  are 
mechanical  and  to  what  extent  toxic  in  nature,  it  is  certain  that 
some  of  the  secondary  changes,  as  the  fracture  of  elastic  fibres 
and  the  formation  of  aneurysms,  are  largely  due  to  mechanical 
factors. 

Comparison  of  the  Experimental  Lesions  and  those  Occurring 
in  Man.  If  due  allowance  is  made  for  the  difference  in  size  be- 
tween the  aorta  of  the  rabbit  and  that  of  man  it  must  be  admitted 
that  the  lesions  produced  in  the  former  as  the  result  of  the  ad- 
ministration of  adrenalin  are  somewhat  similar  to  those  occurring 
in  human  arteriosclerosis.  They  are  not,  however,  analogous.  All 
the  essential  processes  are  represented,  and,  considering  the  deli- 
cate character  of  the  wall  of  the  rabbit's  aorta,  the  lesions  are 
relatively  as  extensive  and  cause  the  same  degree  of  deformity. 
There  is,  however,  as  compared  with  the  human  lesion,  a  differ- 
ence in  the  initial  lesion  and  in  the  degree  of  atheroma  which  is 
insignificant,  and  limited  to  the  media.  Extensive  atheroma, 
however,  cannot  be  expected  in  a  vessel  wall  as  thin  as  the  rab- 
bit's aorta ;  and,  moreover,  in  none  of  these  experiments  has  a 
period  of  time  sufficient  for  the  occurrence  of  degeneration  in 
areas  of  excessive  intimal  proliferation  elapsed.  More  prolonged 
experiments  will  yield,  it  is  to  be  hoped,  lesions  more  conclusive 
in  this  respect.  For  the  present  the  condition  may  perhaps  be 
regarded  as  arteriosclerosis  for  the  rabbit,  but  not  as  a  condition 
analogous  to  the  arteriosclerosis  of  man. 

In  the  light  of  the  information  gained  from  the  study  of  these 
experimental  lesions  it  would  be  desirable,  perhaps,  to  critically 
discuss  the  various  theories  concerning  the  nature  of  arterioscle- 
rosis, and  especially  the  character  and  sequence  of  the  histologic 
changes.  Such  discussion,  however,  does  not  come  within  the 
scope  of  this  communication,  and  many  minor  points  must  be 
determined  before  comparisons  are  justifiable.  It  is  sufficient 
for  the  present  to  point  out  the  strong  support  afforded  Thoma's 
view  that  the  primary  lesion  of  arteriosclerosis  occurs  in  the 


88 


EXPERIMENTAL  ARTERIOSCLEROSIS 


media,  and  is,  essentially,  the  result  of  injury  to  the  elastica 
and  that  the  changes  in  the  intima  constitute  a  repair  process,  the 
object  of  which  is  to  compensate  for  the  weakened  media  and 
the  widened  lumen. 


Explanation  of  Plates  I  and  II. 

Fig.  i.  Gross  appearance  of  a  portion  of  the  aorta  from  an  animal  which  had  received 
27  injections  and  was  killed  on  the  29th  day.  The  drawing  is  twice  the  actual  size  of  the 
original  specimen. 

Fig.  2.  DifTuse  degeneration  of  central  zone  of  media;  1 1  injections;  24th  day;  haema- 
toxylin  and  eosin;   4  oc,  3  obj. — Leitz. 

Fig.  3.  Microscopic  picture  of  lesion  shown  in  fig.  1.  Destruction  of  media  with 
infiltration  of  lime  salts;  extensive  proliferation  of  intima  and  subintimal  tissue;  haema- 
toxylin  and  eosin;  4  oc,  3  obj. — Leitz. 

Fig.  4.  Elastic  tissue  stain  of  an  area  very  similar  to  the  above  illustrating  extreme 
destruction  of  the  elastica. 

Bibliography. 

1.  Gilbert,  A.,  and  Lion,  G.         Note  sur  1'atheVome  arteriel  experimental,  Arch. 

de  m£d.  expeY.  et  d'anat.  path.,  1904,  xvi.  73. 

2.  Jores,  L.  A.  Wesen  und  Entwickelung  der  Arteriosclerose.  Wies- 

baden, 1903. 

3.  JosuE,  0.  AtheYome  aortique    experimental    par  injections 

r£p£t6es  d'adrenaline  dans  les  veines,  La  presse 
medicale,  1903,  xi.  798. 

4.  Erb,  W.,  Jr.  Ueber  experimentell  erzeugte  Arterienerkrankung 

beim  Kaninchen,  Verhandl.  des  Kongress  f.  innere 
Med.,  1904,  xxi.  no. 

5.  v.  Rzentkowski,  C  Atheromatosis  Aortae  bei  Kaninchen  nach  intrav- 

enosen  Adrenalin-injectionen,  Berl.  klin.  Woch- 
enschr.,  1904,  xli.  830. 

6.  Fisher,  B.  Experimentelle    Arterienerkrankungen    durch  Ad- 

renalin injectionen,  Munch,  med.  Wochenschr., 
1905,  Hi.  46. 

7.  Josue,  O.  Pathogenie  de  certains  cas  d'ed^me  aigu  du  poumon, 

La  presse  medicale  1905. 

8.  Pic.  A.  and  Bonnamour,  S.      Contribution  a  l'etude  du  d^terminisme  de  l'ath£- 

rome  aortique  experimentell,  C.  R.  de  la  Soc.  de 
biol.,  1905,  lviii.  219. 

9.  Drummond,  W.  B.  The  Histological  Changes  Produced  by  the  Injection 

of  Adrenalin  Chlorid.  The  Journal  of  Physiology, 
1904,  xxxi.  81. 

10.  Lissauer,  M.  Experimentelle  Arterienerkrankungen  beim  Kanin- 

chen,  Berl.  klin.  Wochenschr.,  1905,  xlii.  675. 


To  illustrate  Drs.  Pearce  and  Stanton's  article  on  "Experimental  Arteriosclerosis 

Albany  Medical  Annals.  February,  iao6 


PLATE  1 


To  illustrate  Drs.  Pearce  and  Stanton's  article  on  "Experimental  Arteriosclerosis' 

Albany  Medical  Annals.  February,  iqo6 


Fig.  3 


Fig.  4 


PLATE  II 


EXPERIMENTAL  CIRRHOSIS  OF  THE  LIVER 


89 


EXPERIMENTAL  CIRRHOSIS  OF  THE  LIVER  * 
By  RICHARD  M.  PEARCE,  M.  D. 

(From  the  Bender  Laboratory,  Albany,  N.  Y.) 

(Plate  III.) 

The  experimental  studies  upon  which  this  communication  is 
based  were  suggested  by  an  investigation1'  of  the  necroses  occur- 
ring in  the  liver  of  the  dog  as  the  result  of  the  intravenous  in- 
jection of  haemolytic  immune  sera.  These  necrotic  lesions,  which 
appear  to  have  a  very  definite  relation  to  thrombi  composed  of 
fused  red  blood  corpuscles,  vary  in  position  and  extent  according 
to  the  amount  of  serum  administered.  Small  doses  cause  focal 
lesions  more  or  less  isolated  and  irregularly  distributed;  large 
doses  produce  a  diffuse  necrosis  which  spares  only  the  tissue 
about  the  larger  portal  spaces.  The  uniformity  and  extent  of 
this  latter  lesion  suggested  the  importance  of  studying  the  repair 
process  which  naturally  follows  it  in  those  animals  surviving 
the  acute  toxic  effects  of  the  serum.  It  was  evident  that  the 
extent  of  the  injury  was  such  as  to  preclude  complete  repair  by 
the  regeneration  of  liver  cells  alone.  If  then,  the  defect  were 
to  be  repaired  by  connective  tissue  proliferation  the  resulting 
histological  picture  would,  except  for  a  difference  in  the  distribu- 
tion of  the  new  tissue,  closely  resemble  cirrhosis  in  man. 

Experiments  based  on  this  method  have  not,  heretofore,  been 
made.  Joannovics,2  alone,  of  the  few  investigators  who  have 
studied  the  lesions  of  the  liver  due  to  haemolytic  sera,  has  de- 
scribed repair  about  foci  of  necrosis.  Flexner,3  in  1894,  while 
studying  the  lesions  occurring  in  the  organs  of  the  rabbit  after 
the  injection  of  dog's  serum  observed  a  well  marked  cirrhosis 
due  apparently  to  repair  about  multiple  necroses.  The  lesion 
was  found,  however,  but  once  and  could  not  be  reproduced  in 
other  animals.  The  literature  contains,  as  far  as  I  am  aware,  no 
other  references  to  similar  lesions  due  to  serum  injections. 

Methods. — Dogs  were  injected  either  in  the  smaller  branches 
of  the  femoral  vein  or  in  the  abdominal  cavity  with  serum  ob- 
tained from  rabbits  which  had  received  repeated  injections  of 

*  This  study  has  been  conducted  under  a  grant  from  the  Rockefeller  Institute  for  Medical 
Research.  Read  before  the  American  Association  of  Pathologists  and  Bacteriologists, 
Chicago,  April  19,  1905.  Published  also  in  The  Journal  of  Experimental  Medicine,  1906. 
viii,  64. 

4 


9° 


EXPERIMENTAL  CIRRHOSIS  OF  THE  LIVER 


the  red  blood  corpuscles  of  the  dog.  The  dose  usually  employed 
was  one  cubic  centimetre  of  serum  to  500  to  1000  grammes  of 
body  weight.  The  majority  of  the  animals  died  within  forty- 
eight  hours ;  those  which  survived  were  killed  at  intervals  vary- 
ing from  forty-eight  hours  to  thirty-six  days. 

Character  of  the  Primary  Necrosis. — The  necrotic  lesions  in 
the  liver  vary  according  to  the  dose  of  the  serum.  As  the  etiology 
and  the  general  character  of  the  focal  necroses  have  been  dis- 
cussed elsewhere,  only  the  more  extensive  form  of  necrosis,  which, 
through  an  equally  wide-spread  process  of  repair  leads  to  cirrhosis, 
will  be  considered  at  this  time.  The  macroscopic  appearance  of 
the  liver  in  animals  dying  within  a  few  minutes  or  hours  after 
injection  is  that  of  intense  congestion.  Microscopically,  the  ves- 
sels are  found  to  be  distended  by  closely  massed  red  blood  cor- 
puscles. The  coalescence  of  red  cells  is  very  evident  in  the  portal 
veins;  while  in  the  capillaries  the  occlusion  leads  to  a  distension 
so  great  that  the  columns  of  liver  cells  are  more  or  less  obscured. 
This  congestion  is  less  evident  about  the  larger  portal  spaces. 
After  twenty-four  to  forty-eight  hours,  the  liver  presents  a  uni- 
formly mottled  appearance ;  fine  irregular  yellowish  brown  or 
greyish  yellow  non-elevated  areas  being  sharply  separated  from 
deeply  congested  or  occasionally  even  haemorrhagic  areas.  On 
section  the  brownish  portions  have  a  distinct  hyaline  appearance. 
The  superficial  portions  of  the  liver  are  uniformly  more  exten- 
sively involved  than  are  the  deeper  portions  though  in  some  of 
the  smaller  lobes  the  necrosis  may  be  quite  general.  Histologic- 
ally, the  necrosis,  which  is  hyaline  in  character,  involves  all  por- 
tions of  the  liver  tissue  except  circular  areas  of  varying  size  in 
the  immediate  neighborhood  of  the  larger  portal  spaces  (see 
Fig.  1). 

In  the  necrotic  areas  the  destruction,  as  far  as  the  hepatic  cells 
are  concerned,  is  uniform  and  complete;  the  cells  of  the  capil- 
laries may,  however,  persist.  A  narrow  ring  of  liver  cells  with 
vacuolated  protoplasm  and  pyknotic  nuclei  separates,  as  a  rule, 
the  necrotic  from  the  normal  tissue.  Leucocytic  infiltration  may 
or  may  not  be  present.  The  capillaries  of  the  necrotic  tissue  are 
widely  dilated  and  tightly  packed  with  swollen  and  distorted 
red  blood  corpuscles  which  may  occur  in  masses  or  may  retain 
distinct  outlines.  In  the  congested  portal  veins  on  the  other 
hand  the  fusion  is  quite  constant,  the  plugs  for  the  most  part 
having  a  distinctly  hyaline  appearance.    The  perivascular  spaces 


RICHARD  M.  PEARCE 


91 


of  the  capillaries  are  distended  with  serum  and  the  bile  passages 
of  all  sizes  are,  as  a  rule,  dilated  and  engorged  with  bile. 

The  cause  of  the  necrosis  is  an  obstructive  congestion  of  the 
capillaries  and  the  smaller  branches  of  the  portal  vein  by  fused 
masses  of  red  cells.  To  the  effect  of  this  obstruction,  essentially 
a  thrombosis,  is  added  the  pressure  exerted  by  the  perivascular 
oedema  and  the  over-filled  bile  capillaries.  In  portions  of  the 
liver  midway  between  the  larger  portal  spaces  these  factors  are 
sufficient  to  overcome  the  pressure  in  the  capillaries  from  the 
hepatic  artery  and  necrosis  results ;  the  cells  in  the  neighborhood 
of  the  larger  portal  spaces,  on  the  other  hand,  are  preserved 
through  a  better  supply  dependent,  presumably,  upon  the  greater 
arterial  pressure  in  this  region. 

A  review  of  the  literature  of  infarction  of  the  liver  in  man 
and  of  experimental  infarction  shows  no  condition  analagous  to 
that  here  described;  nor  are  any  of  the  theories  put  forth  con- 
cerning the  etiology  of  infarction  applicable  to  it.  A  possible 
exception  is  the  wide-spread  haemorrhagic  infarction  produced 
by  Wooldridge4  as  the  result  of  injecting  into  the  jugular  vein  of 
the  dog  a  complex  proteid  substance  derived  from  the  thymus 
and  other  glandular  organs.  The  infarctions  were  associated 
with  thrombi  in  the  branches  of  the  portal  vein  and  in  this 
regard  as  well  as  in  the  character  of  the  necrosis,  Wooldridge's 
lesion  resembles  that  just  described.  Moreover,  in  animals  which 
survived  fourteen  days,  he  observed  scattered  foci  of  repair  re- 
sembling early  cirrhosis.  He  does  not  consider  the  thrombosis 
alone  to  be  sufficient  cause  for  the  necrosis,  but  believes  that  an 
important  adjuvant  is  some  change  in  the  chemical  composition 
of  the  blood  caused  by  the  proteid  substance  injected. 

The  Reparative  Process* — Only  fifteen  of  forty-three  animals 
survived  the  acute  effects  of  the  serum  a  sufficient  length  of  time 
to  allow  repair  of  the  liver  lesion  to  take  place.  The  liver  of 
each,  however,  shows  some  stage  of  repair,  and  as  various 
periods  from  thirty-eight  hours  to  thirty-six  days  are  represented, 
it  has  been  possible  to  study  all  stages  of  the  development  of  the 
cirrhotic  lesion. 

At  thirty  hours  the  first  and  only  evidence  of  repair  is  karyo- 
kinesis  of  the  liver  cells.    This,  however,  is  not  conspicuous  and 

*  Only  a  general  outline  of  the  reparative  process  will  be  given  at  this  time;  the  details 
of  the  finer  changes  and  their  interpretation  will  be  presented  in  a  future  communicaton 
on  the  repair  of  liver  tissue. 


92 


EXPERIMENTAL  CIRRHOSIS  OF  THE  LIVER 


the  mitotic  figures  are  found  only  after  prolonged  search.  They 
occur,  uniformly,  not  at  the  edge  of  the  necrotic  tissue,  but  in 
liver  cells  two  or  three  rows  removed.  Mitotic  figures  have  never 
been  seen  earlier  than  thirty-eight  hours,  and  at  this  period  in 
but  one  animal. 

The  period  from  forty-eight  to  sixty  hours  is  represented  by 
five  animals.  The  character  of  the  repair  is  the  same  in  all,  but 
some  difference  in  degree  is  evident.  The  most  striking  feature 
is  the  proliferation  of  the  endothelial  cells.  These  surround  the 
necrotic  tissue  and  penetrate  it  from  every  side.  Similar  cells 
corresponding  to  the  remains  of  the  capillaries  may  be  seen  in 
some  places  within  the  necrotic  areas.  Many  of  these  cells  have 
irregular  nuclei  suggestive  of  mitosis,  but  a  definite  karyokinetic 
figure,  in  a  cell  surely  endothelial,  was  found  at  this  stage  but 
once ;  and  this  was  in  the  liver  of  an  animal  killed  exactly  forty- 
eight  hours  after  injection.  The  endothelial  cells  show  a  ten- 
dency to  surround  small  fragments  of  necrotic  liver  cells  and 
occasionally  they  contain  one  or  two  red  blood  corpuscles.  Leuco- 
cytic  infiltration  occurs  to  a  very  slight  extent. 

By  the  end  of  the  fourth  day  the  proliferation  has  advanced 
so  rapidly  that  the  bulk  of  the  necrotic  tissue  has  been  replaced. 
Within  the  necrotic  areas  the  bands  of  new  tissue  are  more 
definite.  Mitotic  figures  in  liver  cells  are  so  numerous  that  three 
or  four  may  be  found  in  one  field  of  a  one-twelfth  lens.  A  few 
lymphoid  cells  are  seen  in  the  portal  spaces. 

The  picture  at  the  fifth  day  differs  only  in  the  extent  of  the 
process.  The  new  tissue  has  assumed  all  the  characteristics  of 
granulation  tissue  and  contains  giant  cells  which  surround  frag- 
ments of  hyaline  material.  The  first  suggestion  of  intercellular 
fibrillae  is  seen  at  this  stage. 

The  later  stages  from  the  eleventh  to  the  thirty-sixth  day  illus- 
trate the  gradual  transformation  of  this  young  granulation  tissue 
into  a  very  definite  connective  tissue.  At  the  eleventh  day  the 
new  blood  vessels  are  very  prominent  and  the  fibrillated  character 
of  the  connective  tissue  well  marked.  All  stages  after  the  fourth 
day  show  a  few  scattered  lymphoid  cells,  but  this  has  not  been 
a  prominent  feature  except  in  one  animal,  killed  on  the  twenty- 
fifth  day,  in  which  the  tissues  of  the  portal  spaces  were  filled  with 
lymphoid  and  plasma  cells. 

The  oldest  as  well  as  the  most  typical  lesion  was  that  found  in 
an  animal  killed  on  the  thirty-sixth  day  (see  Fig.  2).  Micro- 


RICHARD  M.  PEARCE 


93 


scopically,  the  liver  was  much  firmer  than  normal,  had  a  finely 
granular  surface,  and  was  deeply  bile  stained.  The  capsule 
showed  irregular  areas  of  thickening  and  was  mottled  by  an  ill- 
defined  congestion.  On  section  a  distinct  pseudo-lobulation  was 
evident ;  definite  islands  of  brownish  yellow  liver  tissue  being 
marked  off  by  a  fine  greyish  network  of  newly-formed  tissue. 
Histological  examination  shows  broad  bands  of  connective  tissue 
entirely  replacing  the  necrotic  areas  and  forming  a  uniformly 
arranged  network  separating  the  surviving  islands  of  liver  tissue 
about  the  larger  portal  spaces.  The  new  tissue  is  distinctly 
fibrous  and  contains  many  newly  formed  blood  vessels  and  bile 
ducts;  it  stains  deeply  by  Mallory's  connective  tissue  method. 
The  formation  of  new  liver  cells  is  still  demonstrable.  Fragments 
of  necrotic  hyaline  cells,  not  infrequently  partially  calcified,  are 
found  in  the  midst  of  the  new  connective  tissue.  Large  irregular 
multi-nucleated  masses  of  protoplasm  surround  these  and  are 
apparently  active  in  englobing  and  removing  them.  These  multi- 
nucleated cells,  essentially  foreign  body  giant  cells,  are  derived 
in  part  from  endothelial  cells  and  in  part  from  liver  cells.  Asso- 
ciated with  them  are  numerous  multinucleated  liver  cells  without 
inclusions.  Lymphoid  and  plasma  cells  are  present,  but  only  in 
small  numbers. 

Discussion. — The  final  stage  of  the  lesion  herein  described, 
constituting  as  it  does  a  chronic  interstitial  hepatitis  of  diffuse, 
but  uniform  distribution,  may  justly  be  termed  an  experimental 
cirrhosis.  Xo  close  analogy,  however,  can  be  drawn  between  it 
and  human  cirrhosis,  for,  with  the  possible  exception  of  the  so- 
called  central  cirrhosis  associated  with  chronic  passive  congestion, 
a  form  of  interstitial  hepatitis  with  similar  distribution  of  the 
new  tissue  does  not  occur  in  man.  In  this  connection  Bostreom's5 
recent  discussion  of  liver  cirrhosis  as  a  repair  process  in  chronic 
passive  congestion  is  of  especial  interest.  As  the  result  of  a 
study  of  material  from  man  he  reaches  the  conclusion  that  the 
congestion  causes  destruction  of  liver  cells  not  necessarily  by  pres- 
sure of  the  widened  capillaries,  but  through  nutritive  and  func- 
tional disturbances.  With  these  conditions  are  associated  rupture 
of  the  capillary  wall  and  the  escape  of  red  cells  into  the  perivascu- 
lar lymph  spaces.  Thrombosis  also  is  not  an  infrequent  occurrence 
and  has  a  close  relation  to  the  destruction  of  liver  cells.  The 
repair,  which  is  most  active  in  the  region  of  the  portal  spaces, 
results  in  a  very  definite  cirrhosis.   When  one  considers  that  the 


94 


EXPERIMENTAL  CIRRHOSIS  OF  THE  LIVER. 


necrosis  in  my  experimental  lesion  is  preceded  by  an  intense  con- 
gestion associated  with  all  the  etiological  factors  described  by 
Bostroem,  the  analogy  of  the  repair  lesion  to  the  cirrhosis  which 
he  describes  becomes  very  apparent.  Comparisons  as  to  the 
etiology  of  cirrhosis  in  general  are  not  justifiable,  for  we  know 
of  no  toxic  substances  associated  with  abnormal  conditions  in 
man  which  are  capable  of  causing  the  wide-spread  necrosis 
seen  in  these  experimental  lesions.  The  only  condition  compar- 
able is  acute  yellow  atrophy  with  which  the  early  necrotic  and 
reparative  lesions  of  the  second  to  the  sixth  day  have  much 
in  common. 

On  the  other  hand, however,  these  experimental  lesions  demon- 
strate that  a  cirrhosis  may  follow  extensive  primary  destructive 
lesions  and  thus  support  the  theory  of  Kretz0  that  cirrhosis  is 
essentially  a  reparative  process.  Kretz,  who  bases  his  conclu- 
sions on  an  extensive  study  of  the  disease  in  man,  believes  cir- 
rhosis to  be  the  result  of  successive  processes  of  repair  following 
repeated  focal  injuries  of  the  liver  parenchyma.  The  primary 
lesion  is,  he  thinks,  a  destruction  of  groups  of  liver  cells  at  the 
periphery  of  the  lobule.  After  such  destruction  the  uninjured 
cells  of  the  lobule,  as  well  as  the  cells  of  the  bile  ducts,  prolifer- 
ate in  an  attempt  to  repair  the  injury.  The  continued  occurrence 
of  degeneration  and  regeneration  causes  the  formation  of  new 
connective  tissue  which  eventually  atrophies  thus  leading  to  the 
picture  seen  at  autopsy.  Cirrhosis,  therefore,  is  the  result  of 
repeated  localized  destructive  lesions  from  which  the  liver  has 
more  or  less  recovered.  This  view  it  will  readily  be  seen  accepts 
Weigert's7  opinion  that  the  primary  lesion  in  all  interstitial  new 
growth  of  tissue  is  cell  death  and  also  includes  Kirikow's8  opinion 
that  in  addition  to  cell  death  the  continual  action  of  the  toxic 
substance  is  necessary;  but  adds  the  important  factor  of  con- 
tinuous regeneration. 

W..  G.  MacCallum's9  study  of  the  regenerative  changes  in 
human  cirrhosis  strongly  supports  the  theory  of  Kretz  as  do  also 
the  studies  by  McPhedran  and  A.  B.  MacCallum,10  Meders,11 
Marchand,12  Stroebe,13  Barbacci,14  W.  G.  MacCallum15  and  others 
of  repair  in  acute  yellow  atrophy  of  the  liver. 

The  experimental  studies  of  repair  after  various  mechanical 
injuries  also  indicates  the  ease  and  rapidity  with  which  liver 
parenchyma  repairs  loss  of  substance.  From  the  observations 
of  Podwyssozki16  and  Ponfick,17  it  is  seen  that  slight  injuries  are 


RICHARD  M.  PEARCE 


95 


repaired  by  the  proliferation  of  either  liver  cells  or  the  smaller 
bile  ducts ;  connective  tissue  repair  occurring  only  when  loss 
of  substances  exists.  Of  special  interest  is  the  true  hyperplasia 
observed  by  Ponfick  and  by  v.  Meister18  after  extirpation  of  large 
portions  (one-quarter  to  three-quarters)  of  the  entire  liver. 

On  the  other  hand  the  argument  is  presented  that  focal  necrotic 
lesions  of  the  liver  frequently  occur  in  man  without  repair  either 
by  proliferation  of  parenchymatous  cells  or  by  formation  of  con- 
nective tissue.  In  this  connection  the  liver  lesions  of  typhoid 
fever,  diphtheria  and  other  acute  infections  as  well  as  various 
experimental  infections  of  animals  are  quoted.  It  is  probable, 
however,  that  in  such  cases  the  reparative  power  of  the  cells  is 
in  some  way  delayed,  or  consists  possibly  of  a  true  regeneration 
of  liver  cells  without  the  proliferation  of  connective  tissue;  for 
in  hog  cholera,  in  which  above  all  other  diseases,  necroses  of 
the  liver  are  most  abundant  and  widespread,  cirrhosis  of  the 
liver  commonly  occurs.  Salmon,  Smith  and  Kilborne,19  in  the 
study  of  hog  cholera  in  an  epidemic  including  both  acute  and 
chronic  cases,  found  well  marked  cirrhosis  in  about  half  of  the 
animals  examined. 

The  question  as  to  whether  the  interstitial  tissue  or  the  paren- 
chyma is  primarily  affected  in  cirrhosis  receives  little  enlighten- 
ment from  the  literature  of  experimental  cirrhosis.  Heukelom,20 
who  reviewed  the  literature  up  to  1896,  collected  nineteen  dif- 
ferent methods  said  to  be  capable  of  producing  cirrhosis  and  to 
these  Joanno'vics21  in  a  recent  summary  adds  others.  None, 
however,  produce  a  lesion  analagous  to  that  occurring  in  man. 
These  methods  may  readily  be  divided  into  two  groups.  In  the 
first  we  have  procedures  essentially  mechanical  in  nature,  as 
ligation  of  the  ducts  or  vessels  of  the  liver,  the  injection  of  irri- 
tating substances  into  the  ducts  or  directly  into  the  liver  sub- 
stance, and  their  application  to  its  surface.  The  second  group 
includes  the  administration  by  the  mouth,  or  by  subcutaneous 
or  intravenous  injection,  of  various  toxic  substances.  As  a 
general  rule  the  mechanical  methods  lead  to  a  more  or  less  irregu- 
lar connective  tissue  formation,  sometimes  with  considerable 
sclerosis,  but  the  lesion  under  these  circumstances  is  more  of  an 
atrophy  than  a  cirrhosis.  The  toxic  agents,  for  which  positive 
results  have  been  claimed,  have  been  introduced  so  that  they 
reach  the  liver  through  the  blood  stream.  The  lesion  attributed 
to  such  substances  is  usually  described  as  a  primary  degeneration 


96 


EXPERIMENTAL  CIRRHOSIS  OF  THE  LIVER. 


of  the  liver  cells  with  a  slight  increase  of  connective  tissue,  limited 
as  a  rule,  to  the  portal  spaces;  in  a  few  instances  a  definite 
perilobular  growth  of  connective  tissue,  independent  of  paren- 
chymatous degeneration,  has  been  described.  Few  of  these 
lesions,  however,  even  in  their  final  stages  are  comparable  to  the 
cirrhosis  of  man  and  in  none  has  it  been  possible  to  follow  step 
by  step  the  development  of  a  lesion  which  could  probably  be 
termed  an  experimental  cirrhosis. 

Summary. — The  reparative  process  which  follows  the  wide- 
spread necrosis  of  the  dog's  liver  caused  by  the  injection  of 
hsemagglutinative  serum  constitutes  a  chronic  interstitial  hepati- 
tis of  definite  and  constant  character.  This  is  not  only  a  new  type 
of  experimental  liver  lesion,  but  is  more  definitely  a  cirrhosis 
than  is  any  other  experimental  lesion  hitherto  described.  It  is 
of  importance  in  explaining  the  histogenesis  of  cirrhosis,  and 
incidentally  various  repair  processes  in  the  liver ;  but  does  not 
aid  in  the  elucidation  of  the  etiology  of  cirrhosis  in  man,  nor 
does  it  explain  the  peculiar  arrangement  of  the  new  connective 
tissue  in  any  form  of  human  cirrhosis  except,  possibly  that 
associated  with  chronic  passive  congestion.  It  definitely  demon- 
strates, however,  that  cirrhosis  may  follow  extensive  primary 
destructive  lesions,  a  view  not  yet  fully  accepted,  and  supports 
the  contention  of  Kretz  that  cirrhosis  is  essentially  a  reparative 
process. 


Fig.  i — The  primary  lesion.  Extensive  hyaline  necrosis  sparing  only  the  tissues  about 
the  larger  portal  spaces.  Thirty-eight  hours.  Dose,  i  :iooo.  Methylene  blue  and  eosin. 
No.  2  oc,  No.  3  obj.,  Leitz. 

Fig.  2 — Experimental  cirrhosis.  Broad  bands  of  newly  formed  connective  tissue  sur- 
round the  islands  of  normal  liver  about  the  portal  spaces.  In  the  stroma  may  be  seen 
newly-formed  bile  ducts  and  numerous  giant  cells.  Thirty- six  days.  Dose,  i:iooo. 
Methylene  blue  and  eosin.    No.  3  oc,  No.  3  obj.,  Leitz. 


Explanation  of  Plate  III. 


References. 


1  Pearce,  R.  M. 


The  Experimental  Production  of  Liver  Ne- 
croses by  the  Intravenous  Injection  of 
Haemagglutinins,  Jour,  of  Med.  Research, 
1904,  XII,  329. 


2  JOANNOVICS,  G. 

3  Flexner,  S. 

4  WOOLDRIDGE,  R.  C. 


Trans.  Path.  Soc.  of  London,  1888,  XXXIX, 


Zeitschr.  f.  Heilkunde,  1904,  XXV,  25. 


Medical  News,  1894,  LXV,  116. 


44. 


5  BOSTROEM. 


Deutsche  Med.  Wochenschr.,  (Vereinsbeilage) 
1905,  XXXI,  167. 


6  Kretz,  R. 


Wiener  klin.  Wochenschr.,  1894,  VII,  365; 
1900,  XIII,  271;  Verhandl.  d.  Deutsche 
path.  Gesellsch.,  1898, 1,  131;  1904,  VIII,  54. 


To  Illustrate  Dr.  Pearce's  Article  on  <l Experimental  Cirrhosis  of  the  Liver" 

Albany  Medical  Annals,  February,  iqo6 


v.t, 


£  '» - 


s«2 


Fig.  i 


Fig.  2 


PLATE  III 


ROENTGEN  RAYS  AS  A  FACTOR  IN  MEDICINE 


97 


7  Weigert,  C. 

8  Kirikow,  N. 

9  MacCallum,  W.  G. 

10  McPhedran,  A.,  &  MacCallum,  A.  B 

11  Meder,  E. 

12  Marchand,  F. 

13  Stroebe,  H. 

14  Barbacci,  O. 

15  MacCallum,  W.  G. 

16  Podwyssozki. 

17  ponfick,  e. 

18  v.  Meister,  V. 

19  Salmon,  D.  E.,  Smith,  T.,  Kilborne,  1 


20  v.  Heukelom. 

21  JOANNOVICS,  G. 


Volkmann's  Saramlung  klin.  Vortrage,  162- 
163. 

Zeitschr.  f.  klin.  Med.,  1899,  XXXVI,  444- 
Jour.  Am.  Med.  Assoc.,  1904,  XLIII,  649. 
Brit.  Med.  Jour.,  1894,  I,  293. 
Ziegler's  Beitrage,  1895,  XVII,  143. 
Ibid.,  1895,  XVII,  206. 
Ibid.,  1897.  XXI,  379- 
Ibid.,  1901,  XXX,  49- 

The  Johns  Hopkins  Hospital  Reports,  1902 
X,  375- 

Ziegler's  Beitrage,  1886  I,  259. 

Virchow's  Archiv.,  1889,  CXVIII,  209;  1890, 
CXIX,  193;  1895.  CXXXVIII,  81. 

Ziegler's  Beitrage,  1894,  XV,  1. 
'.L.Hog  Cholera;  its  History,  Nature  and  Treat- 
ment as  Determined  by  the  Inquiries  and 
Investigations  of  the  Bureau  of  Animal 
Industry,  Washington,  1889. 

Ziegler's  Beitrage,  1896,  XX,  322. 

Wiener  klin.  Wochenschr.,  1904,  XVII,  757- 


THE  ROENTGEN  RAYS  AS  A  FACTOR  IN  MEDICINE. 

Read  before  the  New  York  Academy  of  Medicine,  October  5,  IQ05,  and  the 
Medical  Society  of  the  County  of  Montgomery,  October  15, 1905. 

By  ARTHUR  HOLDING,  M.  D., 

Attending  Specialist  in  Electro-Radio-Therapeutics,  Albany  Hospital,  Albany,  N.  Y. 

Rontgen's  discovery  is  now  ten  years  old  and  during  this 
time  we  have  come  to  realize  that  it  is  not  only  a  diagnostic 
agent  but  that  it  also  has  a  physiological  action,  with  indica- 
tions, contraindications,  and  therapeutic  value.  On  the  skin, 
attention  was  early  called  to  the  X-ray  "  burns." 

Their  characteristics  of  latency  of  development  and  stubborn- 
ness in  healing  associated  with  the  histological  findings  of 
atrophy  of  the  cells  in  the  skin's  appendages,  and  endarteritis 
obliterans  has  later  caused  these  manifestations  to  be  looked  upon 
more  as  gangrenes  than  burns.  Corneal  ulcers,  alopecia,  eczema, 
parchment-like  dryness,  exfoliation  of  nails,  and  preepithelial 
keratoses  were  occasional.  In  cases  where  extensive  areas  were 
involved  and  that  were  fortunate  enough  to  heal,  there  was 
much  soft  scar-tissue  and  frequent  telangiectasis. 

Such  calamities  practically  never  occur  to  the  patient  today. 
The  only  persons  seriously  endangered  are  those  who  are  fre- 
quently in  the  rays.  The  operators  themselves  have  suffered 
the  most.    Three  have  already  departed  this  life  after  hav- 


98 


ROENTGEN  RAYS  AS  A  FACTOR  IN  MEDICINE 


ing  submitted  to  repeated  amputations  of  fingers,  hands,  arms, 
even  to  and  beyond  the  shoulders.  One  surgeon  reports  a  case 
in  which  epitheliomata  developed  on  the  hands  in  nine  dif- 
ferent places;  the  diagnosis  of  each  lesion  being  confirmed  by 
competent  microscopal  examination.  Parts  of  five  fingers  were 
amputated,  the  ulcers  exercised,  and  skin  grafting  done.  This 
required  a  long  course  of  treatment  but  the  condition  was  ulti- 
mately controlled. 

In  my  own  experience  some  thirty  operators  have  been 
troubled  by  chronic  lesions  on  their  hands,  presenting  all  the 
stages  from  the  so-called  chronic  eczema  (  ?)  up  to  lesions  re- 
quiring amputations  of  fingers  and  arms. 

EFFECT  ON  DEEP  STRUCTURES. 

Within  the  past  two  years  attention  has  been  called  to  the 
action  beneath  the  skin,  particularly  on  the  spleen,  lymphatic 
tissues,  bone-marrow,  ovaries,  testicles,  and  prostate  glands. 
On  all  of  these  the  rays  have  a  destructive  action.  In  the  lower 
animals  this  destructive  action  has  been  observed  after  ex- 
posures, aggregating  195  minutes.  Van  Allen  has  reported 
the  examination  of  fifteen  cases  of  men  who  had  been  treated 
with  the  X-rays  for  therapeutic  purposes.  In  every  case  that 
had  received  more  than  fifteen  treatments  over  the  perineum, 
he  could  find  no  spermatazoa  in  the  spermatic  fluid.  Some  of 
the  cases  were  examined  one  year  after  cessation  of  treatment 
and  their  semen  was  still  sterile.  These  symptoms  are  accom- 
panied by  no  loss  of  sexual  desire.  Pusey  has  demonstrated  the 
destruction  of  epithelial  cells  in  carcinomata  and  their  sub- 
stitutions with  connective  tissue  cells.  Therefore  in  the  dis- 
covery of  Rontgen,  we  have  an  agent  with  a  varied  physiologi- 
cal action  and  a  selective  action  on  the  more  highly  organized 
glandular  cells.  The  above  facts  verified  by  competent  observers 
establish  a  scientific  basis  for  many  of  the  therapeutic  claims 
made  for  the  X-rays. 

It  is  only  a  confession  of  limited  experience  or  faulty  technique 
for  anyone  to  deny  the  at  least  ameliorating  if  not  curative 
effect  of  these  rays  in  epidermoids,  carcinomata  of  the  breast, 
spleno-myelogenous  leukaemia,  pseudo-leukaemia,  tubercular 
adenitis,  lupus,  psoriasis,  pruritus,  eczema,  acne.  Because  of 
the  expense,  length  of  treatment,  X-rays  are  only  to  be  recom- 
mended after  simpler  and  quicker  methods  have  failed.    In  fact, 


ARTHUR  HOLDING 


99 


I  never  recommend  it  in  any  case  where  other  therapeutic  pro- 
cedures offer  equally  good  results. 

Its  value  as  a  diagnostic  agent  for  bone  lesions  and  foreign 
bodies  needs  no  mention  here;  but  the  X-ray's  value  in  diagno- 
sis of  chest  diseases  has  not  received  the  attention  they  merit. 
In  several  clinics  in  Europe  an  X-ray  examination  of  the  chest 
is  considered  as  important  as  the  observation  of  the  physical 
signs.  This  will  obtain  here  when  the  profession  realizes  the 
ease  and  accuracy  of  the  method  in  competent  hands. 

While  this  agent  is  dangerous,  yet  it  is  useful ;  those  who 
have  become  proficient  with  it  seem  loath  to  abandon  it,  as 
they  have  spent  several  of  the  best  years  of  their  lives  mastering 
the  intricacies  of  electricity,  photographing  and  vacuum  tubes. 
The  problem  that  must  be  solved  is  that  of  safety  of  the 
operators. 

Fluoroscopic  examination  should  never  be  made.  A  screen 
examination  with  the  observer  protected  from  the  rays  is  the 
only  safe  procedure  in  those  cases  where  it  is  important  to 
watch  the  excursion  of  the  diaphragm  and  pulsations  of  the 
heart  or  aorta. 

Various  protectors  have  been  suggested,  some  to  be  worn  by 
the  operators,  some  to  be  placed  on  the  tubes,  and  others  to 
be  interposed  between  the  tubes  and  the  operators.  A  metal 
of  high  specific  gravity  must  be  employed,  and  lead  is  the 
favorite.  A  lead  suit  or  armor  would  be  too  cumbersome  and 
heavy,  while  the  practice  of  wearing  a  lead  apron  is  insufficient 
protection.  It  will  cover  the  abdomen  and  pelvis,  but  with  an 
agent  as  powerful  and  dangerous  as  the  X-ray  has  proved,  one 
should  not  needlessly  expose  the  liver,  heart,  kidneys,  spleen, 
intestines,  brain,  blood,  and  lymphatic  systems.  If  a  substance 
as  heavy  as  lead  is  used  to  surround  the  tube,  it  should  have 
the  tube  holding  support  attached  to  it;  instead  of  clamping 
the  tube  into  the  tubeholder  and  allowing  the  delicate  glass  to 
support  all  this  weight.  When  the  tube  is  surrounded  in  this 
manner  the  operator  cannot  judge  the  character  of  the  rays 
by  the  fluorescence  of  the  glass;  for  this  reason  experiments 
are  now  being  made  with  tubes  made  of  lead  glass.  The  operator 
must  be  protected  not  only  from  the  direct  rays  but  also  from 
the  secondary  rays  set  up  whenever  the  direct  rays  impinge 
on  other  matters. 

The  switchboard  and  all  regulating  apparatus  should  be  on 


IOO 


ROENTGEN  RAYS  AS  A  FACTOR  IN  MEDICINE 


the  side  of  the  room  farthest  removed  from  the  X-ray  tube. 
A  lead  covered  barrier  should  surround  the  operator;  mirrors 
can  be  so  arranged  that  the  patient,  the  tube,  and  the  appa- 
ratus can  be  constantly  under  inspection.  The  short  exposures 
that  the  patient  is  subjected  to  for  skiagraphs  probably  inflict 
no  material  injury  on  him.  When  the  patient  is  subjected  to 
therapeutic  exposures,  normal  parts  must  be  protected. 

In  conclusion  it  may  be  in  order  to  state  that  radium  is  not 
superior  to  the  X-rays  for  therapeutic  purposes,  but  as  it  is 
free  from  connecting  electrical  wires,  it  can  be  used  in  cavities 
such  as  oesophagus,  stomach  and  bladder,  where  X-rays  cannot 
be  applied  directly. 

Bibliography. 


Albers. 


Frieben. 
Philipp. 


Bergonib  bt  Tribondeau. 
Heineke. 


Freund. 
Krause. 

Halberstaedter. 
Selden. 

Pusey  and  Caldwell. 

PUSEY. 

Dunham. 

Pitkin. 
Hulst. 

RlEDER. 

rleder  and  rosenthall. 
Pfahler. 

Johnston. 

Smith. 

Pancoast. 

Senn. 

Van  Allen. 
Meyer. 

Bull. 


Shoenberg,  Munchner  medicinische  Wochenschift,  1903,  No. 
xliii,  p.  1859. 

Munchner  medicinische  Wochenschrift,  1903,  No.  Hi.  p.  2295. 
Fortschritte  aus  der  Gebiet  der  Rontgenstrahlen,  1904. 

Bd.  viii.    Heft  2,  p.  114. 
Comptes  rendus  Hebdomedaires,  Socidte  de  Biologic  1904,  lvii. 

p.  400-402  and  592-596. 
Mitteilungen  aus  den  Grenzgebieten  der  Medizin  und  Chirur- 

gie,  1905,  Bd.  xiv.    Heft  1  and  2,  p.  21-94. 
Munchner  medicinische  Wochenschrift,  1903,  No.  xlviii,  p. 

2090. 

Munchner  medicinische  Wochenschrift,  1904.  No.  xviii,  p. 
785. 

"Radiotherapy,"  p.  312,  Rebman  &  Co. 

Fortschritte  aus  der  Gebiet  der  Rontgenstrahlen,  1905,  Bd.  vii. 

Heft.  3,  p.  209. 
Berliner  klinische  Wochenschrift,  1905,  January  16. 
Fortschritte  aus  der  Gebiet  der  Rontgenstrahlen,  1903,  Bd.  vii, 

Heft  6,  p.  322. 

"The  Rontgen  Rays  in  Diagnosis  and  Therapeutics"  Phila- 
delphia, 1905. 

Journal  of  the  American  Medical  Association,  July  8,  1905,  p. 
127. 

The  Effects  of  the  Rontgen  Rays  upon  Lower  Animal  Life, 

Transactions  of  the  American  Rontgen  Ray  Society,  1904. 
"Dangers  to  the  X-Ray  Operator,"  Ibid. 

"Skiagraphy  of  the  Chest;  Study  of  the  Stomach  and  Intes- 
tines," Ibid,  1905. 

For  schritte  aus  der  Gebiet  der  Rontgenstrahlen,  Bd.  vi.  Heft  iii, 
S,  115. 

Munchner  medicinische  Wochenschrift,  1889,  Nr.  32,  S,  1048. 
"Interpretations  of  Lung  Negatives."   Transactions  of  the 

American  Rontgen  Ray  Society,  1905. 
"Preparatory  and  postoperative  treatment  of  Carcinoma," 

Translation  of  the  American  Rontgen  Ray  Society,  1905. 
"Treatment  of  Leukaemia,"  Ibid. 
"Treatment  of  Hodgkin's  Disease,  etc.,  Ibid.,  1905. 
New  York  Medical  Record,  August  22,  1903. 
Boston  Medical  and  Surgical  Journal,  March  9,  1905. 
Munchner  klinische  Wochenschrift,  lii.,  No.  4,  January  24, 

1905. 

New  York  Medical  Record,  Juue  24,  1905- 


OUR   LABORATORY  ADVANTAGES 


IOI 


Senn. 

Bryant  and  Crane. 
Lbdingham  &  McKennon. 
Dick. 

PUSEY. 

Brown. 

Grosh  and  Stone. 
Krone. 

Ahrens. 

Kapps  and  Smith. 
Rodhb. 


New  York  Medical  Record,  August  22,  1903. 
New  York  Medical  Record,  April  9,  1904. 
London  Lancet,  January  14,  1905. 

American  Journal  of  the  Medical  Sciences,  April,  1904. 
Journal  of  the  American  Medical  Association,  April  12,  1902. 
Journal  of  the  American  Medical  Association,  March  26,  1904, 
Journal  of  the  American  Medical  Associaton  No.  I,  1904. 
Munchner  medicinische  Wochenschrift,  No.  21,  May  24,  1904. 

June  14,  1904. 
Comptes  rendus  de  la  Societe  de  Biologie,  June  17,  1904. 
Journal  of  the  American  Medical  Association,  September  24, 

1904. 

Deutsche  medicinische  Wochenschrift,  No.  40,  September  29 
1904. 

Munchner  medicinische  Wochenschrift,  No.  40,  October  4,  1904; 

No.  42,  October  18,  1904;  November  29,  1904. 
Deutsche  medicinische  Wochenschrift,  No.  49,  December  1 

1904;  No.  50,  December  8,  1904. 
Berliner  klinische  Wochenschrift,  No.  49,  December  5,  1904; 

xlii,  No.  3,  June  16,  1905. 


OUR  LABORATORY  ADVANTAGES. 

An  address  delivered  before  the  Albany  Medical  College  Alumni  Association 
of  Central  New  York  at  a  meeting  held  at  Utica,  September  27,  1905. 

By  HERMON  C.  GORDINIER,  M.  D., 

Professor  of  Physiology  and  Anatomy  of  the  Nervous  System,  Albany  Medical  College. 

Mr.  Chairman,  Fellow  Alumni,  Ladies  and  Gentlemen. — I  fully 
appreciate  the  courtesy  you  have  extended,  in  permitting  me 
to  make  a  few  remarks  relative  to  our  laboratory  advantages. 
In  return,  I  not  only  want  to  express  my  personal  thanks  but 
those  of  the  faculty. 

Those  of  us  who  graduated  ten,  fifteen,  twenty  or  more  years 
ago,  cannot  but  appreciate  the  great  advantages  which  our  col- 
lege now  offers  to  the  student  of  medicine.  How  enthusiastic 
we  were  in  those  days  with  the  few  laboratory  facilities  offered 
us.  How  well  we  remember  the  excellent  courses  in  practical 
histology  and  pathology  given  by  our  beloved  teacher,  Professor 
William  Hailes.  His  devotion  to  and  his  thorough  knowledge 
of  these  subjects,  the  great  accuracy  with  which  he  described 
the  specimens,  his  artistic  ability,  the  enthusiasm  with  which  he 
spurred  on  the  students  to  better  efforts  and  above  all  to  his  kind- 
ness and  loyalty  to  the  students.  These  were  some  of  the  many 
attributes  which  endeared  him  to  us.  While  we  did  but  little 
of  the  practical  work,  hardening,  embedding,  cutting,  staining, 
etc.,  we  were  presented  with  plenty  of  material  well  prepared 


102 


OUR   LABORATORY  ADVANTAGES 


and  described,  and  each  of  us  obtained  splendid  histological 
and  pathological  collections. 

In  those  days  but  few  well  equipped  pathological  laboratories 
and  museums  were  to  be  found  in  this  country,  hence  it  became 
a  necessity,  if  one  cared  to  enlarge  one's  knowledge  in  this 
particular  field,  to  devote  several  months  abroad  with  some  one 
of  the  great  teachers.  Our  teaching  body,  early  recognizing 
the  importance  of  greater  laboratory  facilities  particularly  in 
pathology  and  in  that  recently  developed  and  closely  allied 
branch,  becteriology,  were  enabled  through  the  munificence  of 
Matthew  W.  Bender,  to  erect  the  Bender  Hygienic  Laboratory. 
We  were  also  very  fortunate  through  the  recommendation  of 
Professor  William  Welch  of  engaging  as  the  first  director  of  the 
laboratory,  Dr.  George  Blumer,  an  earnest  scientific  worker  and 
a  truly  great  teacher.  The  laboratory  under  his  guidance  was 
thoroughly  equipped  with  scientific  apparatus  through  the 
generosity  of  the  faculty  and  was  formally  opened  in  1896, 
since  which  time  our  students  have  received  thorough  courses 
in  histology,  general  and  surgical  pathology,  bacteriology  and 
clinical  microscopy.  This  work  is  entirely  practical.  Each 
student  is  required  to  witness  the  post-mortems,  and  to  study 
and  familiarize  himself  with  the  gross  appearances  of  the  speci- 
mens as  well  as  to  stain,  mount,  describe  and  draw  the  various 
microscopic  appearances. 

In  bacteriology  the  course  is  also  eminently  practical,  the 
student  being  obliged  to  make  the  various  nutrient  media  and 
to  cultivate  and  to  study  the  morphological  appearances,  tincto- 
rial reactions,  etc.,  of  the  various  pathogenic  and  non-pathogenic 
bacteria. 

In  clinical  microscopy  the  students  are  taught  all  the  more 
modern  methods  of  examination  of  the  blood,  urine,  sputum, 
stomach  contents,  faeces,  and  the  cytological  methods  con- 
nected with  the  examination  of  transudates,  exudates  and  the 
cerebro-spinal  fluid. 

An  entirely  new  course  recently  inaugurated  at  the  labora- 
tory is  a  practical  one  on  anatomy,  histology  and  pathology  of 
the  nervous  system.  This  course  is  given  in  conjunction  with 
my  lectures  on  this  subject  at  the  college  and  is  in  preparation 
for  the  very  instructive  lectures  and  clinics  of  Professor  Hun 
on  neurology. 

The  loss  two  years  ago  of  Dr.  Blumer  from  our  teaching 


,  HERMON  C.  GORDINIER 


corps  seemed  to  create  an  abyss  which  would  long  go  unfilled. 
But  owing  to  his  endeavors,  we  were  enabled  to  secure  the  ser- 
vices of  Dr.  Pearce,  a  gentleman  well  trained  in  pathology  and 
bacteriology,  under  whose  guidance  the  work  of  the  laboratory 
has  continued  uninterruptedly.  In  addition  to  the  regular  cur- 
riculum Dr.  Pearce  has  encouraged  our  students  and  alumni 
to  do  advanced  work  in  the  various  branches  taught,  and  has 
also  given  them  abundant  opportunities  to  pursue  special  lines 
of  research  work.  This  has  resulted  in  the  Bender  Hygienic 
Laboratory  not  only  having  a  local  reputation  for  the  excellence 
of  its  work,  but  a  reputation  which  has  spread  broadcast  through- 
out the  land. 

The  laboratory  has  taught  our  students  a  great  deal,  and  our 
faculty  not  a  little.  It  has  been  a  stimulus  to  each  of  us  in  our 
work  and  has  had  its  influence  in  improving  our  methods  of 
teaching  medicine  and  surgery.  It  has  attracted  an  ever  in- 
creasing number  of  students,  and  at  the  same  time  furnished 
a  place  where  the  general  practitioner,  or  specialist,  who  from 
insufficient  knowledge  of  laboratory  methods,  or  from  lack  of 
time  from  overwork,  can  send  their  pathological  or  other 
material  for  examination  at  a  nominal  fee.  In  addition  the 
laboratory  has  been  a  place  of  much  usefulness  to  the  various 
local  boards  of  health  in  furnishing  them  with  water  and  food 
analysis,  together  with  the  bacteriological  reports  of  throat  cul- 
tures and  the  like.  It  is  a  source  of  much  satisfaction  for  me 
to  be  able  to  inform  you,  that  the  laboratory  is  practically  self- 
sustaining,  the  annual  deficit  being  very  small.  This  I  think 
the  more  remarkable  when  one  considers  that  no  laboratory 
endowment  fund  has  thus  far  been  forthcoming,  though  we  hope 
it  may  not  be  far  distant. 

I  wish  to  state  that  the  New  York  State  Antitoxine  laboratory, 
through  the  courtesy  of  Dr.  Pease,  the  director,  it  at  the  dis- 
posal of  our  students.  Dr.  Pease  gives  them  a  course  of  lectures 
on  the  history,  mode  of  production,  therapeutic  indications, 
methods  of  use  and  proper  dosage  of  the  various  products  of 
the  laboratory. 

The  intimate  relation  of  physiology  to  clinical  medicine  is 
well  exemplified  in  all  departments  of  medicine  but  in  none 
so  forcibly  as  in  that  branch  of  science  known  as  neurology. 
While  the  progress  of  neurology  is  in  part  due  to  a  more  clear 
conception  of  our  ideas  of  the  anatomy  of  the  nervous  system, 


104  OUR   LABORATORY  ADVANTAGES 

its  origin  and  the  wonderful  development  made  in  this  depart- 
ment during  the  past  few  decades  have  been  entirely  due  to 
physiological  experimentation.  Hence  the  great  importance  to 
the  student  of  medicine  of  a  thorough  knowledge  of  this 
subject. 

Physiology  has  been  taught  in  many  if  not  most  of  our  medi- 
cal colleges  up  to  within  the  past  decade  simply  by  means  of 
didactic  lectures,  illustrated  possibly  by  a  few  simple  experi- 
mental demonstrations.  Such  as  the  study  of  the  gastric  or 
pancreatic  secretions  by  means  of  artificial  fistulae,  or  the  action 
of  the  heart  or  circulation  on  some  of  the  lower  animals. 

In  the  Albany  Medical  College,  physiology  was  taught  most 
successfully  for  a  great  many  years  by  my  predecessor  and 
teacher,  the  late  Professor  Franklin  Townsend.  His  method 
was  almost  entirely  by  didactic  lectures  with  the  addition  of 
some  animal  experiments.  Since  Dr.  Townsend's  illness  and 
death  the  teaching  of  physiology  has  been  entrusted  to  me. 
It  has  been  taught  in  much  the  same  manner  as  by  him,  with 
the  exception  that  many  of  the  branches  have  been  more  elabor- 
ated and  the  student  is  made  to  realize  the  close  interdependence 
of  physiology  and  pathology,  as  well  as  the  intimate  relationship 
of  physiology  to  clinical  medcine  and  surgery. 

I  have  endeavored  to  improve  the  methods  of  teaching  the 
physiology  of  the  nervous  system  by  demonstrating  the  more 
recent  advances  made  in  this  important  branch.  Although  prac- 
tical physiological  demonstrations  have  been  given,  the  work 
has  been  hampered,  owing  to  inadequate  apparatus  and  lack  of 
room. 

Realizing  the  importance  of  a  special  laboratory  building  for 
teaching  physiological  chemistry  and  experimental  physiology, 
the  faculty  for  some  time  have  tried  to  obtain  the  necessary 
funds  for  such  a  purpose.  The  crisis  however  came  this  Spring 
when  it  seemed  absolutely  essential  that  such  laboratory  facili- 
ties should  be  at  hand  for  our  opening  in  the  Autumn,  even 
though  we  were  unable  to  erect  a  permanent  laboratory  build- 
ing. Accordingly  it  was  thought  best  to  use  a  part  of  the 
good  old  college  building  for  such  purposes,  and  it  was  by  the 
unanimous  consent  of  the  faculty  that  such  a  laboratory  should 
be  created  at  once.  Our  committee  concluded  that  it  would 
be  best  to  make  use  of  the  very  familiar  Alumni  Hall,  to  com- 
pletely evacuate  from  it,  its  present  contents,  and  to  transfer 


EDITORIAL 


them  to  the  southeast  corner  of  the  museum.  All  this  has  been 
admirably  done.  Alumni  Ha1!  has  been  transformed  into  a 
perfect  working  physiological  laboratory,  and  all  that  remains 
for  its  completion  is  the  equipment  with  physiological  apparatus, 
most  of  which  has  been  ordered  from  Germany.  We  have 
engaged  Professor  Jackson,  a  very  competent  expert  in  both 
these  departments,  and  we  are  sure,  at  his  hands,  you  will  hear 
of  much  good  and  original  work  coming  from  this  laboratory 
in  the  near  future,  as  well  as  a  place  where  our  students  can  be 
thoroughly  trained  in  physiological  chemistry  and  experimental 
physiology. 

The  southeast  corner  of  our  museum  has  also  undergone  a 
transformation  into  a  very  capacious  and  beautiful  lecture  room, 
which  we  hope  will  serve  you  well  on  Alumni  Day. 


BOttorial 


From  every  human  being  whose  body  has  been 
racked  by  pain,  from  every  human  being  who  has 
suffered  from  accident  or  disease,  from  every  human 
being  drowned,  burned,  or  slain  by  negligence,  there 
goes  up  a  continually  increasing  cry  louder  than 
the  thunder — an  awe-inspiring  cry,  dread  to  listen 
to,  which  no  one  dares  listen  to,  against  which 
ears  are  stopped  by  the  wax  of  superstition  and 
the  wax  of  criminal  selfishness.  These  miseries  are 
your  undoing,  because  you  have  mind  and  thought, 
and  could  have  prevented  them.  You  can  prevent 
them  in  the  future.   You  do  not  even  try. 

The  Story  of  My  Heart.  Richard  Jkfferibs. 


^ 

The  Annals  has  received  a  copy  of  the  report 
for  the  year  ending  September  30,  1905,  of  the 
Hospital  Association  of  the  City  of  Schenectady, 
Hospital      t^e  corporate  title  of  the  management  of  the 
Ellis  Hospital,  and  takes  occasion  to  congratulate  the  Associa- 
tion and  the  citizens  of  Schenectady  on  the  accomplishments 
and  the  excellent  promise  of  the  institution. 
5 


io6 


EDITORIAL 


The  work  of  the  year  has  been  on  approved  lines  and  shows 
activity.  The  special  features  of  the  report,  however,  are 
progress  in  the  erection  of  new  hospital  buildings  and  develop- 
ment of  the  training  school  for  nurses.  The  sketch  of  the  new 
buildings  shows  a  practical  plan  of  a  central  administration 
building  with  a  rear  extension  for  service  buildings,  and  two 
two-story  ward  pavilions  as  wings.  On  the  triangular  lot 
enclosed  by  Rosa  Road  and  Nott  Street,  which  appears  ample, 
are  also  erected  at  comfortable  distance  from  the  main  struc- 
ture, an  ambulance  stable  and  the  Whitmore  Home  for  Nurses. 

Architecturally  the  group  of  new  buildings  is  pleasing.  The 
design  is  classic,  and  in  the  elevation  shown  carries  out  the 
style  of  Independence  Hall  of  Philadelphia.  The  organization 
of  the  School  of  Nursing  has  been  perfected.  Lectures  are 
given  by  fifteen  physicians  and  surgeons,  and  recitations  are 
conducted  by  the  superintendent.  The  medical  board  consists 
of  two  consulting  physicians,  four  surgeons,  six  physicians,  five 
specialists,  a  dispensary  staff  of  six  and  two  house  physicians. 
Sixteen  of  these,  it  is  gratifying  to  note,  are  alumni  of  the 
Albany  Medical  College. 

The  president  of  the  hospital,  Mr.  Joseph  W.  Smitley,  states 
that  a  total  of  $112,660.76  has  been  subscribed  by  thirty-two 
individuals,  and  he  asks,  where  are  the  contributions  of  the 
other  58,327  citizens  of  Schenectady?  The  inquiry  is  natural. 
The  probable  explanation  is  that  the  citizens  of  Schenectady 
have  not  yet  been  educated  to  an  appreciation  of  the  personal 
value  to  each  of  such  an  institution.  Nor  is  this  situation 
peculiar  to  Schenectady.  The  condition  of  a  hospital  may  be 
taken  as  a  measure  of  the  forethought  of  a  community  in  the 
preservation  of  its  health.  An  interesting  investigation  would 
be  one  into  the  amount  of  accident  and  health  insurance  carried 
by  the  58.327  people  who  have  not  yet  subscribed  to  this  insti- 
tution. It  would  probably  be  shown  that  greater  anxiety  had 
been  manifested  in  the  financial  than  in  the  biological  problem. 
If  hospital  authorities  expend  the  same  energy  as  insurance 
agents  in  securing  contributions,  the  results  would  no  doubt 
compare  favorably.  Indeed,  when  the  use  of  the  hospital  is 
understood  by  each  individual,  and  there  is  brought  home  to 
him  a  realization  of  his  own  possible  needs,  there  should  be  no 
want  of  cooperation.  That  each  community  should  provide 
for  the  care  of  its  sick  and  injured  is  just  as  important  as  that 


EDITORIAL  I07 

it  should  sustain  a  public  department  for  the  prevention  of 
disease. 

Schenectady  is  to  be  congratulated  upon  the  excellent  show- 
ing of  this  report  and  upon  the  bright  prospects  of  the  new 
hospital. 

*    *  * 

The  Readers  of  the  Annals  may   have  noticed 

State  during  the  last  year  in  the  department  of  Current 
Medical  Medical  Literature  a  series  of  communications 
Library  fr0m  the  State  Medical  Library,  prepared  by 
Miss  Bunnell,  the  medical  librarian.  These  have  consisted  of 
lists  of  books,  periodicals  and  donations,  and  on  one  occasion, 
when  the  subject  was  urgent,  a  complete  bibliography  of 
cerebro -spinal  meningitis.  These  contributions  were  of  value 
from  the  information  given  and,  in  addition,  carried  the  assur- 
ance to  physicians  of  the  practical  purposes  of  this  State 
department  and  of  an  active  and  intelligent  administration. 
The  desire  to  bring  this  fact  to  the  knowledge  of  every  physi- 
cian in  the  State  of  New  York  is  now  emphasized  by  the  pub- 
lication as  one  of  the  Bulletins  of  the  State  Library  of  the  list 
of  serials  now  being  received.  The  total  number  is  517.  The 
Bulletin  has  been  sent  to  the  county  societies  and  medical 
journals  with  an  explanatory  letter.  This  deserves  careful 
consideration,  and  every  county  society  should  take  prompt 
action  to  assist  this  important  enterprise.  The  action  needed 
is  indicated  in  the  communication  to  secretaries  of  county 
societies  as  follows: 

Dear  Sir. — We  send  you  herewith  our  new  catalogue  of 
serials  in  the  State  Medical  Library,  which  we  believe  will  be 
very  useful,  specially  to  physicians  outside  Albany.  The 
recent  union  of  the  state  society  and  state  association  and  the 
growing  harmony  in  examinations  for  license  to  practice  are 
favorable  indications  for  our  State  Medical  Library.  This  is  a 
propitious  time  to  strengthen  it.  For  years  it  has  been  crip- 
pled by  insufficient  appropriation,  the  $5,000  a  year  agreed  on 
when  the  Albany  Medical  College  gave  their  library  as  a 
nucleus,  never  having  been  granted.  I  send  this  circular 
letter  to  suggest: 

(1)  That  you  call  the  attention  of  your  society  to  the 
importance   and   value  of  the  state  library  and  urge  your 


io8 


EDITORIAL 


boards  to  interest  their  assemblymen  and  members  in  giving 
the  promised  necessary  support  of  not  less  than  $5,000  a  year; 

(2)  That  you  call  special  attention  to  the  importance  of 
gifts  and  bequests  from  physicians.  Many  of  them  have  older 
volumes,  old  numbers  of  serials  and  other  material  which  is  of 
practically  no  use  in  their  private  collections  and  yet  might  be 
of  great  value  to  us  in  completing  sets  and  in  strengthening 
our  historical  medical  collection.  A  single  library  in  the  State, 
available  to  every  physician,  should  have  one  copy  of  every- 
thing pertaining  to  medicine,  so  that  historical  researches  could 
be  carried  on  here  or  by  sending  for  the  books. 

Often  physicians  have  no  one  in  the  immediate  family  who 
cares  for  medical  books  and  could  provide  in  their  wills  that 
their  collection  should  be  sent  to  the  State  Medical  Library, 
where  the  books  not  now  here  could  be  included  and  others 
could  be  used  for  exchange,  thus  helping  materially  in  build- 
ing up  what  should  be  the  best  medical  library  in  the  country 
except  the  surgeon -general's  at  Washington.  Will  you  not  at 
least  read  this  circular  letter  at  your  next  meeting,  or  still 
better,  get  some  one  interested  to  enlist  the  active  sympathies 
and  cooperation  of  the  physicians  of  your  county? 

The  State  Medical  Library  grows  steadily  in  value  and  use- 
fulness, but  by  no  means  as  rapidly  as  it  should  to  meet  the 
demands  of  this  great  State. 

Melvil  Dewey, 
Director. 

Ada  Bunnell, 

Medical  Librarian. 


LITTLE  BIOGRAPHIES 


109 


Xlttle  ^Bioorapbiee 

II.  ANTONIO  SCARPA. 

THIS  talented  scholar  and  skilled  student  of  surgical 
anatomy  was  born  at  Motta,  a  small  village  in  Aus- 
trian Italy  in  the  year  1746.  He  obtained  a  liberal 
education,  and  at  the  age  of  fourteen  entered  the 
medical  school  at  the  University  of  Padua.  Scarpa  chose 
anatomy  and  surgery  as  his  favorite  studies  and  rose  so  rapidly 
in  favor  and  reputation  that  at  the  age  of  twenty-two  he  was 
elected  to  the  professorship  of  anatomy  in  the  "University  of 
Modena.  This  position  at  Modena,  the  birthplace  of  Fallopius, 
he  held  for  fifteen  years,  and  was  then  made  Professor  of 
Anatomy  at  Pa  via,  one  of  the  most  distinguished  positions  the 
medical  world  of  that  day  had  to  offer.  The  classes  in  anatomy 
under  Scarpa  were  said  to  number  as  many  as  two  thousand 
students.  Here  he  carried  on  researches  in  dissections  and 
surgical  methods  which  made  him  not  only  the  foremost 
authority  of  his  own  time  on  surgical  anatomy  but  gave  him  a 
name  which  will  always  be  honored  as  one  of  the  pioneers  in 
the  field  of  scientific  medical  research. 

His  labors  have  come  down  to  us  in  the  form  of  many  essays 
and  memoirs  representing  profound  and  exhaustive  application 
and  careful  painstaking  methods.  In  1787  he  published 
"Anatomicae  Desquistiones  de  Auditu  et  Olfactu"  which  is 
still  looked  upon  as  a  classical  treatise  by  the  curious  in  science. 
Later  appeared  another  treatise  on  the  ear  entitled,  "De  Struc- 
tura  Fenestrae  Rotundae  et  de  Tympano  Secundario."  He 
describes  the  membrane  attached  to  the  orifice  of  the  fenestra 
rotunda  and  also  the  aqua  labryinthi,  detailing  it  with  so  much 
care  that  it  has  often  been  called  Liquor  Scarpae. 

A  few  years  later  he  issued  a  work  entitled,  "Tabulae  Neuro- 
logicae  ad  illustrandam  Historiam  Cardiacorum  Nervorum." 
Other  anatomists  had  shown  that  the  blood  vessels  of  the  heart 
are  accompanied  by  nerves  but  to  Scarpa  is  due  the  discovery 
that  the  muscular  structure  is  also  supplied  with  nerves.  The 
plates  accompanying  the  text  are  masterpieces  and  have  been 
called  "among  the  best  anatomical  plates  that  were  ever  pub- 
lished." In  1799  Scarpa  published  a  memoir  on  the  structure 
of  bone  in  which  he  argues  among  other  things  that  membranous 


no 


LITTLE  BIOGRAPHIES 


bone  is  not  made  up  of  concentric  lamellae — a  view  which  we 
cannot  now  support.  His  writings  on  aneurism,  ligation  of 
the  principal  arteries  and  hernia  were,  for  a  long  time,  classics 
in  the  field  of  surgical  anatomy.  Between  the  years  1801  and 
18 1 6  Scarpa  presented  six  editions  of  a  treatise  on  diseases  of 
the  eye,  written  in  Italian  and  subsequently  translated  into 
English  by  Dr.  James  Briggs.  He  describes  in  detail  many 
operations,  some  of  which  he  had  himself  invented.  Dr.  Briggs 
also  translated  his  memoir  on  scirrhus  and  cancer  under  the 
title,  "Memoria  sullo  Scirro  e  sul  Cancro."  This  essay  refers  to 
many  points  still  under  discussion.  He  defines  the  glandular 
form  of  scirrhus  as:  "A  disease  of  advanced  or  middle  life,  at- 
tacking most  frequently  the  bilious-sanguine;  a  solitary  affec- 
tion excessively  hard  and  indolent ;  insensible  until  it  degenerates 
into  the  second  or  latent  stage  of  cancer  when  it  is  attended 
with  pruritus,  a  sense  of  burning  heat  and  darting  pains."  His 
treatment  is  distinctly  modern,  "operate  in  the  early  stage." 

As  the  name  of  Scarpa  became  widely  known,  honors  flowed 
in  upon  him  from  all  quarters  and  in  his  sixty-third  year  he 
was  appointed  Rector  of  the  Medical  Faculty  of  Pavia,  a  posi- 
tion he  held  for  nearly  twenty  years.  He  died  at  Pavia  on  October 
20th,  1832,  during  an  attack  of  inflammation  of  the  bladder. 

To  students  of  the  present  time  he  is  known  as  the  one  who  first 
accurately  described  and  gave  the  value  of  the  relations  in  the 
triangle  which  bears  his  name.  How  inadequate  that  memory 
is  we  can  gather  from  the  following  tribute  paid  Scarpa  at  the 
time  of  his  death  by  the  Duke  of  Sussex,  President  of  the  Royal 
Society:  "Antonio  Scarpa,  one  of  the  eight  foreign  members  of 
the  Academie  des  Sciences  of  Paris  was  probably  the  most  pro- 
found anatomist  of  the  present  age.  He  was  the  author  of 
many  magnificent  and  classical  works  on  anatomy,  surgery 
and  physiology.  He  accumulated  a  handsome  fortune  by  the 
practice  of  his  profession  and  collected  in  his  palace  at  Pavia  a 
considerable  number  of  works  of  art,  where  he  lived  for  the 
latter  years  of  his  life  surrounded  by  his  pupils,  reverenced  by 
his  countrymen,  and  in  the  enjoyment  and  contemplation  of 
that  brilliant  reputation,  the  full  development  of  which  a  great 
man  can  rarely  live  to  witness."  H.  E.  Robertson. 

Bibliography  "Scarpa" 

1.  "Disciples  of  Aesculapius."  Richardson,  iqoo.   Vol.  I,  p.  143. 

a.  "Biographisches  Lexilcon  der  hervorragenden  'Aertze.'  "   1887.    Vol.  V,  p.  1Q7. 

3.  "Histoire  des  Membresdes  L'Acadenne  Royale  des  Medicine."  1845.  Vol.  II,  p.  149. 


SCIENTIFIC  REVIEW 


III 


Scientific  1Rtx>tew 

The  Hypertrophies  of  the  Thyroid  Gland. 

i.    Inflammations  and  Tumors  of  the  Thyroid  and  Thymus  Glands, 

J.  C.  Bloodgood, 

Pamphlet,  Vol.  IX.    April,  1903. 
*.    Cysts  of  the  Thyroid  Gland.    A  Clinical  and  Pathological  Study, 

Surgery,  Gynecology  and  Obstetrics,  August,  1905. 

3.  An  Experimental  Study  of  the  Thyroid  Gland  of  Dogs,  with  Especial 

Consideration  of  Hypertrophy  of  this  Gland, 
S.  W.  Halsted, 
The  Johns  Hopkins  Hospital  Reports,  Vol.  I,  page  373. 

4.  On  the  Etiology  and  Symptomatology  of  Goitre, 

Adami, 

Montreal  Medical  Journal,  Vol.  XXIX,  page  1, 

5.  The  Bradshaw  Lecture,  Exophthalmic  Goitre  and  its  Treatment, 

Geo.  R.  Murray, 

Lancet,  November  11,  1905. 

6.  Beitrag  zur  Aetiologie  der  Basedow'schen  Krankheit  und  des  Thyre- 

oidismus, 

Robert  Breuer, 
Wiener  klinische  W ochenschrift ,  No.  29,  1900,  page  671, 
7-    Ibid,  No.  33,  1900,  page  855. 

8.  Bericht  uber  ein  zweites  Tausend  Kropfexcisionem, 

Theodore  Kocher, 
Archiv  fur  klinische  Chirurgie.    Vol.  LXIV,  page  454, 

9.  Mittheilungen  aus  den  Grenzyebiet  der  Medecin  und  Chirurgie, 

Vol.  VII,  page  165  . 

10.  Ibid,  Vol.  IX,  page  1 . 

1 1 .  Affections  of  the  Thyroid  in  California, 

H .  C.  Moffit, 

The  Journal  of  the  American  Medical  Association.  September  16,  1905  . 
13.  Uber  Dauererfolge  nach  operative  Behandlung  des  Morbus  Base- 
dowii, 

Friedheim, 

Archiv  fur  klinische  Chirurgie,  Band  77,  Heft  4  . 

The  successful  surgical  treatment  in  recent  years,  of  lesions 
of  the  thyroid  gland,  has  made  possible  a  more  comprehensive 
study  of  the  pathological  conditions  met  with  in  this  organ. 
Nowhere  in  the  body,  however,  do  we  find  a  greater  diversity 
of  pathologic  changes  and  of  processes  more  difficult  of  explana- 
tion than  those  met  with  in  this  situation. 

In  1867  Virchow  published  his  classical  description  of  the 
anatomical  forms  of  goitre.    His  classification,  which  was  based 


112 


SCIENTIFIC  REVIEW 


entirely  on  the  macroscopic  appearances  was  the  one  accepted 
for  many  years.  Later  Woffer  (1883)  attempted  a  classification 
according  to  what  he  believed  the  mode  of  origin  of  the  various 
types  of  lesion,  but  as  this  classification  was  largely  upon  a 
hypothetical  basis,  it  was  not  accepted  to  any  extent  by  patholo- 
gists. Thus  is  it  apparent  that  only  from  a  histological  stand- 
point can  an  intelligent  study  be  made. 

In  a  study  of  122  cases  made  by  Bloodgood  from  the  clinic 
of  Dr.  Halsted,  of  the  Johns  Hopkins  Hospital,  covering  a 
period  of  about  sixteen  years,  the  following  types  of  lesions  were 
observed :  simple  goitre,  exophthalmic  goitre,  cysts,  foetal  ade- 
noma, mixed  adenoma,  adenoma  with  metastases,  carcinoma, 
sarcoma  and  acute  and  chronic  thyroiditis.  He  has  met  with 
no  examples  of  tuberculosis  or  lues  of  the  thyroid  gland.  He 
further  divides  these  various  lesions  into  hypertrophies,  tumors 
and  inflammations.  Simple  goitre  and  exophthalmic  goitre  both 
representing  a  diffuse  process  are  hypertrophies.  In  simple 
goitre  the  enlargement  of  the  thyroid  is  a  hypertrophy  of  the 
more  or  less  normal  thyroid  tissue.  The  author  insists  that  "the 
term  simple  goitre  be  confined  to  the  disease  in  which  the  entire 
thyroid  is  enlarged  and  which  microscopically  consists  chiefly 
of  dilated,  epithelial  acini  of  various  sizes,  filled  with  compara- 
tively normal  colloid  material."  It  is  true  that  one  lobe  may  be 
larger  than  the  other  and  rarely  asymmetrical  encapsulated 
tumors  are  observed  which  histologically  appear  exactly  similar 
to  the  simple  goitre,  which  it  seems,  might  properly  be  termed 
colloid  adenoma.  No  direct  light  has  been  thrown  on  the  etio- 
logy of  this  condition,  although  from  these  observations  certain 
points  seem  pretty  clearly  determined.  That  in  certain  districts 
the  disease  is  much  more  common,  notably  the  mountainous  re- 
gions of  Pennsylvania,  Maryland  and  West  Virginia.  That 
the  age  of  onset  varies  from  fifteen  to  twenty-five  years.  The 
disease  tends  toward  great  chronicity,  but  an  onset  after  thirty 
is  extremely  rare.  During  puberty  the  enlargement  of  the  thy- 
roid is  very  common,  but  usually  disappears  after  from  twenty- 
three  to  thirty  years  of  age.  Pregnancy  also  seems  to  be  an 
etiological  factor.  It  may  be  accompanied  with  nervous  phenom- 
ena and  the  swelling  sufficient  at  times  to  give  considerable  dis- 
comfort. As,  at  least  rifty  per  cent  of  this  author's  reported  cases 
of  simple  goitre  appeared  before  or  at  the  beginning  of 
puberty,  it  is  probable  that  all  these  cases  of  enlargement  at 


SCIENTIFIC  REVIEW 


"3 


puberty  represent  a  simple  colloid  hypertrophy,  the  majority  of 
them  tending  toward  recovery.  Why  the  epithelium  of  the  thy- 
roid vesicle  at  this  period  should  be*  so  active  in  the  secretion  of 
colloid  is  not  clearly  determined.  It  represents,  however,  to  a 
certain  extent  a  physiological  process,  for  it  is  known  that  in 
embryonic  life  the  gland  is  composed  of  closely  packed  acini, 
lined  with  its  characteristic  cell,  and  that  these  acini  are  empty 
or  have  only  a  cellular  content.  It  is  some  time  after  birth  that 
colloid  is  seen,  first  in  small  amounts,  but  with  the  advancing 
age  of  the  child  this  material  becomes  increased  dilating  the 
individual  vesicles.  The  fact  that  often  in  the  early  stages  of 
this  form  of  hypertrophy  the  nervous  symptoms  are  pronounced 
and  there  may  also  be  palpitation  and  tremor,  leads  frequently 
to  the  diagnosis  of  exophthalmic  goitre.  These  cases,  however, 
never  present  the  symptoms  of  exophthalmus  and  we  should 
therefore  use  care  in  diagnosis.  In  regard  to  these  isolated  and 
encapsulated  tumors  of  the  thyroid  which  histologically  resemble 
the  simple  colloid  hypertrophy  several  interesting  points  arise. 
(Such  a  case  is  reported  by  Bloodgood  and  in  my  recent  studies 
at  the  Bender  Laboratory  at  least  two  similar  cases  have  been 
observed).  In  the  first  place  as  to  the  nature  of  these  tumors. 
If  they  represent  a  simple  hypertrophy  it  is  hard  to  understand 
why  only  a  small  portion  of  the  gland  takes  part  in  the  process. 
It  seems  probable  that  they  may  represent  an  entirely  different 
type  of  lesion.  In  Bloodgood's  case,  that  of  a  colored  girl  aged 
thirty-three,  the  tumor  was  of  four  years'  duration,  making  the 
age  of  onset  twenty-nine.  This  is  rather  late  for  the  beginning 
of  a  simple  hypertrophy.  The  tumor  on  removal  was  found  to 
contain,  in  its  centre,  a  large  amount  of  degenerated  blood  and 
necrotic  tissue.  This,  as  the  author  notes,  would  have  undoubt- 
edly resulted  in  a  hemorrhagic  cyst.  As  the  walls  of  many 
cysts  contain  areas  showing  colloid  hypertrophy,  it  seems  prob- 
able that  the  source  of  origin  of  many  of  the  cysts  may  be  from 
this  type  of  tumor.  In  simple  hypertrophy  it  is  uncommon  to 
find  cysts  of  large  size. 

The  interesting  question  as  to  what  always  exactly  constitutes 
a  malignant  tumor  of  the  thyroid  should  be  considered  here  for 
a  moment.  Bloodgood  (Progressive  Medicine,  December,  1899) 
referring  to  an  article  by  Hansel  (Beitrage  zur  Klinische  Chirur- 
gie,  1899,  Band  24,  Heft  I)  who  reports  a  case  of  simple  colloid 
adenoma,  and  who  collects  all  similar  cases  which  have  hereto- 


ii4 


SCIENTIFIC  REVIEW 


fore  appeared  in  the  literature — eleven  in  all — in  which  there 
were  metastases  to  bone  from  these  primary  thyroid  tumors, 
makes  the  comment  that  "  now  and  then  it  is  known  that  benign 
colloid  adenoma  of  the  thyroid  gives  rise  to  metastases."  If 
these  are  metastatic  tumors  it  seems  a  question  whether  they  can 
be  considered  of  a  benign  nature,  and  then  the  possibility  of 
their  being  due  to  misplaced  embryonic  thyroid  tissue  has  to  be 
borne  in  mind.  The  case  of  adenoma  with  metastases  reported 
from  the  Clinic  of  the  Johns  Hopkins  Hospital  was  histologically 
of  a  somewhat  different  type.  It  occurred  in  a  white  female, 
aged  twenty,  in  which  the  diagnosis  of  tuberculous  glands  of 
the  neck  had  been  made.  The  onset  had  been  two  years  previous, 
when  her  attention  had  been  called  to  a  small  painful  tumor  be- 
neath the  angle  of  the  jaw.  Following  this  other  nodules  made 
their  appearance  on  the  same  side  of  the  neck.  Previous  to 
operation  no  enlargement  of  the  thyroid  gland  was  noted,  but 
during  the  removal  of  what  appeared  to  be  these  tuberculous 
lymphatic  glands  the  lobe  of  the  thyroid  on  the  same  side  was 
found  to  be  enlarged  and  was  removed  and  in  its  centre  was  a 
small  isolated  nodule.  On  microscopical  examination  the  thyroid 
gland  was  found  to  be  normal,  but  the  small  tumor  of  the  thyroid 
and  the  isolated  tumors  of  the  neck  were  found  to  be  composed 
principally  of  tissue  resembling  the  exophthalmic  variety  of 
hypertrophy.  (The  patient  had  presented  exophthalmic  symp- 
toms of  a  mild  type).  Three  years  after  operation  there  was 
no  tendency  apparently  toward  recurrence. 

Exophthalmic  Hypertrophy. — While  there  have  been  many  pub- 
lications of  recent  date  on  this  subject,  notably  those  by  Kocher, 
Dana,  Adami,  Mackenzie  and  Murray,  nothing  has  been  definitely 
established  as  to  its  pathogenesis,  the  main  dispute  being  as  to 
whether  the  disease  is  of  nervous  origin  or  whether  it  has  its  basis 
in  an  abnormal  condition  of  the  gland  itself.  Kocher  is  inclined 
to  accept  the  latter  view,  while  Dana  believes  "  that  the  primary 
disturbance  is  in  the  cerebral  centres  and  particularly  those  which 
control  the  nutrition  of  the  thyroid  and  regulate  the  action  of 
the  circulation." 

Of  late  attention  has  been  directed  to  the  parathyroids  in  re- 
gard to  their  relation  to  this  condition.  The  changes  that  have 
been  found  are  not  at  all  constant.  MacCallum  (The  Patho- 
logical Anatomy  of  Exophthalmic  Goitre,  J.  H.  H.  Bull,  August, 
1905),  in  nine  recent  cases  of  exophthalmic  goitre  in  which  he 


SCIENTIFIC  REVIEW 


examined  the  parathyroid  glands  found  them  practically  normal 
in  all.  In  some  instances  there  was  slight  atrophy  of  cells  and 
some  increase  in  the  interstitial  connective  tissue,  but  these 
changes  he  did  not  consider  sufficiently  extensive  to  warrant  the 
supposition  that  they  had  any  connection  with  the  development 
of  the  disease.  But  whatever  its  pathogenesis  it  presents  as  far 
as  the  glad  itself  is  concerned  a  pretty  definite  and  constant 
pathological  picture.  Halsted's  work  in  this  regard  has  been  one 
of  the  most  important  contributions  to  the  subject.  He  was  able 
to  produce  in  animals  by  the  removal  of  part  of  the  thyroid 
gland  a  compensatory  hypertrophy  of  the  remaining  portion. 
"This  hypertrophy  consists  in  the  disappearance  of  the  colloid 
material,  a  change  in  the  morphology  of  the  thyroid  epithelium 
to  one  of  a  so-called  higher  type,  an  invagination  of  the  wall 
of  the  acinus,  which  gives  a  larger  surface  for  the  epithelial 
lining,  and  proliferation  of  the  epithelial  cells  with  the  formation 
of  typical  intra-acinous  papillomatous  groups"  (Bloodgood). 
This  is  the  exact  picture,  presented  by  the  exophthalmic  hyper- 
trophy. It  can  thus  be  said  to  be  a  true  hypertrophy.  There 
seems  to  have  been  established  also  a  direct  relationship  between 
the  severity  of  the  disease  and  its  duration  and  the  amount  of 
the  hypertrophy  shown  in  the  gland.  The  longer  the  duration 
of  the  disease  the  more  advanced  is  the  hypertrophy.  This  form 
like  the  simple  hypertrophy  seems  to  be,  as  a  rule,  a  diffuse 
process ;  though  Dr.  Halsted  has  recently  (The  Johns  Hopkins 
Hospital  Medical  Society,  May  15,  1905)  called  attention  anew 
to  the  fact  that  various  pathological  lesions  of  the  thyroid,  as 
cysts,  adenomata,  carcinomata  and  even  "normal"  thyroids  often 
give  rise  to  one  or  more  of  the  symptoms  of  exophthalmic  goitre. 
This  has  been  the  experience  of  other  observers,  notably  Mikulicz 
and  Kocher.  It  is  true  also  that  very  frequently,  especially  in 
cysts  which  are  accompanied  by  these  symptoms,  to  find  upon 
careful  search  certain  areas  which  show  definite  exophthalmic 
hypertrophy.  These  facts,  the  establishing  of  the  similarity  in 
the  histology  of  the  compensatory  form  of  hypertrophy  and  the 
exophthalmic  variety  and  the  relationship  between  the  duration 
of  the  clinical  symptoms  and  the  advancement  of  the  hypertrophy 
together  with  the  beneficial  results  that  are  obtained  in  this 
condition  by  removal  of  a  portion  of  the  gland  seems  to  give 
support  to  the  opinions  of  those  who  hold  that  the  disease  is 
caused  by  a  disordered  or  excessive  secretion  of  the  gland  itself. 


n6 


SCIENTIFIC  REVIEW 


With  regard  to  the  amount  of  enlargement  of  the  gland,  most 
observers  have  found  that  while  it  may  be  so  slight  as  to  be 
almost  imperceptible,  it  is  a  fairly  constant  symptom.  Murray 
has  recently  in  his  observation  of  180  cases  found  some  enlarge- 
ment of  the  gland  in  172.    In  five  others  while  there  was  no 
enlargement  at  the  time  of  examination,  the  histories  showed 
that  at  an  early  stage  of  the  disease  there  had  been.    In  the  re- 
maining three,  there  was  no  enlargement  at  the  time  of  examina- 
tion and  no  history  of  any  previous  enlargement  could  be  ob- 
tained.   A  slight  hypertrophy  might  easily  pass  unnoticed  and 
this  author  is  inclined  to  believe  that  if  all  cases  were  observed 
frequently  throughout  the  duration  of  the  disease  some  percepti- 
ble enlargement  of  the  gland  would  be  found  in  practically  all 
cases.    While  the  disease  is  more  frequent  in  women,  it  is  by  no 
means  rare  that  men  are  affected.    The  proportion  as  stated  by 
different  observers  varies  from  three  to  one  to  seventeen  to  one. 
As  regards  the  age  of  onset  the  statistics  are  pretty  uniform.  It 
rarely  develops  before  puberty  or  after  forty  years  of  age.  Most 
cases  probably  arise  between  the  ages  of  twenty  and  thirty.  The 
geographical  distribution  of  this  disease  and  likewise  that  of 
simple  goitre  always  present  points  of  interest.    Moffitt  has  re- 
cently called  attention  to  the  fact  that  exophthalmic  goitre  is 
much  more  common  in  the  counties  about  San  Francisco  Bay 
than  in  other  parts  of  California.    Nowhere  in  this  country,  how- 
ever, do  these  diseases  approach  the  endemic  form  as  occurs  in 
certain  localities  in  Europe,  notably  Geneva  and  the  Pyrennees. 
Of  great  interest  in  this  connection  are  the  recent  observations 
by  Brener  of  Vienna  (Loc.  Cit)  and  Gautier  of  Geneva,  (Revue 
Med.  de  la  Suisse,  Rom.  Vol.  19,  No.  5),  who  have  noted  the 
occurrence  of  the  symptoms  of  exophthalmic  goitre  after  treating 
locally  with  iodine  cases  of  simple  goitre.    Again,  Moffitt  states 
that  he  has  seen  severe  cases  of  iodism  after  small  doses  of 
potassium  iodide  in  patients  with  small  goitres.    The  similarity 
between  the  symptoms  of  severe  iodism  and  exophthalmic  goitre 
have  been  noted  by  a  number  of  observers  (P.  Jaunin,  Revue 
Med.  de  la  Suisse  Rom.  Vol.  19,  No.  5),  (G.  Gautier,  Ibid),  some 
believing  that  chronic  iodism  produces  a  condition  which  cannot 
be  distinguished  from  thyroidism  or  exophthalmic  goitre.  Since 
the  active  principle  of  the  thyroid  secretion  is  an  iodine  com- 
pound (iodothyrin)  it  seems  probable  that  there  may  be  a  close 
association  between  the  two  conditions. 


SCIENTIFIC  REVIEW 


117 


Treatment. — In  the  simple  hypertrophy  as  the  symptoms  pro- 
duced are  mainly  of  a  mechanical  nature  I  believe  all  authorities 
are  now  agreed  that  surgery  offers  the  only  possible  relief  from 
the  condition.  As  all  sorts  of  thyroid  lesions  are  so  frequently 
treated  locally,  one  should  bear  in  mind  the  ill  effects  that  some- 
times arise  from  the  application  of  iodine  to  simple  goitre  We 
only  have  to  glance  at  the  statistics  from  some  of  our  American 
and  foreign  clinics  to  ascertain  how  safe  is  the  modern  surgical 
treatment  of  this  condition.  Kocher  in  his  report  of  his  second 
thousand  cases  of  thyroidectomy,  of  which  929  were  of  this  and 
other  benign  forms,  had  only  four  deaths,  a  mortality  of  0.4  of 
1  per  cent.  The  Mayo's  in  seventy-one  cases  had  only  one  death 
and  that  on  the  eighth  day  from  pneumonia. 

In  regard  to  the  exophthalmic  variety  the  various  drugs  and 
methods  of  treatment  are  almost  innumerable.  In  recent  years 
attempts  have  been  made  in  many  German  clinics  to  develop  a 
specific  treatment  of  exophthalmic  goitre  Lanz,  (Munchener 
Wochenschrift,  No.  4,  1903),  as  early  as  1894  began  the  use  of 
the  milk  of  thvroidectomized  goats  in  patients  with  Basedow's 
disease.   He  has  recently  recorded  favorable  results  in  five  cases. 

Burhart  and  Blumenthal  (Deutsche  Med.  Wochenschrift, 
September  21,  1899),  from  Leyden's  Clinic  have  used  the  blood 
serum  of  myxoedematous  patients,  injecting  it  into  those  suffer- 
ing from  exophthalmic  goitre.  Leyden  reviews  their  results 
and  thinks  they  are  encouraging.  Later  in  this  clinic,  was  intro- 
duced the  use  of  a  precipitate  from  the  milk  of  thyroidectomized 
goats,  called  "rodagin."  A  few  cases  are  recorded  of  slight  im- 
provement after  continued  use  of  this  substance.  Kollaritis 
reports  no  improvement  in  three  cases  in  which  he  employed 
this  method. 

Moebius  and  Schultes  (Muchener  Med.  Wochenschrift,  Nov. 
12,  1901)  have  used  the  serum  of  thyroidectomized  sheep.  This 
serum  is  called  antithyroidin.  In  1901  Moebius  (Loc.  cit.)  re- 
ported three  cases  somewhat  improved  by  this  treatment,  later 
two  other  cases  which  were  benefited.  Schultes  and  Rosenfield 
have  likewise  each  reported  a  case.  In  a  recent  communication 
Moebius  (Munch.  Med.  Wochenschrift,  No.  4,  1903)  speaks 
rather  guardedly  of  the  employment  of  this  serum.  Kuh  (Medi- 
cine, September,  1905)  after  treating  eleven  cases  with  the  serum 
is  unwilling  to  make  any  statement  as  to  its  curative  effect.  He 
thinks  it  relieved  nervousness   and    diminished  tachycardia. 


n8 


SCIENTIFIC  REVIEW 


Against  these  uncertain  results  are  those  of  operative  treatment. 
In  matters  pertaining  to  the  treatment  of  lesions  of  the  thyroid 
gland  we  can  justly  look  to  Kocher  for  advice.  He  insists  that 
all  cases  of  Basedow's  disease,  and  especially  those  in  the  incipient 
stage,  should  submit  to  operation.  Operative  treatment  to  be  of 
the  most  value  should  be  undertaken  early  before  the  damage 
has  been  done  to  the  nervous  system. 

Briefly  considered  the  most  important  surgical  procedures  are 
two ;  partial  thyroidectomy  and  cervical  sympathectomy.  The 
first  is  advocated  by  Kocher  and  is  the  one  now  practiced  by  the 
majority  of  surgeons  throughout  the  world.  Sympathectomy 
was,  I  believe,  first  advocated  by  Jonnesco  and  the  best  published 
results  of  this  operation  are  his  own.  In  seventeen  cases  fifty- 
nine  per  cent,  were  cured,  twenty-nine  per  cent,  improved,  twelve 
per  cent  unimproved,  none  died.  The  best  results  of  partial 
thyroidectomy  yet  published  are  Kocher's,  fifty-nine  cases, 
seventy-six  per  cent,  cured,  seventeen  per  cent,  improved,  six  and 
seven-tenths  per  cent.  dead.  At  the  last  German  Surgical  Con- 
gress, April,  1905,  Friedheim  from  the  Clinic  of  Kiimmel  reported 
the  results  of  twenty  cases  of  partial  thyroidectomy  after  five 
or  more  years  have  elapsed.  Fourteen  were  cured,  two  much 
improved,  three  slightly  improved,  and  one  had  died.  In  seven 
of  the  cured  cases  the  operation  had  been  performed  nine  or  more 
years  previous.  In  one,  fifteen  and  a  half  years.  As  further 
proof  of  the  superioritiy  of  the  operative  treatment,  he  presents 
the  statistics  of  the  other  large  German  clinics  for  the  last 
years,  i.  e. : 


To  these  statistics  may  be  added  those  of  the  Mayo's,  thirty- 
four  cases  with  six  deaths,  and  Halsted's,  "forty-six  cases  with 
symptoms  operated  upon  with  one  death." 

George  E.  Beilby. 


Cases.     Cured.    Improved.  Dead. 


v.  Mikulicz 
Kronlein  .  . 
Kocher  .  .  . 
Konig  .  .  .  . 


18  10  7  1 

24  16  6  2 

59  45  10  4 

8  4  1 


PUBLIC  HEALTH 


119 


public  fcealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 

Department  of  Health — City  of  Albany,  N.  Y. 
Abstract  of  Vital  Statistics,  December,  1905. 
Deaths. 


1901 

1902 

1903 

1904 

1905 

Consumption 

29 

14 

11 

22 

23 

I 

0 

3 

1 

1 

0 

0 

0 

3 

X 

0 

0 

0 

0 

0 

2 

0 

0 

1 

Diphtheria  and  Croup  

5 

4 

2 

2 

1 

1 

1 

1 

1 

0 

Diarrhoeal  Diseases   

1 

1 

1 

1 

1 

11 

14 

13 

IS 

13 

4 

5 

3 

7 

5 

Bright's  Disease   

8 

14 

17 

17 

21 

8 

9 

9 

11 

9 

13 

9 

11 

11 

4 

3 

9 

3 

5 

4 

24 

29 

33 

21 

20 

18 

10 

13 

9 

138 

139 

142 

151 

133 

16.24 

16.36 

6.70 

17.77 

15-53 

Death  rate  less  non-residents  15.65 

1553 

15-41 

16.9S 

14-35 

Deaths  in  Institutions. 

1901 

1P02 

1903 

1904 

1905 

Non 

Non- 

Non- 

Non- 

Non- 

Resi-  resi- 

Resi- resi- 

Resi- 

resi- 

Resi- 

resi-  Reei-  re si- 

dent  dent 

dent  dent 

dent  dent  dent  dent  dent  dent 

.     9  1 

7  5 

10 

5 

6 

3 

8  3 

0  0 

0  0 

0 

0 

0 

0 

1  0 

Albany  Orphan  Asylum  

3  0 

0  0 

0 

0 

0 

0 

O  I 

Child's  Hospital   

0  0 

1  0 

0 

0 

0 

I  0 

Countv  House   

0  1 

1  2 

3 

0 

3 

1 

5  0 

Home  for  Aged  Men  

0  0 

1  0 

1 

0 

0 

0 

0  0 

Homeopathic  Hospital   

1  0 

3  0 

1 

3 

1 

1 

0  1 

0  0 

0  0 

0 

0 

0 

0 

0  0 

House  of  Shelter  

1  0 

1  0 

0 

0 

0 

0 

1  0 

Little  Sisters  of  the  Poor  

0  0 

1  0 

0 

0 

1 

0 

2  0 

Public  Places   

0  1 

0  0 

4 

1 

0 

1 

0  0 

0  0 

0  0 

0 

0 

2 

0 

1  1 

St.  Peter's  Hospital  

2  2 

2  0 

0 

2 

3 

1 

3  4 

•  83 

Still  Births  

8 

Marriages  

•  45 

120 


PUBLIC  HEALTH 


Plumbing  Inspections. 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  one 
hundred  and  nine  inspections  made,  of  which  sixty-one  were  of  old  build- 
ings and  forty-eight  were  of  new  buildings.  There  were  forty-two  iron 
drains  laid,  eighteen  connections  with  street  sewers,  twenty-three  tile 
drains,  two  urinals,  seventy-nine  cesspools,  fifty-five  wash  basins,  sixty- 
one  sinks,  forty-four  bath  tubs,  thirty-two  wash  trays,  nine  hopper 
closets,  seventy-eight  tank  closets,  one  stable  wash  stand  and  one 
shower  bath.  There  were  seventy-three  permits  issued,  of  which  fifty 
were  for  plumbing  and  twenty-three  for  building  purposes.  There  were 
eleven  plans  submitted,  of  which  four  were  of  old  buildings  and  seven 
for  new  buildings.  Eight  houses  tested  on  complaint,  six  with  blue,  red 
and  two  with  peppermint.  Nineteen  water  tests  were  made  and  thirty- 
three  houses  were  examined  on  complaint  and  sixty-nine  were  re- 
examined. Twenty-four  complaints  were  found  valid  and  nine  without 
cause. 

Bureau  of  Contagious  Disease. 
Cases  Reported. 


1901  1902  1903  1904  1905 

Typhoid  Fever    6  8  6  6  2 

Scarlet  Fever    2  9  7  14  14 

Diphtheria  and  Croup   51  25  45  12  10 

Chickenpox   8  22  13  23  3 

Measles   11  1  29  o  1 

Whooping-cough   o  3  0  0  0 

Consumption   2  1  0  2  o 


Total   80         69        100         57  30 

Contagious  Disease  in  Relation  to  Public  Schools. 

REPORTED  DEATHS 
D.         S.  F.  D.        S.  F. 

Public  School  No.  1   1 

Public  School  No.  2   ..  1 

Public  School  No.  3   ..  3 

Public  School  No.  5   ..  1 

Public  School  No.  6   1 

Public  School  No.  8   . .  1 

Public  School  No.  9   1 

Public  School  No.  13   ..  2 

Public  School  No.  14   1 

High  School   1 

Number  of  days  quarantine  for  scarlet  fever: 

Longest  70  Shortest   3         Average          32  21-26 

Number  of  days  quarantine  for  diphtheria: 

Longest          19  Shortest          13  Average   16 


SOCIETY  PROCEEDINGS 


121 


Fumigations : 

Houses   36  Rooms  

Cases  of  diphtheria  reported  

Cases  of  diphtheria  in  which  antitoxin  was  used  

Cases  of  diphtheria  in  which  antitoxin  was  not  used 
Deaths  after  use  of  antitoxin  


66 


10 


9 
1 


1 


Society  Proceedings 


Medical  Society  of  the  County  of  Albany 


A  regular  meeting  of  the  Medical  Society  of  the  County  of  Albany  was 
held  in  the  College  building  Wednesday  evening,  December  13,  1905. 

The  President  called  the  meeting  to  order  at  9  p.  m. 

There  were  present:  Drs.  Baldauf,  Bedell,  Beilby,  Blair,  Gutmann, 
Hacker,  W.  L.  Hale,  Holding,  Lempe,  Lomax,  Merrill,  C.  H.  Moore, 
Munson,  O'Leary,  Jr.,  Rooney,  Traver,  Wiltse. 

Dr.  Bedell  moved  that  the  minutes  be  accepted  as  printed  in  the 
Annals.    Seconded.  Carried. 

The  Secretary  read  the  notice  of  approaching  consolidation  of  the  State 
Society  and  the  State  Association. 

Dr.  Lempe  read  a  paper  on  acute  osteomyelitis  which  will  appear  in  the 
Annals. 

Dr.  Beilby  said  that  this  case  of  Dr.  Lempe's  impressed  one  with  the 
importance  of  early  diagnosis.  It  seemed  to  him  that  this  case  was  one 
of  a  primary  slight  localized  area  of  infection,  with,  perhaps,  a  severe 
secondary  infection  by  another  organism. 

Of  the  recent  articles  on  this  subject  that  of  Nichols  is  the  best.  His 
treatment  may  almost  be  termed  revolutionary.  He  advises  early  opera- 
tion to  liberate  pus,  first  carefully  opening  the  periosteum  by  incision 
before  attacking  the  medulla.  Much  care  is  taken  to  preserve  the 
periosteum  intact  to  aid  in  forming  new  bone  after  the  separation  of  the 
sequestrum.  An  early  secondary  operation  is  also  advised;  not  waiting 
for  a  formation  of  a  firm  involucrum,  but  removing  the  sequestrum  early 
and  by  careful  coaptation  of  the  periosteum  depending  on  these  efforts 
for  the  formation  of  a  new  shaft.  This  greatly  shortened  the  period  of 
discharging  sinuses. 

Dr.  Traver  spoke  of  a  case  of  difficulty  in  diagnosis  in  which  the 
patient,  a  boy,  fell  out  of  bed  injuring  his  shoulder.  At  least  that  was 
the  history  of  the  boy.  An  examination  under  ether  was  made  which 
revealed  nothing.   The  arm  was  held  fixed  and  motion  was  painful.  There 


122 


MEDICAL  NEWS 


were  tenderness  and  swelling  in  the  neighborhood  of  the  shoulder.  A 
tentative  diagnosis  of  rheumatism  was  made.  About  three  weeks  later 
the  shoulder  was  explored  and  a  focus  of  osteomyelitis  was  found  in  the 
head  of  the  humerus,  which  had  broken  into  the  shoulder  joint  and  led 
to  its  disorganization. 

Dr.  Wiltse  asked  whether  in  the  cases  seen  by  Dr.  Lempe  or  Dr.  Traver 
any  point  was  found  which  might  furnish  entrance  for  bacteria. 

Dr.  Lempe  replied  in  the  negative,  saying  that  at  first  the  case  was  sup- 
posed to  be  one  of  neuromimesis. 

Dr.  Traver  said  that  the  boy  said  that  he  had  injured  his  shoulder,  but 
that  there  was  no  evidence  of  traumatism. 

Dr.  Blair  read  a  paper  on  the  medical  essays  of  Oliver  Wendell  Holmes. 

The  President  thanked  Dr.  Blair  in  the  name  of  the  Society  for  his 
excellent  and  interesting  address,  and  hoped  that  there  might  be  others 
of  the  same  kind  read  oftener  in  the  future. 

Dr.  Rooney  expressed  his  appreciation  of  the  paper,  and  spoke  of  the 
treatment  Semmelweiss  received  in  being  hounded  from  his  positions, 
ostracised  from  the  profession  and  dying  in  an  insane  asylum  as  a  result 
of  his  persecution.  Holmes  was  by  far  the  more  fortunate,  as  he  lived 
to  see  his  work  credited  and  recognized. 

On  motion,  the  Society  adjourned.         James  F.  Rooney,  Secretary. 

[Minutes  received  for  publication  December  29,  1905.] 


ZlDeMcal  news 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick. — Statistics  for 
December,  1905. — Number  of  new  cases,  88,  classified  as  follows :  district 
cases  reported  by  health  physicians,  6;  charity  cases  reported  by  other 
physicians,  39 ;  patients  of  limited  means,  39 ;  old  cases  still  under  treat- 
ment, 43;  total  number  of  patients  under  nursing  care  during  the  month, 
131.  Classification  of  diseases  (new  cases),  medical,  20;  surgical,  7; 
gynaecological,  3 ;  obstetrical  work  of  the  Guild,  28  mothers  and  26  infants 
under  professional  care ;  dental,  3 ;  throat  and  nose,  1 ;  contagious  diseases 
in  medical  list,  3;  removed  to  hospitals,  2;  deaths,  4. 

Special  Obstetrical  Department:  Number  of  obstetricians  in  charge  of 
cases,  2 ;  attending  obstetricians,  1 ;  medical  students  in  attendance,  4 ; 
Guild  nurses,  4;  cases,  3;  number  of  visits  by  head  obstetricians,  4;  by 
attending  obstetricians,  6;  by  the  medical  students,  10;  the  Guild  nurses, 
(all  departments),  number  of  visits  with  nursing  treatment,  870;  for  the 
professional  supervision  of  convalescents,  220;  total  number  of  visits, 
1090;  six  graduate  nurses  and  3  assistant  nurses  were  on  duty.  Cases 
were  reported  to  the  Guild  by  one  of  the  health  physicians  and  by  30 
other  physicians  and  by  three  dentists. 


MEDICAL  NEWS 


Lincoln  Hospital  in  New  York  City. — The  managers  of  the  Lincoln 
Hospital,  East  141st  Street  and  Southern  Boulevard,  New  York  City, 
announce  that  Dr.  Louis  Faugeres  Bishop,  is  giving  a  series  of  Clinical 
Lectures  in  the  Medical  Wards.  Special  reference  to  disorders  of  the 
heart  and  circulation  and  the  commoner  diseases  of  general  practice  on 
Wednesday  afternoons,  commencing  December  27,  1905,  at  two  o'clock. 
The  course  is  free  to  the  medical  profession. 

Coroner's  Physicians  of  Albany  County. — The  Albany  County  Board 
of  Supervisors  on  December  20,  1905,  re-elected  Dr.  Alvah  H.  Traver  of 
Albany,  Dr.  James  F.  Rooney  of  Albany,  Dr.  Charles  L  Witbeck  of 
Cohoes,  and  Dr.  William  E.  Silcocks  of  Green  Island,  coroner's  physi- 
cians. 

New  York  State  Association  for  Promoting  the  Interest  of  the 
Blind. — The  first  public  meeting  of  this  Association  will  be  held  in  New 
York,  March  29th,  at  which  Mr.  Clemens  (Mark  Twain)  will  preside 
and  Hon.  Joseph  H.  Choate  and  Helen  Keeler  will  speak.  The  Asso- 
ciation was  formed  to  extend  the  efficiency  of  services  already  given  the 
blind. 

Albany  Hospital. — The  Board  of  Governors  of  the  Albany  Hospital 
are  contemplating  many  building  improvements.  A  separate  building  with 
larger  and  more  suitable  accommodations  for  the  exclusive  use  of  nurses 
will  probably  be  first  considered.  The  present  nurses'  home  will  be  used 
for  ordinary  hospital  purposes  while  the  space  used  in  ambulance  pavilion 
it  is  hoped  to  employ  for  ambulance  patients  and  also  lecture  rooms  for 
physicians. 

The  pavilion  for  contagious  diseases  which  the  city  has  presented  is 
completed  and  equipped  ready  for  occupancy.  The  building  stands  north 
of  the  main  plant  and  is  the  same  general  style  of  architecture,  two  stories 
high.  Each  floor  is  divided  into  four  distinct  compartments  in  order  to 
ensure  complete  isolation.  Each  of  these  compartments  has  its  own 
kitchen,  serving  room  and  lavatory,  wash  stands  of  course  not  being  used. 
The  laundry,  storeroom,  servants'  quarters  and  sterilizing  rooms  are  in 
the  basement.  About  three-fourths  of  the  second  floor  remains  unparti- 
tioned  and  will  probably  be  used  for  the  nurses'  dormitory.  Dr.  Arthur 
Sautter  will  be  in  charge.  Small-pox  patients  will  not  be  admitted,  a 
separate  building  being  used  for  that  purpose. 

A  successor  for  Superintendent  Godley,  who  recently  resigned,  has  not 
yet  been  appointed. 

Union  University.— At  the  regular  meeting  of  the  Board  of  Trustees 
of  the  Union  University  held  at  the  Albany  Medical  College,  January  23rd, 
the  endowment  fund  committee  made  a  very  encouraging  report  of  its 
efforts  to  raise  $100,000,  to  secure  Andrew  Carnegie's  gift  of  $100,000. 

A  canvass  of  the  graduates  of  the  Union  University  is  to  be  made  and 
it  is  hoped  that  the  desired  amount  will  be  secured  by  next  June. 


I24 


MEDICAL  NEWS 


Civil  Service  Examinations  for  State  and  County  Service. — The 
State  Civil  Service  Commission  announces  examinations  to  be  held  on 
February  17,  1906,  for  the  following  positions : 

Architectural  Draughtsman,  $15  to  $25  a  week;  Architectural  Designer, 
$25  to  $40  a  week;  Assistant  Civil  Engineer;  Leveler;  Civil  Engineering 
Draughtsman;  Assistant  Electrical  Engineer;  Cooking  Instructor;  Fore- 
man of  Laborers,  Department  of  Public  Buildings,  Albany,  $1,500;  Super- 
intendent for  Placing  Dependent  Children,  Ononadaga  County,  $900;  Tele- 
phone Operator,  New  York  County  Offices,  $720;  Trained  Nurse,  State 
Institutions,  $420  to  $600  and  maintenance. 

The  last  day  for  filing  applications  for  these  examinations  is  February 
12th. 

The  Commission  also  announces  an  examination  to  be  held  about  March 
1st,  for  Pathologist  at  the  Craig  Colony  for  Epileptics  at  $2,500  and  main- 
tenance. 

Application  forms  and  detailed  information  may  be  obtained  by  address- 
ing the  Chief  Examiner  of  the  Commission  at  Albany. 

Personals. — Dr.  Alva  E.  Abrams  (A.  M.  C,  1880),  was  elected  Presi- 
dent of  the  Hartford  City  Medical  Society,  Hartford,  Conn.,  at  its  recent 
meeting. 

— Dr.  Frank  Hinkley  (A.  M.  C,  1898),  has  been  appointed  house 
physician  at  Manhattan  State  Hospital,  Central  Islip,  N.  Y. 

— Dr.  Eugene  E.  Hinman  (A.  M.  C,  1899),  has  given  up  his  position 
with  the  Equitable  Life  Assurance  Co.,  and  will  open  his  offices  at  No. 
202  Lark  Street,  Albany,  N.  Y.  He  will  do  general  practice  paying  special 
attention  to  nose  and  throat  cases. 

— Dr.  Gerald  Griffin  (A.  M.  C,  1901),  recently  purchased  the  residence 
No.  140  Washington  Avenue,  Albany,  N.  Y.,  and  will  open  his  offices 
there  May  1st. 

— Dr.  Geo.  H.  Van  Gasbeek  (A.  M.  C,  1893),  was  recently  appointed 
attending  surgeon  at  Benedictine  Hospital,  Kingston,  N.  Y. 

— Dr.  Frank  Keator  (A.  M.  C,  1903),  has  been  appointed  attending 
surgeon  at  Benedictine  Hospital,  Kingston,  N.  Y.,  and  has  opened  offices 
at  No.  249  Broadway,  Kingston,  N.  Y. 


Deaths. — Dr.  Norman  B.  Sherman  (A.  M.  C,  1861),  died  suddenly 
at  the  age  of  63  years,  December  22,  1905,  at  his  home  in  Marshall,  Mich. 

— Dr.  Selwyn  A.  Russell  (A.  M.  C,  1877),  died  at  his  home,  Mill 
Street,  Poughkeepsie,  N.  Y.,  January  10,  1906.  He  had  been  physician  in 
several  of  the  State  hospitals.  He  practiced  for  a  time  in  Albany,  N.  Y., 
and  married  the  only  daughter  of  Hamilton  Harris.    Two  children  survive. 


IN  MEMORIAM 


In  fl&emortam 

Abisha  Shumway  Hudson,  M.  D. 

Dr.  Abisha  Shumway  Hudson  died  at  Mount  Vernon,  Ohio,  October 
9,  1905,  of  the  infirmities  of  old  age,  the  immediate  cause  of  death  being 
oedema  of  the  glottis. 

Dr.  Hudson  was  born  in  Massachusetts  May  I,  1819.  After  receiving 
a  common  school  education  he  entered  the  Albany  Medical  College,  and 
was  graduated  in  January,  1846.  His  twin  brother,  Dr.  Abijah  T.  Hudson, 
graduated  in  the  following  class,  and  was  also  an  energetic  and  promi- 
nent plrysician.  His  death  occurred  in  Stockton,  Cal.,  February  2,  1902, 
and  a  memorial  tribute  was  published  in  the  Albany  Medical 
Annals  of  April  of  that  year.  The  brothers  were  associated  in  practice, 
and  Dr.  Abijah  had  also  a  most  creditable  Civil  War  record.  Shortly 
after  his  graduation  Dr.  Abisha  Hudson  located  at  Sterling,  111.,  where  he 
practiced  his  profession  with  marked  success  for  a  period  of  twenty  years. 
He  became  very  prominent  in  medical  circles  while  residing  at  Sterling, 
and  his  fame  extended  over  the  United  States.  He  was  one  of  the 
organizers  of  the  Keokuk  Medical  College  of  Keokuk,  Iowa,  and  was 
a  member  of  its  faculty.  He  was  also  a  member  of  the  faculty  of 
Rush  Medical  College  of  Chicago. 

During  the  Civil  War  he  served  as  surgeon  of  the  Thirty-fourth  Illinois 
Infantry. 

In  1871  Dr.  Hudson  moved  to  Stockton,  Cal.,  and  later  to  Oakland, 
in  the  same  State.  Owing  to  the  failure  of  his  health,  he  retired  from 
the  active  practice  of  his  profession. 

Dr.  Hudson  married  Miss  Rose  Elliot  of  Mount  Vernon,  Ohio, 
on  May  2,  1853,  and  to  them  one  child  was  born,  Lyal  E.  Hudson,  who, 
like  his  father,  became  a  physician,  and  who  died  while  in  active  practice 
January  6,  1879. 

In  1899  Dr.  and  Mrs.  Hudson  went  to  Mount  Vernon  to  live  and 
made  this  city  their  home, 

While  engaged  in  the  active  practice  of  his  profession,  Dr.  Hudson 
possessed  one  of  the  brightest  medical  minds  in  the  country,  and  was 
known  by  reputation  to  the  medical  profession  throughout  the  country. 
He  was  not  only  prominently  connected  with  the  Rush  Medical  College 
and  the  Keokuk  Medical  College,  but  was  a  liberal  contributor  to  current 
medical  literature  and  scientific  publications. 


126 


CURRENT   MEDICAL  LITERATURE 


Current  flDefctcal  Xtterature 

REVIEWS  AND  NOTICES  OF  BOOKS 

Manual  of  Chemistry.    A  Guide  to  Lectures  and  Laboratory  work  for 
Beginners  in  Chemistry.    A  Text-book  especially  adapted  for  Stu- 
dents of  Medicine,  Pharmacy  and  Dentistry.    By  William  Simon, 
Ph.D.,  M.  D.,  Professor  of  Chemistry  in  the  College  of  Physicians 
and  Surgeons  of  Baltimore,  and  in  the  Baltimore  College  of  Dental 
Surgery,  etc.    New  (8th)  Edition,  thoroughly  revised  to  conform 
with  the  eighth  decennial  revision  of  the  U.  S.  Pharmacopceia.  In 
one  octavo  volume  of  643  pages,  with  66  engravings,  8  colored  plates 
representing  64   important  chemical   reactions,   and   one  colored 
spectra  plate.    Cloth,  $3.00  net.    Lea  Brothers  &  Co.,  Publishers, 
Philadelphia  and  New  York,  1905. 
After  thorough  revision  this  well-known  manual  reappears  in  its  eighth 
edition.    Although  the  general  arrangement  of  the  subject  matter  remains 
intact,  the  various  chapters  have  been  altered,  enlarged  and  in  some  in- 
stances entirely  rewritten  in  order  that  the  text  might  be  brought  into 
conformity  to  modern  views.    More  detailed  consideration  is  given  to 
dental  metallurgy  and  the  additions  and  changes  to  the  recent  Phar- 
macopceia are  incorporated.    As  a  whole  the  book  presents  the  general 
subject  of  chemistry  in  a  manner  which,  in  regard  to  the  amount  of  space 
devoted  to  the  various  branches,  is  extremely  well-balanced. 

h.  c.  j. 


The  Treatment  of  Fractures;  with  Notes  on  a  Few  Common  Dislocations. 
By  Charles  L.  Scudder,  M.  D.,  Surgeon  to  the  Massachusetts  Gen- 
eral Hospital.    Fifth  Edition,  Revised  and  Enlarged.    Octavo  of 
563  pages,  with  739  original  illustrations.    Philadelphia  and  London : 
W.  B.  Saunders  &  Company,  1905.    Polished  buckram,  $5.00  net; 
half  morocco,  $6.00  net. 
The  appearance  of  this  volume  in  its  fifth  edition,  the  first  edition  having 
been  published  in  1900,  is  the  best  evidence  of  its  general  popularity.  The 
author  originally  started  out  with  the  idea  that  he  would  present  as 
accurately  and  completely  as  possible  the  symptoms  and  the  best  methods 
of  treatment  of  fractures,  comparatively  little  attention  being  paid  to  the 
etiological  or  pathological  features.    To  this  original  principle  he  has 
adhered  in  each  new  edition,  and  in  the  present  volume  he  presents  all 
that  is  best  in  the  diagnosis  and  treatment  of  practically  all  forms  of 
fractures  that  may  occur  in  the  human  body. 

The  volume  is  subdivided  into  21  chapters,  the  first  fifteen  of  which  deal 
with  the  individual  fractures.  In  each  variety  of  fracture  the  important 
symptoms  are  briefly  enumerated,  and  following  this  is  a  more  or  less 
detailed  discussion  of  the  most  approved  method  of  treatment.  After- 
treatment,  complications  and  prognosis  also  receive  due  consideration. 
In  chapter  16  the  more  important  anatomical  facts  connected  with  the 


CURRENT  MEDICAL  LITERATURE 


127 


epiphysis  are  presented  and  the  relative  frequency  of  separation  of  the 
different  epiphyses  discussed. 

Gunshot  fracture  of  bone  is  the  subject  of  chapter  17,  wherein  the 
important  clinical  features  and  the  treatment  are  outlined. 

Chapter  18,  written  by  Dr.  Codman,  is  an  excellent  presentation  of  the 
important  facts  concerning  the  Rontgen  ray  and  its  relation  to  fractures, 
and  anyone  who  may  have  occasion  to  interpret  radiographs  should  read 
this  chapter. 

In  chapter  19  the  methods  of  use  of  plaster  of  paris  in  the  treatment  of 
fractures  are  outlined  and  numerous  points  in  the  technique  of  its  em- 
ployment emphasized. 

Chapter  20  deals  with  a  subject  which  is  progressively  attracting  more 
attention,  namely,  the  ambulatory  treatment  of  fractures.  The  author 
does  not  believe  that  this  method  accomplishes  all  that  is  claimed  for  it, 
but  rather  prefers  the  early  use  of  plaster  of  paris  in  fractures  of  the  leg, 
and  plaster  of  paris  or  some  hip  splint  in  fractures  of  the  thigh,  thus 
allowing  the  patient  to  be  out  of  bed  comparatively  soon  after  the  occur- 
rence of  the  fracture. 

The  volume  closes  with  a  chapter  upon  the  symptoms  and  treatment  of 
a  few  of  the  more  important  dislocations.  In  all  there  are  563  pages  of 
subject  matter,  and  the  illustrations,  of  which  there  are  739,  are  the  best 
in  any  volume  upon  the  subject  of  fractures  in  the  English  language. 
In  fact,  one  of  the  strongest  features  of  the  work  are  the  illustrations, 
which  are  so  accurate  and  so  well  executed  as  often  to  make  the  subject 
matter  almost  superfluous.  To  the  student,  the  practitioner  of  medicine 
and  the  surgeon  the  volume  will  prove  invaluable,  and  if  the  principles 
regarding  treatment  are  adhered  to  there  will  be  far  fewer  bad  results. 
The  publishers  are  also  entitled  to  a  great  deal  of  credit  for  a  splendid 
example  of  the  highest  type  of  medical  book  making.  a.  w.  e. 


Atlas  and  Text-Book  of  Topographic  and  Applied  Anatomy.  By  Prof. 
Dr.  O.  Schultze,  of  Wiirzburg.  Edited,  with  additions,  by  George 
D.  Stewart,  M.  D.,  Professor  of  Anatomy  and  Clinical  Surgery, 
University  and  Bellevue  Hospital  Medical  College,  New  York. 
Large  quarto  volume  of  187  pages,  containing  25  figures  on  22 
colored  lithographic  plates,  and  89  text-cuts,  60  in  colors.  Phila- 
delphia and  London:  W.  B.  Saunders  &  Company,  1905.  Cloth, 
$5-50  net. 

It  is  naturally  impossible  to  present  anything  especially  new  in  the  way 
of  gross  anatomy,  and  about  the  only  opportunity  for  the  demonstration 
of  originality  is  in  the  method  of  consideration  and  presentation  of  the 
subject.  In  this  volume  the  author  has  endeavored  to  present  to  the 
student  or  medical  man  the  most  important  practical  features  of  gross 
anatomy.  Detail  has  necessarily  been  omitted  and  the  subject  matter 
condensed  as  much  as  possible.  The  entire  subject  is  considered  in  six 
chapters:  the  first  dealing  with  the  Head,  the  second  with  the  Upper 
Extremity,  the  third  with  the  Thorax,  the  fourth  with  the  Abdomen,  the 
fifth  with  the  Pelvis,  and  the  sixth  with  the  Lower  Extremity.   At  the  end 


128 


CURRENT  MBDICAL  LITERATURE 


of  each  chapter  is  appended  a  list  of  so-called  "  review  questions,"  the 
object  of  which  is  to  call  especial  attention  to  the  most  salient  features 
of  the  chapter  presented.  The  volume  contains  189  pages  of  subject 
matter,  22  lithographic  plates  and  89  text  cuts,  60  of  which  are  in  colors. 
The  cuts,  especially  the  colored  ones,  cannot  be  too  highly  commended, 
and  demonstrate  the  highest  type  of  the  illustrator's  art.  The  subject 
matter  is  very  clear  and  concise  and  the  more  important  medical  and 
surgical  features  connected  with  the  parts  described  are  briefly  referred 
to,  so  that  the  volume  has  much  the  value  of  a  medical  or  surgical 
anatomy.  The  volume  cannot  be  too  highly  commended  to  both  the 
medical  student  and  the  medical  practitioner,  for  in  no  other  work  of 
its  size  are  all  the  essentials  of  regional  anatomy  so  clearly  set  forth. 

a.  w.  E. 


The  Diagnostics  of  Internal  Medicine.  A  Clinical  Treatise  upon  the 
Recognized  Principles  of  Medical  Diagnosis,  Prepared  for  the  Use 
of  Students  and  Practitioners  of  Medicine.  By  Glentworth  Reeve 
Butler,  Sc.  D.,  M.  D.  With  Five  Colored  Plates  and  Two  Hundred 
and  Eighty-six  Illustrations  and  Charts  in  the  Text.  Second  Re- 
vised Edition.    New  York  and  London:    D.  Appleton  &  Co.  1905. 

The  exhaustion  of  the  first  edition  of  this  work,  which  has  been  re- 
printed several  times,  shows  that  it  has  proved  itself  of  value  to  the 
student  and  practitioner.  The  arrangement  of  the  subject-matter  remains 
the  same  as  in  the  first  edition,  but  it  has  been  carefully  revised  and  a 
new  section  has  been  written  by  Dr.  William  A.  White  on  Diseases  of 
the  Mind,  and  one  on  Medical  X-Ray  Diagnosis  has  been  contributed  by 
Dr.  Paul  M.  Pilcher. 

The  book  is  divided  into  two  parts,  which  are  complementary  to  each 
other,  as  the  first  part  deals  with  the  evidences  of  disease  and  the  second 
with  direct  and  differential  diagnosis.  The  first  part  forms  by  itself  a 
treatise  on  undirect  diagnosis  consisting  of  714  pages,  in  which  there  are 
considered  the  various  symptoms  and  their  diagnostic  significance,  practical 
points  in  the  anatomy  and  physiology  of  important  organs  and  descriptions 
of  methods  of  physical  examination  and  laboratory  investigation.  There 
are  in  this  portion  of  the  book  many  valuable  points  in  regard  to  history 
taking  and  the  exact  observation  of  signs  of  disease.  In  considering 
general  symptoms  the  causes  are  given  and  also  the  diseases  in  which 
they  occur,  so  that  the  second  part  of  the  book  can  be  referred  to  for 
other  symptoms  of  the  disease  suggested.  The  different  regions  of  the 
body  are  taken  up,  and  in  connection  with  them  special  methods  of 
examination  are  fully  described.  The  section  on  the  examination  of  the 
circulatory  system  contains  a  good  analysis  of  the  character  and  time 
relations  of  normal  and  abnormal  heart  sounds,  and  includes  descriptions 
of  the  use  of  the  sphygmomanometer  and  sphygmograph.  Methods  of 
examination  of  the  nervous  system,  of  the  blood,  sputum,  stomach  con- 
tents, feces,  urine  and  of  fluids  obtained  by  puncture,  are  all  fully  de- 
scribed, as  well  as  kryascopy  and  the  use  of  the  Rontgen  light  in  medical 
diagnosis. 


CURRENT  MEDICAL  LITERATURE 


129 


In  part  two  diseases  are  taken  up  and  the  symptoms  and  diagnosis  or 
differential  diagnosis  of  each  are  given,  and  in  many  of  them  the  causes, 
complications,  sequelae  and  prognosis  are  included.  References  are  made 
to  the  descriptions  of  methods  of  examination  and  investigation  in  part 
one.  In  the  section  on  diseases  of  the  mind  Dr.  White  briefly  describes 
the  general  symptomatology  of  the  psychoses  and  then  the  different  dis- 
eases. He  gives  a  modern  classification,  but  says  that  it  is  to  be  con- 
sidered as  tentative  and  as  affording  clinical  and  descriptive  advantages 
rathen  than  as  in  any  sense  final. 

The  book  can  be  highly  recommended  as  a  useful  reference  work.  It 
has  been  carefully  written  and  revised,  and  in  it  a  great  amount  of  in- 
formation is  given  in  a  systematic  way.  Nothing  seems  to  be  omitted 
which  can  aid  in  the  careful  consideration  of  the  history  of  a  case,  in 
the  physical  examination  of  the  patient  or  in  making  the  laboratory  tests 
required  for  exact  diagnosis.  The  illustrations  are  numerous,  and  many 
of  them  are  photographic  reproductions  upon  which  the  outlines  of  in- 
ternal organs  are  drawn  or  physical  signs  are  marked.  Many  of  the 
diagrams  are  excellent  and  helpful  to  the  reader,  such  as  those  illus- 
trating the  cardiac  cycle  and  the  types  of  movement,  and  the  colored  plates 
showing  the  motor  and  sensory  pathways.  r.  g.  c. 


Clinical  Treatises  on  the  Pathology  and  Therapy  of  Disorders  of  Metabol- 
ism and  Nutrition.  By  Professor  Dr.  Carl  von  Noorden.  Part  VII. 
Diabetes  Mellitus.  Its  Pathological  Chemistry  and  Treatment. 
New  York :  E.  B.  Treat  &  Co.  1905. 
This,  the  seventh  volume  in  the  series  dealing  with  disorders  of 
metabolism  and  nutrition,  treats  in  von  Noorden's  clear  way,  of  certain 
aspects  of  diabetes.  The  subject  matter  of  the  book  was  originally 
delivered  as  a"' course  of  lectures  in  the  University  and  Bellevue  Medical 
College,  and  it  is  evident  from  the  avoidance  of  disputed  points  and 
doubtful  theories  that  the  writer  realized  that  part  of  his  audience  was 
composed  of  medical  students.  The  first  part  of  the  book  is  taken 
up  with  a  consideration  of  the  pathological  chemistry  of  glycosuria.  Both 
the  glycosuria  of  diabetes  and  that  due  to  other  causes  is  carefully  con- 
sidered, and  the  matter  is  made  so  clear  that  it  should  be  possible  for 
any  one  reasonably  familiar  with  the  subject  to  comprehend  it,  and 
avoid  the  mistake,  so  often  made,  of  calling  every  patient  with  sugar  in 
his  urin«.  a  diabetic.  The  second  part  of  the  book  takes  up  the  general 
course  and  prognosis  of  the  disease,  the  more  important  complications, 
and  the  treatment.  The  whole  volume  is,  in  a  sense,  an  epitome  of  the 
author's  larger  monograph  on  the  subject,  or  at  any  rate  of  certain 
portions  of  it  of  importance  to  the  practitioner.  The  chapters  on  treat- 
ment are  of  special  value,  as  they  give  clearly  what  is  practically  an 
epitome  of  the  whole  subject  illuminated  by  the  large  experience  of  the 
author.  The  question  of  treatment  by  drugs,  at  health  resorts,  and  by 
dietetic  measures  is  carefully  considered,  and  the  latter  part  of  the  sub- 
ject is  made  doubly  useful  by  diet  lists.    In  no  disease  is  adherence  to 


130  CURRENT  MEDICAL  LITERATURE 

certain  dietary  standards  more  necessary,  and  in  but  few  books  is  the 
subject  discussed  so  satisfactorily.  We  can  highly  commend  this  little 
work  to  those  interested  in  this  common  disease,  and  especially  to  those 
who  desire  detailed  directions  as  to  the  dietetic  treatment.  G.  b. 


A  Treatise  on  Diagnostic  Methods  of  Examination.  By  Prof.  Dr.  H. 
Sahli,  of  Bern.  Edited,  with  additions,  by  Francis  P.  Kinnicutt, 
M.  D.,  Professor  of  Clinical  Medicine,  Columbia  Univesity,  N.  Y. ; 
and  Nath'l  Bowditch  Potter,  M.  D.,  Visiting  Physician  to  the  City 
Hospital  and  to  the  French  Hospital;  and  Consulting  Physician  to 
the  Manhattan  State  Hospital,  N.  Y.  Philadelphia  and  London: 
W.  B.  Saunders  &  Company,  1905.  Octavo  of  1,008  pages,  profusely 
illustrated.    Cloth,  $6.50  net;  Half  Morocco,  $7.50  net. 

The  character  of  Professor  Sahli's  book  is  indicated  by  the  well  chosen 
title,  "  Diagnostic  Methods,"  by  which  it  is  shown  to  be  a  treatise  upon 
symptoms,  and  not  a  manual  of  differential  diagnosis.  As  a  work  of 
reference  for  clearing  the  obscure  points  in  doubtful  diagnosis  it  could 
not  be  used.  It  is,  more  exactly,  a  commentary  upon  methods  of  observa- 
tion and  the  philosophy  of  morbid  appearances,  and  is  thus  a  storehouse 
of  semeiological  culture.  Only  incidentally  and  occasionally  are  symptoms 
grouped.  For  the  student  the  book  is  suggestive  and  for  the  practitioner 
it  affords  opportunity  for  review  and  recasting  of  his  ideas  after  con- 
sideration of  the  work  of  a  master.  And  yet,  though  nothing  but  the 
highest  eulogium  can  be  expressed  upon  Professor  Sahli's  diagnosis,  it 
must  be  acknowledged  that  the  manipulations  he  describes  cannot  be  car- 
ried on  outside  a  highly  organized  clinic.  Many  chemical  procedures,  for 
example,  are  complicated,  difficult  and  require  expert  knowledge.  And 
these  are  not  all  conclusive.  Although  more  than  sixty  changes  in  subject 
matter  have  been  made  in  the  fourth  German  edition,  there  has  been  no 
enlargement,  because,  as  the  author  confesses,  some  of  the  older  methods 
have  not  stood  the  test  of  time.  There  is  much  to  discourage  a  prac- 
titioner, even  if  he  be  ambitious  to  move  beyond  a  daily  routine,  in  the 
discovery  that  the  smooth  surface  of  intellectual  precision  conceals  a 
structure  corroded  by  doubt.  The  reader  is  justified  in  the  regret  that 
the  independence  of  the  author  was  not  carried  to  the  exclusion  of  ques- 
tionable or  experimental  procedures.  Inquiry  into  the  viscosity  and  the 
chemical  examination  of  the  blood  are  not  only  preliminary,  but  involve 
the  use  of  apparatus  which  is  only  available  in  a  large  clinic  and  by 
trained  observers.  This  comment  may  also  be  made  upon  certain  com- 
plicated analyses  of  the  urine  and  of  the  contents  of  the  stomach  and  in- 
testines. Professor  Sahli  deprecates,  in  a  way,  medical  journal  literature, 
and  believes  that  text  books  should  not  be  compiled  from  them.  But 
in  exploiting  tentative  investigations,  in  successive  editions,  his  book 
becomes  in  part  evanescent,  and  partakes  of  the  character,  though  not  of 
the  form,  of  a  periodical. 

In  the  sections  given  to  physical  diagnosis,  this  criticism  is  not  valid. 
These  descriptions  and  the  author's  philosophy  of  morbid  appearances 
should  be  carefully  considered  by  every  medical  man.    The  chapters  on 


CURRENT   MEDICAL  LITERATURE 


diseases  of  the  chest  are  particularly  clear.  The  nervous  system  is  ap- 
proached from  a  new  standpoint,  and  the  work  upon  sensory  disturbances 
is  entirely  novel  and  suggestive. 

On  the  whole  Professor  Sahli's  book  bears  the  impress  of  originality. 
It  reveals  a  distinct  individuality.  In  freedom  from  convention  and 
independence  of  thought  it  is  a  striking  volume  and  one  a  careful  physician 
cannot  afford  to  neglect.  It  has  not  been  injured  in  the  translation,  and 
the  sense  of  the  author  has  been  preserved  without  the  adoption  of  awk- 
ward German  idioms. 


The  Principles  of  Bacteriology.  A  Practical  Manual  for  Students  and 
Physicians.  By  A.  C.  Abbott,  M.  D.,  Professor  of  Hygiene  and 
Bacteriology,  and  Director  of  the  Laboratory  of  Hygiene  in  the 
University  of  Pennsylvania.  New  (7th)  Edition,  enlarged  and 
thoroughly  revised.  In  one  i2mo  volume  of  689  pages  with  100 
illustrations,  of  which  24  are  colored.  Cloth  $2.75  net.  Lea 
Brothers.  &  Co.,  Publishers,  Philadelphia  and  New  York,  1905. 

The  first  edition  of  Dr.  Abbott's  book  appeared  in  1891,  and  at  once 
supplied  a  serious  need  of  students  and  beginners  in  the  then  compara- 
tively recent  field  of  bacteriology.  Since  that  time  by  revisions  and  new 
editions  this  valuable  manual  has  been  kept  apace  with  the  marked  ad- 
vances made  in  this  branch  of  medical  science,  and  at  the  same  time  the 
interests  of  the  student  have  been  safeguarded  by  omitting  unproved 
theories  and  introducing  into  the  revisions  only  those  discoveries  and 
methods  which  have  added  real  knowledge  to  the  subject. 

Within  the  past  two  years  since  the  appearance  of  the  sixth  edition, 
much  has  been  accomplished  in  certain  fields,  and  Dr.  Abbott  has  recog- 
nized these  by  several  important  additions  and  revisions  to  the  present 
edition.  First,  the  adoption  of  the  Migula  classification  of  bacteria.  At 
first  hand  this  classification  may  seem  more  cumbersome  than  the  older 
and  simpler  classification,  but  when  it  is  once  mastered,  it  is  a  great  help 
to  the  student.  More  detailed  information  with  regard  to  the  immunity 
induced  by  different  pathogenic  organisms  has  been  given.  There  have 
also  been  added  brief  descriptions  of  several  organisms  that  had  here- 
tofore not  been  described,  notably  Bacterium  Welchii  and  Bacillus  Sporo- 
genes,  while  several  organisms  have  been  dropped  because  of  their  slight 
importance. 

The  book  is  valuable  not  only  to  the  beginner  in  bacteriology,  but  is  a 
reference  book  to  busy  practitioners  who  have  been  unable  to  keep  up 
with  advances  in  this  field.  Directions  for  performing  all  of  the  more 
common  laboratory  methods  of  bacteriological  research  are  given  clearly 
and  fully. 

The  morphology,  staining  reactions,  pathology  and  clinical  phenomena 
of  the  more  important  pathological  bacteria  are  described,  special  attention 
being  paid  to  the  tubercle  bacillus.  Infection  and  immunity  are  discussed 
in  a  separate  chapter,  with  a  resume  of  the  facts  and  most  widely  accepted 
theories  on  this  complicated  subject.    General  directions  for  study  of 


132 


CURRENT   MEDICAL  LITERATURE 


water  and  milk  are  given  along  with  useful  data  and  technique  in  regard 
to  methods  of  sterilization  and  disinfection. 

The  few  excellent  illustrations  do  not  do  full  justice  to  the  subject 
matter,  and  colored  plates  illustrating  gross  cultural  and  pathological 
appearances  would  add  a  distinct  value  to  the  book.  h.  e.  r. 


A  Text-Book  of  Clinical  Diagnosis  by  Laboratory  Methods.  For  the  use 
of  Students,  Practitioners,  and  Laboratory  Workers.  By  L. 
Napoleon  Boston.  A.  M.,  M.  D.,  Associate  in  Medicine  and 
Director  of  the  Clinical  Laboratories,  Medico-Chirurgical  College, 
Philadelphia;  formerly  Bacteriologist  at  the  Philadelphia  Hospital 
and  at  the  Ayer  Clinical  Laboratory  of  the  Pennsylvania  Hos- 
pital. Second  Edition.  Revised  and  enlarged,  with  330  illustra- 
tions.   Philadelphia  and  London :  W.  B.  Saunders  &  Co.,  1905. 

The  first  edition  of  this  manual  of  clinical  laboratory  methods  has 
already  been  reviewed  in  the  Annals.  The  fact  that  a  second  edition  has 
been  called  for  within  eight  months  shows  the  popularity  of  the  work. 
Besides  slight  changes  and  additions  throughout  the  text,  seventeen  pages 
of  new  matter  have  been  added  at  the  end.  Some  of  the  new  subjects 
treated  are  Picker's  Reaction,  the  Leishman-Donovan  Bodies,  Ravold's 
Test  for  Albumin,  etc.  The  book  is  well  printed  on  fine  paper  and  fully 
illustrated.  a.  t.  l. 


A  Manual  of  Surgical  Diagnosis.  For  Students  and  Practitioners.  By 
Albert  A.  Berg,  M.  D.,  Adjunct  Attending  Surgeon  to  Mt.  Sinai 
Hospital,  New  York.  In  one  i2mo  volume  of  543  pages  with  215 
engravings  and  21  full  page  plates.  Cloth,  $3.25  net.  Lea  Brothers 
&  Co.,  Publishers,  Philadelphia  and  New  York. 

A  good  modern  work  on  surgical  diagnosis,  written  in  a  concise  and 
yet  not  marginal  manner,  has  for  some  time  been  needed  by  the  busy 
practitioner  of  medicine. 

Frequently  we  have  read  books  which  have  treated  the  subject  so 
briefly  and  superficially  as  to  leave  us  as  much  doubt  as  before  their 
perusal. 

Dr.  Berg's  book  of  about  500  pages  is  very  plain  and  practical.  It  is 
well  supplied  with  excellent  illustrative  plates,  but  is  not  a  mere  picture 
book,  as  there  is  an  abundance  of  wholesome  reading  matter. 

The  shadowgraphs,  by  copy,  have  less  distinct  outlines  than  was  prob- 
ably the  case  with  the  originals.  In  his  preface  the  author  lays  great 
stress  upon  the  early  diagnosis  of  surgical  diseases,  and  throughout  the 
work  can  be  noted  his  attempt  toward  the  recognition  of  many  diseases 
at  their  incipiency.  Part  one  takes  up  the  general  considerations  on 
diagnosis,  as  the  taking  of  the  clinical  history,  the  examination  of  the 
patient,  etc.,  and  while  this  part  may  be  of  more  use  to  the  student  than 
the  practitioner,  still  the  latter  will  no  doubt  be  benefitted  by  a  careful 
reading  of  the  forceful  sentences. 

Under  this  general  heading  the  author  includes  the  clinical  import  of 


CURRENT  MEDICAL  LITERATURE 


133 


general  symptoms  in  diseases  of  surgical  nature.  Parts  II,  III,  IV,  V 
and  VI  deal  with  injuries  and  diseases  of  the  head  and  neck,  thorax, 
abdomen,  genito-urinary  system  and  extremities  respectively,  and  the 
various  chapter  subdivisions  give  clearly  and  definitely  the  more  rational 
methods  and  symptoms  of  surgical  diagnosis. 

The  writer  evidently  believes  in  the  laboratory  as  a  most  efficient  aid 
in  such  diagnosis,  and  strongly  advises  using  the  advantages  it  affords. 
Altogether  the  work  impresses  one  as  having  been  written  by  a  man  who 
thoroughly  knows  his  subject  and  that  the  practical  part  has  the  more 
important  place.  e.  f.  s. 


Operative  Surgery.  For  Students  and  Practitioners.  By  John  J.  Mc- 
Grath,  M.  D.,  Professor  of  Surgical  Anatomy  and  Operative 
Surgery  at  the  New  York  Post-Graduate  Medical  School,  Surgeon 
to  the  Harlem,  Post-Gaduate,  and  Columbus  Hospitals,  New  York. 
Second  Edition.  Thoroughly  Revised.  With  265  illustrations,  in- 
cluding many  Full-Page  Plates  in  Colors  and  Half-tone.  628 
Octavo  Pages,  Extra  Cloth,  $4.50,  net;  Half  Morocco,  $5.50,  net. 
Sold  only  by  subscription.  F.  A.  Davis  Company,  Publishers, 
1914-16  Cherry  Street,  Philadelphia,  Pa. 

The  second  edition  of  this  work  has  been  thoroughly  revised  and 
brought  up  to  date.  It  combines  in  a  very  practical  manner  the  subjects 
of  surgical  anatomy  and  operative  surgery,  and  embraces  the  general 
plan  followed  by  the  author  in  the  author's  courses  in  operative  surgery 
at  the  New  York  Post-Graduate  Medical  School.  Purely  technical  con- 
siderations have  been  eliminated  as  far  as  possible,  so  that  while  the 
volume  comprises  only  600  pages,  the  most  important  surgical  procedures 
are  dealt  with  'comprehensively.  The  illustrations  are  largely  diagram- 
matic and  are  thus  satisfactory  for  teaching  purposes. 

The  section  upon  the  surgery  of  the  head  and  face  is  very  complete, 
and  includes  descriptions  of  the  most  recently  approved  methods  of  ex- 
ploratory craniotomy,  Cushing's  method  of  Gasserian  ganglion  extirpation 
and  a  detailed  consideration  of  the  plastic  operations  for  congenital  de- 
formities of  the  face. 

Much  has  been  written  recently  upon  abdominal  operations,  and  this 
work  treats  in  detail  the  surgery  of  the  stomach  and  intestinal  tract  as 
well  as  operations  upon  the  pancreas,  spleen,  liver,  gall-bladder  and 
ducts. 

There  is  rather  a  brief  consideration  of  the  surgery  of  the  prostate 
gland,  with  a  description  and  illustrations  of  Young's  method  of  perineal 
prostatectomy. 

A  feature  which  commends  the  book  is  that  the  author  has  dwelt  largely 
upon  those  fields  of  operative  surgery  in  which  there  have  been  important 
developments  in  recent  years,  and  has  only  devoted  a  brief  space  in  con- 
sidering, for  instance,  such  well  known  procedures  as  amputation  and 
resection  of  the  extremities.  g  e  b 


134 


CURRENT  MEDICAL  LITERATURE 


NEW  YORK  STATE  MEDICAL  LIBRARY. 
Edited  by  Miss  Ada  Bunnell,  B.  L.  S. 

Hours  of  opening.  The  library  is  open  for  readers  and  borrowers  each 
week  day  from  8  a.  m.  to  10  p.  m.,  including  Saturdays  and  holidays,  except 
during  July  and  August,  when  it  closes  at  6  p.  m. 

Loans.  Books  can  be  lent  to  any  registered  physician,  but  will  be  deliv- 
ered only  on  personal  application  or  on  a  written  order,  by  which  full 
responsibility  for  books  so  delivered  is  assumed. 

Loans  outside  Albany.  Books  will  be  lent  by  the  medical  library  to  any 
registered  physician  outside  Albany,  provided : 

1.  That  such  precautions  be  taken  in  packing  as  to  guard  against 
any  probability  of  injury  in  transportation. 

2.  That  the  medical  library  shall  not  pay  postage  or  express  either 
way. 

The  library  is  collecting  articles  on  minute  subjects  and  will  be  glad  to 
receive  gifts  of  reprints  of  articles  in  magazines  from  authors  or  publishers. 

NEW  BOOKS  ADDED  TO  THE  LIBRARY. 

Abrams,  Albert.  (The)  Blues  (Splanchnic  Neurasthenia)  causes  and 
cure.    2d  ed.,  enl.    N.  Y.,  1905. 

Bergmann,  Ernst  von,  Bruns,  Paul  von  and  Mikulicz,  J.  System  of 
Practical  Surgery.    5  v.    N.  Y.,  1904. 

Binnie,  J.  F.    Manual  of  Operative  Surgery.    2d  ed.    Phil.,  1905. 

Hare,  H.  A.  The  National  Standard  Dispensatory.  Containing  the 
Natural  History,  Chemistry,  Pharmacy,  Actions,  and  Uses  of  Medicines. 
In  Accordance  with  the  Eighth  Decennial  Revision  of  the  United  States 
Pharmacopoeia,  1905.  Phil.,  1905.  "This  dispensatory  is  designed  to 
succeed  the  National  dispensatory  of  Stille  and  Maisch." — Author's  pref. 

Kiliani,  O.  G.  T.  Surgical  Diagnosis;  a  Manual  for  Practitioners  of 
Medicine  and  Surgery.    N.  Y.,  1905. 

Krehl,  Ludolf.  (The)  Principles  of  Clinical  Pathology;  a  Text-book 
for  Students  and  Physicians.  Authorized  translation  from  the  3d  German 
ed.,  by  Albion  Walter  Hewlett,  with  an  introduction  by  William  Osier. 
Phil.,  1905. 

Mumford,  J.  G.    Surgical  Aspects  of  Digestive  Disorders.    N.  Y.,  1905. 

Reinert,  Emil.  Die  Zahlung  der  Blutkorperchen  und  der  Bedeutung 
fiir  Diagnose  und  Therapie.    Lpz.  1891. 

United  States  pharmacopoeial  convention,  8th,  Washington,  1900.  The 
Pharmacopoeia  of  the  United  States  of  America.  8th  Decennial  Revision. 
By  authority  of  the  United  States  Pharmacopoeial  Convention  held  at 
Washington,  a.  d.  1900.  Revised  by  the  Committee  of  Revision  and  pub- 
lished by  the  Board  of  Trustees.  Official  from  September  1st,  1905. 
Phil.,  1905. 

SOCIETY  TRANSACTIONS  AND  PERIODICALS. 
American  Gastro-Enterological  Association.    Transactions.  1904. 
American  Laryngological,  Rhinological  and  Otological  Society.  Trans- 
actions. 1905. 

Association  of  American  Physicians.    Transactions.  1905. 
New  Hampshire  Medical  Society.    Transactions.  1905. 
Journal  of  Anatomy  and  Physiology.    London,  v.  1-8,  9  pt.  1-2,  10-15, 
29.    Index  to  v.  1-20. 


CURRENT   MEDICAL  LITERATURE 


135 


SURGERY 

Edited  by  Albert  Vander  Veer,  M.  D.,  and  Arthur  W.  Elting,  M.  D. 

The  Permanent  Results  after  the  Operative  Treatment  of  Basedow's 
Disease.  (Ueber  Dauererfolge  nach  operativer  Behandlung  des 
Morbus  Basedozvii.) 

Friedheim.    Archiv  fur  klinische  Chirurgie,  Band  77,  Heft  4. 

In  1901  Schulz  reported  twenty  cases  of  Basedow's  disease  operated 
upon  by  Kiimmell.  Since  a  positive  cure  of  the  disease  by  operation  is 
even  yet  doubted  by  many  internists  and  since  many  hold  the  view  that 
the  benefit  of  surgical  treatment  is  very  much  overshadowed  by  the 
danger  of  the  operation,  the  writer  felt  it  desirable  to  make  a  report  upon 
the  present  condition  of  the  twenty  cases  previously  reported.  In  this 
way  he  believes  that  he  can  demonstate  that  Basedow's  disease  can  be 
permanently  cured  by  an  operation  and  that  with  the  proper  surgical 
technic  there  is  no  greater  danger  to  the  patient  than  is  associated  with 
medical  treatment. 

Of  these  twenty  cases  it  has  been  impossible  to  locate  three,  and  one 
other  patient  died  four  years  after  operation  from  tuberculosis.  Of  the 
twenty  cases  the  writer  regards  fourteen  as  completely  cured  and  the 
time  which  has  elapsed  between  the  operation  and  the  last  examination 
has  varied  from  four  to  fifteen  and  one-half  years.  Five  cases  he  regards 
as  improved,  while  death  followed  the  operation  in  one  case.  The  exact 
cause  of  death  could  not  be  determined  positively,  although  the  writer 
is  inclined  to  think  it  was  due  to  the  fact  that  too  little  secreting  gland 
tissue  was  left. 

Rehn  was  the  first  surgeon  in  Germany  to  advocate  operation  in  Base- 
dow's disease,  and  in  1884  reported  cures  effected  in  this  way.  Inas- 
much as  at  that  time  the  goitre  was  regarded  as  only  a  symptom  of 
Basedow's  disease  his  work  did  not  attract  much  attention.  When,  how- 
ever, in  1886,  Moebius  advanced  the  belief  that  Basedow's  disease  was 
due  to  a  diseased  hypersecretion  of  the  thyroid,  Rehn's  views  first  began 
to  be  accepted.  The  results  of  surgical  treatment  since  that  time  have 
demonstrated  the  correctness  of  the  views  of  both  of  these  investigators. 

It  is  always  desirable  to  determine,  if  possible,  that  portion  of  the 
gland  which  is  most  diseased  and  to  remove  this.  Only  a  portion  of  the 
gland  should  be  removed,  and  yet  enough  should  be  removed  in  order 
that  the  organism  may  care  for  the  poison  produced  by  the  remainder. 
Kocher's  .iew  is  that  one  might  better  operate  several  times,  removing 
small  portions  at  each  time,  than  to  take  out  too  much  at  one  operation. 
The  distressing  symptoms  which  sometimes  follow  immediately  after  an 
operation  of  this  kind  are  usually  regarded  as  due  to  an  absorption  from 
more  or  less  of  an  hematoma  in  the  wound.  For  this  reason  an  especial 
effort  should  be  made  to  have  the  smallest  possible  wound  surface,  and 
also  to  secure  the  most  complete  haemostasis. 

In  none  of  the  fourteen  cases  which  were  cured  was  there  at  the  last 
examination  any  evidence  of  an  enlarged  thyroid;  while  all  of  the  five 
cases  which  were  improved  showed  more  or  less  enlargement  of  that 


I36  CURRENT  MEDICAL  LITERATURE 

portion  of  the  gland  which  remained.  In  one  case  the  right  lobe  was  re- 
moved at  the  first  operation,  with  relief  of  the  symptoms.  These 
symptoms,  however,  recurred  a  year  later.  At  this  time  the  left  lobe 
was  removed  and  a  permanent  cure  obtained. 

From  a  study  of  the  statistics  from  the  clinics  of  Mikulicz,  Kronlein, 
Kocher  and  Koenig,  it  is  shown  that  the  mortality  was  less  than  eight 
per  cent.  Treated  medically,  statistics  show  that  there  are  very  few 
permanent  cures,  while  the  mortality  is  generally  estimated  at  about 
twelve  per  cent.  This  would  appear  to  demonstrate  the  relatively  slight 
danger  attendant  upon  operative  treatment. 


What  are  the  Chances  for  an  Early  Diagnosis  in  Carcinoma  of  the  In- 
testine? (Welche  Aussichten  bcstehen  fur  eine  Friihdiagnose  der 
Intestinal-car  cinome?) 

I.  Boas.  Mitteilungen  aus  den  Grenzgebieten  der  Medizin  und  Chirurgie, 
Band  15,  Heft  1  and  2. 

The  writer  recognizes  the  fact  that  the  internist  should  make  every 
effort  to  turn  his  cases  of  intestinal  carcinoma  over  to  the  surgeon  at  as 
early  a  date  as  possible.  In  carcinoma  of  the  esophagus  and  cardiac 
orifice  of  the  stomach,  however,  it  makes  little  difference  whether  or  not 
an  early  diagnosis  is  made,  for  there  is  practically  no  radical  surgical 
treatment.  The  carcinomata  which  are  available  for  surgical  treatment  are 
those  of  the  stomach,  colon,  rectum  and  small  intestine. 

Considering  the  early  diagnosis  of  intestinal  carcinoma  one  must 
sharply  distinguish  two  stages:  First,  the  stage  of  latency;  secondly,  the 
beginning  of  evident  symptoms.  Of  course,  it  is  impossible  to  diagnosti- 
cate carcinoma  of  the  intestine  during  the  period  of  latency.  Carcinoma 
of  the  rectum  is  the  variety  which  should,  theoretically,  be  earliest  diag- 
nosticated. Of  eighty-four  cases  of  carcinoma  of  the  rectum  seen  by  the 
writer  in  the  last  ten  years,  only  twenty  of  them  were  regarded  as 
operative  cases,  and  in  only  sixteen  of  these  was  a  radical  operation 
attempted.  That  is,  in  about  eighty  per  cent,  of  all  diagnosticated  car- 
cinomata of  the  rectum  the  radical  operation  is  out  of  the  question.  The 
writer  attributes  the  failure  to  diagnosticate  these  cases  early  to  two 
facts:  first,  neglect  on  the  part  of  the  great  majority  of  physicians  to 
make  a  rectal  examination;  and,  secondly,  that  these  carcinomata  fre- 
quently give  practically  no  symptoms  until  they  are  well  advanced.  Of 
the  eighty-four  cases,  in  only  nine  had  the  symptoms  lasted  less  than 
three  months,  and  of  these  nine,  four  were  practically  inoperable,  while 
two  were  on  the  border  line,  and  in  only  three  was  a  radical  operation 
strongly  indicated.  On  the  other  hand,  in  some  of  the  cases  in  which 
symptoms  had  lasted  for  a  considerable  period  of  time,  the  prognosis  of 
operation  was  most  favorable. 

Of  thirty  cases  of  carcinoma  of  the  colon  seen  by  the  writer  in  the 
last  ten  years,  in  only  six  was  a  radical  operation  attempted,  the  opera- 
tions done  upon  the  rest  of  this  number  being  purely  palliative. 

In  regard  to  carcinoma  of  the  stomach,  the  writer  expresses  the  belief 
that  the  operability  of  a  case  bears  no  direct  relationship  to  the  duration 


CURRENT  MEDICAL  LITERATURE 


137 


cf  the  disease.  Of  243  cases  of  carcinoma  of  the  stomach  seen  by  him 
in  the-  last  ten  years,  sixty,  or  practically  one-quarter,  were  seen  during 
the  first  three  months  after  the  beginning  of  symptoms.  A  considerable 
number  of  them  presented  themselves  within  a  few  weeks  after  symptoms 
first  developed.  Only  three  of  these  sixty  cases  were  of  a  sufficiently 
favorable  character  to  allow  resection;  that  is,  five  per  cent;  while  of  the 
127  cases  in  which  the  symptoms  had  lasted  from  six  months  to  a  year 
or  more,  eight  cases  were  regarded  as  suitable  for  resection;  that  is,  six 
and  three-tenths  per  cent.  It,  therefore,  follows  that  the  early  diagnosis 
in  the  great  majority  of  instances  of  carcinoma  of  the  stomach  is  no 
guarantee  for  a  radical  removal  of  the  tumor.  The  important  factors 
are  the  malignancy  and  the  tendency  to  extension.  An  early  diagnosis 
does  not  necessarily  offer  a  good  prognosis  for  operation,  nor,  on  the  con- 
trary, does  a  late  diagnosis  always  exclude  the  possibility  of  a  radical 
procedure.  In  the  writer's  experience,  those  cases  in  which  no  tumor 
was  palpable  have  proved  no  more  favorable  for  operation  than  those  in 
which  it  could  be  felt.  He  regards  the  diagnosis  of  carcinoma  of  the 
stomach  as  more  or  less  uncertain,  especially  as  based  upon  examination 
of  the  stomach  contents.  He  believes,  however,  that  in  fully  ninety  per 
cent,  of  cases  of  carcinoma  of  the  stomach  a  relatively  early  diagnosis 
can  be  made.  Gastroscopy  has  not  proven  of  any  value.  Exploratory 
laporotomy  would  appear  to  be  the  most  valuable  method  for  early 
diagnosis. 


Concerning  Cysts  of  the  Mesentery.    (Ueber  Mesenterialzysten.) 

Heinrich    Adler.     Miinchener   medizinische    Wochenschrift,    No.  46, 
November,  1905. 

In  spite  of  the  marked  advances  in  surgery  the  clinical  and  pathological 
picture  of  this  interesting  condition  is  by  no  means  well  understood. 
The  writer  reports  the  case  of  a  woman  of  48  years  who  complained  of 
pain  in  the  lower  portion  of  the  abdomen,  lassitude  and  depression.  She 
was  extremely  fat.  There  had  also  been  some  irregularity  of  menstrua- 
tion. She  presented  a  somewhat  movable  fluctuating  tumor  the  size  of  a 
man's  head  which  appeared  to  extend  downward  into  the  pelvis  and  which 
could  be  felt  in  the  right  vaginal  fornix.  The  tumor  was  regarded  as  an 
ovarian  cyst.  At  the  operation  it  was  found  to  be  a  multilocular  cyst  of 
the  mesentery  which  was  situated  between  the  layers  of  the  mesentery, 
and  which  was  somewhat  adherent  to  the  intestine.  The  other  abdominal 
organs  were  found  to  be  normal.  The  tumor  was  excised  and  the  cystic 
cavities  were  found  to  contain  a  clear,  watery  fluid.  Certain  portions  of 
the  tumor  presented  solid  elements  which  microscopically  were  found  to 
be  composed  of  connective  tissue.  The  inner  wall  of  the  cyst  was  com- 
posed of  several  layers  of  cylindrical  epithelium.  The  patient  made  an 
uneventful  recovery. 

In  most  of  the  cysts  of  the  mesentery  reported  it  has  been  impossible 
to  demonstrate  any  epithelium  upon  the  inner  surface,  although  Kiister 
has  reported  a  case  which,  like  the  one  of  the  author,  presented  an  inner 
lining  composed  of  several  layers  of  epithelium.    The  cyst  fluid  was  of 


7 


CURRENT  MEDICAL  LITERATURE 


high  specific  gravity,  rich  in  albumen,  and  contained  numerous  epithelial 
cells  and  leucocytes. 

Comparatively  few  cases  of  cyst  of  the  mesentery  have  been  reported, 
and  according  to  Augagneur  only  about  a  third  of  the  tumors  of  the 
mesentery  are  cystic.  The  following  varieties  of  tumors  have  been 
observed  in  the  mesentery:  lipoma,  fibroma,  sarcoma,  carcinoma,  chy- 
langioma,  echinococcus  cysts,  dermoid  cysts  and  chylus  cysts.  Some 
extremely  large  tumors  of  the  mesentery  have  been  reported,  weighing 
as  much  as  sixty  or  seventy  pounds,  but  it  is  quite  probable  that  these 
were  really  retro-peritoneal  tumors,  for  a  sharp  distinction  has  not 
apparently  been  made  between  mesenteric  tumors  and  retro-peritoneal 
tumors.  Most  retro-peritoneal  cysts  originate  from  the  kidneys,  pan- 
creas or  female  genitalia.  Occasionally  dermoid  cysts  are  observed  in 
this  region,  as  are  echinococcus  cysts. 

There  are  three  mesenteries  in  which  tumors  may  originate — that  of 
the  small  intestine,  that  of  the  transverse  colon,  and  that  of  the  sigmoid 
flexture.  In  the  literature,  however,  all  of  the  cysts  reported  appear  to 
have  been  located  in  the  mesentery  of  the  small  intestine.  Hahn  has 
divided  cysts  of  the  mesentery  into  the  blood  cysts,  chylus  cysts,  serous 
cysts  and  echinococcus  cysts.  Pean  states  that  tumors  of  the  mesentery 
usually  give  rise  to  but  few  symptoms.  Other  observers,  however,  have 
noted  more  or  less  marked  disturbance  of  the  digestion,  together  with 
pain,  which  may  be  the  first  symptom  of  the  disease  or  may  only  present 
after  it  has  attained  some  size.  This  pain  is  usually  referred  to  the 
region  of  the  umbilicus.  Constipation  is  of  rather  common  occurrence 
in  these  cases.  The  general  health  is  decidedly  impaired.  Pallor,  anemia, 
emaciation,  and  in  women  disturbance  of  menstruation,  are  usually  ac- 
companying symptoms.  There  is  never  any  fever.  The  tumor  usually 
developes  rather  rapidly  and  ordinarily  is  elastic  and  fluctuating.  A 
positive  diagnosis  can  practically  never  be  made  before  operation.  The 
most  that  can  be  done  is  to  suspect  the  possibility  of  the  existence  of  a 
mesenteric  cyst. 

As  to  treatment,  all  are  agreed  that  mechanical  measures  should  be 
employed  as  early  as  possible.  In  some  instances  puncture  has  been 
practiced,  but  this  is  hardly  a  justifiable  procedure.  In  every  instance 
where  it  can  be  done  the  cyst  should  be  excised,  and  where  this  is  im- 
possible it  should  be  sutured  to  the  parietal  peritoneum  and  drained.  In 
these  cases  drainage  frequently  persists  for  a  long  time  and  there  is 
often  more  or  less  difficulty  in  securing  a  complete  healing  of  the  wound. 
The  question  as  to  whether  an  excision  or  drainage  is  to  be  performed 
can  only  be  determined  at  the  time  of  operation. 


Diagnosis  of  Tumors  of  the  Adrenal.    (Zur  Diagnose  der  Nebennieren- 
geschwiilste.) 

James  Israel.    Deutsche  medizinische  Wochenschrift,  No.  44,  November, 
1905. 

That  the  diagnosis  of  this  class  of  tumors  is  extremely  difficult  is 
demonstrated  by  the  fact  that  many  surgeons  believe  that  it  is  impossible 
to  differentiate  them  clinically  from  tumors  of  the  kidney.    On  the  basis 


CURRENT  MEDICAL  LITERATURE 


139 


of  the  writer's  personal  experience  of  100  malignant  tumors  of  the 
kidney  which  he  has  operated  upon,  and  nine  primary  tumors  of  the 
adrenal,  he  has  attempted  to  establish  certain  diagnostic  points.  He 
states  that  one  may  be  able  to  determine  with  a  fair  degree  of  probability 
the  presence  of  a  tumor  of  the  adrenal,  but  a  positive  diagnosis  is  possible 
only  in  rare  instances.  The  tumors  of  the  adrenal  cannot  be  clinically 
distinguished  from  pararenal  tumors  originating  from  the  remains  of 
the  Wolffian  body  or  misplaced  adrenal.  The  difficulty  of  the  differential 
diagnosis  between  tumors  of  the  adrenal  and  tumors  of  the  kidney  is  d»e, 
first,  to  the  similarity  in  their  topographical  relationship;  and,  secondry, 
to  the  fact  that  in  both  varieties  of  tumors  urinary  changes,  especialry 
hematuria,  are  common. 

The  nine  cases  of  tumor  of  the  adrenal  observed  by  the  writer  may  be 
divided  into  five  groups : 

The  first  group  contains  those  cases  in  which  there  is  no  palpable  tumor 
nor  any  symptom  which  directs  attention  to  the  adrenal  or  the  kidney. 
It  is  only  the  metastases  which  call  attention  to  the  presence  of  a  latent 
malignant  primary  focus.  Under  such  conditions  a  diagnosis  is  naturally 
impossible. 

In  the  second  group  he  would  include  those  cases  in  which  there  is  no 
palpable  tumor,  but  in  which  there  are  symptoms  which  point  to  the 
adrenal  or  the  kidney,  namely:  hematuria  and  paroxysms  of  pain  or 
parasthesia  in  the  region  of  the  lumbar  plexus.  Of  course,  the  possi- 
bility of  stone  in  the  kidney  must  always  be  excluded.  If  there  is  suffi- 
cient reason  for  the  assumption  of  a  malignant  disease  either  of  the 
kidney  or  the  adrenal,  the  paroxysms  of  pain  or  the  parasthesia  in  the 
region  of  the  lumbar  plexus,  with  febrile  distubance,  unassociated  with 
the  presence  of  any  assignable  cause  for  the  fever  or  any  demonstrable 
tumor,  would  speak  strongly  in  favor  of  the  presence  of  tumor  of  the 
adrenal.  Pain  is  an  especially  important  factor  and  occurs  very  much 
earlier  in  tumors  of  the  adrenal  than  in  tumors  of  the  kidney,  because  of 
the  fact  that  the  fibrous  capsule  of  the  kidney  prevents  the  involvement 
of  the  surrounding  nerves  early  in  the  course  of  the  disease.  The  adrenal 
presents  no  such  capsule  and  the  tumor  tends  to  extend  to  the  sur- 
rounding tissue  at  a  much  earlier  period.  In  fifty-seven  per  cent,  of  the 
cases  of  tumor  of  the  adrenal  observed  by  the  writer  there  was  more  cr 
less  febrile  disturbance,  while  of  the  100  cases  of  tumor  of  the  kidney 
there  were  only  one  or  two  in  which  it  occurred. 

In  the  third  group  the  writer  would  include  those  cases  in  which  a 
tumor  can  be  felt  and  which  tumor  is  due  to  the  malignant  disease  of  the 
adrenal,  the  uninvolved  kidney,  however,  not  being  demonstrable. 

In  the  fourth  group  he  would  include  those  cases  in  which  diagnosis 
is  the  easiest,  namely :  when  the  tumor  of  the  adrenal  can  be  distinctly 
felt  and  distinguished  from  the  normal  kidney  which  is  situated  just  to 
the  outer  side  of  it. 

In  the  fifth  group  he  would  classify  those  cases  in  which  there  is  a 
tumor  formed  by  the  fusion  of  the  adrenal  and  the  kidney  without  its 
being  possible  to  differentiate  the  component  parts.  The  differentiation 
of  this  condition  from  one  of  primary  neoplasm  of  the  kidney  is  ex- 


MO  CURRENT  MEDICAL  LITERATURE 

tremely  difficult.  One  apparently  characteristic  fact,  however,  is  that  the 
tumor  originating  from  the  adrenal  tends  to  approach  more  nearly  the 
median  line— in  the  region  from  the  seventh  to  the  ninth  costal 
cartilages:  while  the  primary  tumor  of  the  kidney  appears  first  in  the 
region  from  the  ninth  to  the  eleventh.  Tumor  of  the  adrenal  at  the 
time  of  its  presentation  beneath  the  margin  of  the  ribs  appears  broader 
than  does  that  of  tumor  of  the  kidney,  and  the  lower  contour  of  the 
tumor  of  the  adrenal  is  much  less  rounded  than  is  that  of  the  kidney. 

In  conclusion,  the  writer  states  that  the  results  after  operative  treat- 
ment of  this  condition  are  extremely  unsatisfactory.  This  is  mainly  due 
to  the  fact  that  the  tumor  of  the  adrenal  cannot  be  diagnosticated  when  it 
is  early  enough  to  be  operable. 


i  • 

Importance  of  Trauma  in  the  Etiology  of  Carcinoma  and  Sarcoma.  (Die 
Bedeutung  des  Traumas  fur  die  Entstehung  der  Carcinome  und 
Sarcoma.) 

Wilhelm  Ropke.   Archiv  fur  klinische  Chirurgie,  Band  78,  Heft  2. 

The  writer  presents  an  extended  study  of  the  relationship  of  trauma  to 
the  cases  of  carcinoma  and  sarcoma  observed  in  the  surgical  clinic  in 
Jena  from  1889  to  1904.  The  study  includes  800  cases  of  carcinoma  and 
189  cases  of  sarcoma.  He  gives  a  brief  resume  of  the  various  theories 
advanced  to  explain  the  origin  of  new  growths  and  calls  attention  to  the 
fact  that  the  majority  of  observers  have  believed  that  there  was  a  re- 
lationship between  trauma  and  the  production  of  neoplasm.  Under  the 
heading  of  trauma  he  includes  all  forms  of  chronic  irritation  such  as  are 
frequently  produced  by  chronic  inflammations. 

The  first  group  of  carcinomata  considered  are  those  involving  the 
head.  Of  this  group  the  greatest  number  were  the  carcinomata  of  the  lip, 
of  which  there  were  seventy-four  cases.  The  trauma  resulting  from  the 
use  of  a  pipe  was  apparently  an  important  etiological  factor  in  a  very 
considerable  number  of  these  cases,  especially  the  short  pipe  with  a 
curved,  downward-hanging  stem.  The  irritation  of  the  mucous  membrane 
of  the  mouth  or  tongue  by  bad  teeth  seemed  to  determine  the  location  of 
carcinomata  in  which  trauma  was  an  important  etiological  factor. 

In  carcinomata  of  the  skin  of  the  face  and  head  he  found  the  most 
frequent  etiological  factors  to  be  seborrhea,  warts,  and  sebaceous  cysts, 
the  disturbance  of  the  latter  two  in  the  process  of  shaving  being  in 
several  instances  apparently  an  important  factor. 

In  carcinomata  of  the  gastro-intestinal  tract  he  believes  that  trauma 
has  something  to  do  with  the  determination  of  the  frequency  of  the 
involvement  of  the  pylorus,  although  in  only  seven  and  three-tenths  per 
cent,  of  his  cases  of  carcimoma  of  the  stomach  could  a  direct  relation- 
ship to  an  ulcer  of  the  stomach  be  demonstrated.  In  carcinomata  of  the 
intestinal  tract  chronic  constipation,  hemorrhoids  and  chronic  catarrh  of 
the  intestine  appeared  to  be  rather  frequent  antecedent  disturbances. 
Ulcerative  processes,  with  the  resulting  scars,  and  fistuke  in  the  region 


CURRENT  MEDICAL  LITERATURE 


141 


of  the  anus  are  also  not  infrequently  noted  as  the  forerunners  of  carcino- 
mata.. He  calls  especial  attention  to  the  very  much  greater  frequency  of 
carcinomata  of  the  rectum  in  the  male  than  in  the  female.  He  calls 
especial  attention  to  the  extremely  frequent  relationship  of  gallstones  to 
carcinoma  of  the  gall  bladder.  He  compares  numerous  statistics  about 
the  frequency  of  this  combined  lesion  and  finds  that  in  from  eighty-five 
to  ninety-five  per  cent,  of  the  cases  of  carcinoma  of  the  gall  bladder  re- 
ported, gallstones  were  regarded  as  an  extremely  important  etiological 
factor.  Carcinoma  of  the  gall  bladder  is  decidedly  more  common  in 
women  than  in  men,  which  is  in  keeping  with  the  relative  frequency  of 
occurrence  of  gallstones  in  the  two  sexes. 

In  carcinomata  of  the  breast  he  finds  that  in  a  small  percentage  of 
cases  the  development  of  the  tumor  seems  to  bear  a  direct  relationship 
to  some  antecedent  trauma,  which  is  not  infrequently  in  the  nature  of  a 
chronic  mastitis.  He  presents  a  large  number  of  statistics  collected  from 
the  literature,  in  which  eleven  and  three-tenths  per  cent,  of  the  cases 
of  carcinoma  of  the  breast  were  regarded  as  bearing  a  direct  relationship 
to  a  single  trauma. 

The  relationship  of  the  traumatism  resulting  from  the  chronic  irrita- 
tion of  ulcers  and  sinuses  upon  the  extremities  to  the  development  of 
carcinoma  is  especially  emphasized. 

Of  the  800  carcinomata  studied,  in  only  nineteen  cases  could  a  single 
trauma  be  assumed  as  a  probably  important  cause  of  the  development  of 
the  carcinoma;  while  of  189  sarcomata,  in  nineteen  cases  a  single  trauma 
was  believed  to  have  played  an  important  role  in  the  development  of  the 
new  growth.  These  statistics  would  seem  to  indicate  that  there  is  a 
very  much  more  intimate  relationship  between  either  a  single  trauma  or  a 
chronic  irritation  and  the  development  of  a  sarcoma,  than  between  these 
conditions  and  the  development  of  a  carcinoma.  Others  have  advanced 
the  view  that  the  chronic  irritative  processes  are  of  greater  importance 
in  the  development  of  carcinomata,  while  a  single  trauma  is  of  very  much 
greater  importance  in  the  development  of  sarcomata.  These  facts  seem 
to  speak  in  favor  of  Virchow's  view  regarding  the  origin  of  new  growths, 
which  is  that  the  cause  is  to  be  found  in  some  local  predisposition.  Of 
course,  something  further  than  the  trauma  must  be  assumed  in  the  pro- 
duction of  a  new  growth,  which  something  does  not  appear  as  yet  to  have 
been  satisfactorily  explained.  The  writer  believes  in  the  possibility  of  "an 
inheritance  of  a  predisposition  to  new  growths,  although  this  is  probably 
of  less  importance  than  generally  assumed. 

In  conclusion,  he  presents  cases  illustrating  the  importance  of  trauma 
in  determining  the  location  of  metastasis  from  carcinomata  already  ,  ex- 
isting in  the  organism.  He  believes  that  a  contusion  of  a  part  favors 
deposition  of  cancer  cells,  which  may  be  at  times  present  in  the  circulating 
blood,  and  that  the  disturbance  of  the  circulation  as  a  result  of  the  con- 
tusion so  lowers  the  resistance  of  the  part  that  the  tumor  cells,  instead 
of  being  destroyed,  gain  the  upper  hand  and  produce  a  new  focus.  In 
this  he  believes  that  there  is  a  marked  similarity  to  the  occurrence  of 
osteomyelitis  and  tuberculosis  after  trauma. 


I42 


CURRENT  MEDICAL  LITERATURE 


LARYNGOLOGY,  RHINOLOGY  AND  OTOLOGY 
Edited  by  Clement  F.  Theisen,  M.  D. 

The  Frontal  Sinus. 

C.  G.  Coakley.    Laryngoscope,  August,  7905. 
The  writer  discusses  the  following  points  in  his  paper: 

(a)  What  symptoms  in  diseases  of  the  sinuses  demand  radical  surgical 
intervention  ? 

(b)  What  have  been  the  comparative  results  of  conservative  and  radical 
methods  of  reatment? 

The  following  symptoms  demand  external  opening  of  the  frontal  sinus: 
Edema  and  redness  of  the  upper  eyelid,  accompanied  by  throbbing  pain 
over  the  sinus,  provided  they  show  a  tendency  to  increase  in  severity  for 
more  than  twenty-four  hours  after  resection  of  the  anterior  third  of  the 
middle  turbinate,  and  a  thorough  contraction  of  the  mucous  membrane  of 
the  middle  meatus  by  means  of  local  applications  of  adrenalin  and 
cocaine;  marked  prolapse  of  the  orbital  wall  of  the  sinus;  displacement 
of  the  globe  of  the  eye  outwards  and  downwards  with  diplopia ;  the 
development  of  a  fistula  at  the  upper  angle  of  the  orbit,  as  evidenced  by 
redness,  greater  swelling,  and  fluctuation  in  this  region ;  intense  supra- 
orbital and  frontal  pain,  which  cannot  be  relieved  by  establishing  adequate 
drainage  through  the  naso-frontal  duct,  with  a  tendency  to  an  elevation 
in  temperature,  and  symptoms  of  beginning  meningeal  involvement. 

In  a  series  of  fifty-eight  cases  of  acute  frontal  sinusitis  Occurring  in  the 
author's  private  practice  between  January  1,  1903,  and  January  1,  1905, 
fifty-four  made  complete  recoveries  as  a  result  of  proper  intra-nasal 
treatment.  One  patient,  seen  for  the  first  time  forty  hours  after  the  onset 
of  the  attack,  in  which  the  left  ethmoid  and  sphenoid  were  involved, 
died  twenty-three  hours  later,  from  an  acute  meningitis  with  symptoms 
of  great  intra-cranial  pressure,  as  evidenced  by  a  pulse  of  forty.  The 
anterior  third  of  the  middle  turbinate  had  been  excised,  and  judging 
from  the  discharge  drainage  was  good.    No  autopsy  was  obtained. 

Chronic  Frontal  Sinusitis. — Chronic  frontal  sinusitis  as  a  distinct  entity, 
unassociated  with  suppuration  in  some  of  the  neighboring  sinuses,  is  a 
condition  the  author  has  never  met  with.  There  has  always  been  an 
ethmoiditis  present,  and  the  antrum  in  a  large  percentage  of  the  cases 
was  either  diseased,  or  the  receptacle  for  pus  flowing  down  from  the 
frontal  and  ethmoid  sinuses.  The  following  symptoms  demand  radical 
operation :  Chronic  suppurative  frontal  sinusitis,  accompanied  by  multiple 
polyp  formation  in  the  nose.  A  radical  operation  is  indicated  in  severe 
acute  exacerbations  of  the  chronic  condition,  whenever  any  of  the  symp- 
toms enumerated  under  acute  frontal  sinusitis  develop.  If  intra-nasal 
treatment  of  a  frontal  sinusitis  does  not  suffice  to  prevent  the  discharge 
from  passing  into  the  antrum,  then  in  order  to  cure  the  antrum,  the 
frontal  must  be  operated  upon  radically.  Very  large  frontal  sinuses  with 
multiple  septa,  and  particularly  those  with  recesses  extending  backwards 
over  the  roof  of  the  orbit,  can  be  but  imperfectly  irrigated.  Such  cases 
require  the  radical  operation. 


CURRENT  MEDICAL  LITERATURE 


143 


Conservative  Treatment.— The  author  has  records  of  seventy-nine  cases 
so  treated.  Eleven,  or  fourteen  per  cent.,  may  be  considered  cured,  as 
they  could  be  observed  for  at  least  two  years  after  having  been  discharged 
as  cured.  Of  the  remaning  sixty-eight  cases,  twenty-seven,  or  thirty-five 
per  cent,  have  been  lost  sight  of.  Of  the  remaining  forty-one,  twenty- 
four,  or  thirty  per  cent.,  have  returned  with  recurrences  one  or  more 
times  a  year.  Twenty-two  of  these  cases  have  polypi.  The  remaining 
seventeen  cases  consented  to  a  radical  operation  after  having  been  under 
treatment  for  a  long  time,  and  all  have  been  cured. 

The  author  then  discusses  the  different  radical  operations,  the  Ogston 
Luc.  the  Kuhnt,  and  finally  his  own  operation  by  the  open  method,  i,  e., 
to  operate  in  the  manner  of  Kuhnt,  but  to  pack  the  frontal  sinus  and  naso- 
frontal duct  so  that  granulations  would  spring  up,  and  first  occlude  the 
narrowest  part  of  the  cavity,  the  bottom  of  the  naso-frontal  duct.  Later, 
just  as  in  a  mastoid  wound,  it  would  be  merely  a  matter  of  time  for  the 
upper  part  to  fill  with  granulations  and  become  obliterated. 

Of  one  hundred  four  patients  operated  upon  by  this  method,  two 
are  dead,  one  has  fistula,  and  one  hundred  and  one  are  living  and  cured  of 
the  frontal  sinusitis.  Seven  are  Under  occasional  treatment.  Three  of  the 
seven  have  sinuses  in  their  antra,  six  of  the  seven  have  occasional  dis- 
charge from  the  sphenoid. 


Some  Facts  in  Regard  to  the  Origin  of  Laryngeal  Papillomata.  (Beitrdge 
Zur  Entstehung  der  Kehlkopfpapillome.) 

L.  Rethi.    Wiener  medicinische  Wochenschrift.  Xozember  11,  1905. 

Very  little  is  known  concerning  the  origin  of  papillomata  of  the  larynx. 
Some  cases  of  benign  neoplasms  are  undoubtedly  congenital  and  they  are 
sometimes  seen  during  the  first  few  years  of  life.  Some  authorities  believe 
that  heredity-  is  of  importance  in  the  etiology  of  papillomata,  and  the 
writer  does  not  exclude  this  factor,  although  he  states,  that  while  papil- 
lomata sometimes  develop  simultaneously  in  the  larynges  of  brothers  or 
sisters,  or  parents  and  children,  such  occurrences  may  be  accidental  and 
merely  coincidences.  The  question  of  heredity  as  an  etiological  factor 
cannot,  however,  be  positively  excluded.  In  support  of  this  view  he 
reports  the  cases  of  two  children,  aged  respectively  eight  and  ten  years, 
who  both  had  multiple  laryngeal  papillomata.  The  mother  had  been 
operated  on  for  the  same  laryngeal  condition  fourteen  years  before.  He 
reports  two  other  cases  occurring  in  a  young  boy  and  his  sister,  in  whom 
there  had  been  no  recurrence  after  operation.  There  were  no  other  cases 
in  this  family. 

The  acute  infectious  diseases  such  as  measles  and  influenza  sometimes 
favor  the  development  of  papilloma,  because  laryngitis  is  such  a  com- 
mon complication  of  acute  infectious  diseases,  and  an  etiological  relation- 
ship exists  between  hyperemia,  inflammation,  and  the  development  of 
papillomata.  On  the  other  hand,  as  Schrotter  has  brought  out,  inflamma- 
tory processes  in  the  larynx  sometimes  subside  spontaneously  after  the 
removal  of  a  papilloma,  and  in  such  cases  the  laryngitis  was  probably  not 


144 


CURRENT  MEDICAL  LITERATURE 


the  cause  but  the  result  of  the  neoplasm.  There  is  no  doubt,  however, 
that  there  must  be  a  certain  predisposition.  Even  the  most  severe  inflam- 
matory conditions  could  not  be  sufficient  to  bring  about  the  development 
of  a  papilloma  if  this  predisposition  is  absent.  Where  it  is  present,  an 
irritation  of  the  laryngeal  mucosa  very  quickly  causes  its  development. 

A  case  is  reported  in  which  two  papillomas  were  removed  from  the 
larynx  of  a  young  man  aged  twenty  years.  The  voice  was  completely 
restored  after  the  operation,  but  two  years  later,  after  getting  very  wet, 
he  developed  another  laryngitis,  and  on  examination  both  vocal  cords 
were  found  reddened,  with  superficial  erosions  on  their  free  edges 
as  well  as  along  the  edge  of  the  epiglottis.  When  the  patient  was  again 
seen  two  weeks  later,  papillomatous  swellings  had  commenced  at  these 
eroded  areas,  and  in  three  weeks  more  had  increased  in  size.  They  were 
removed,  and  he  remained  free  from  a  recurrence  for  a  year,  when  he 
developed  a  laryngitis  with  erosions  on  the  right  vocal  cord,  and  again  a 
papilloma  developed  at  one  of  these  points. 

Gerhardt  has  noticed  that  papillomata  easily  develop  at  points  acci- 
dentally injured  during  the  operation  for  the  removal  of  a  papilloma,  and 
Gottstein  has  reported  two  cases,  in  both  of  which  papillomas  developed 
after  cauterizing  the  seat  of  a  removed  growth. 


Concerning  the  Cause  and  Treatment  of  Dangerous  Hemorrhage  after 
Removing  the  Tonsils.  (Ueber  Ursache  und  Behandlung  bedroh- 
licher  Blntungcn  nach  Abtragung  der  Gaumemnandeln.) 

Ed.  Heuking.    Frdnkel's  Archiv,  Bd.  XVII,  1905. 

A  great  many  cases  of  severe,  and  a  few  fatal  cases  of  hemorrhage 
after  tonsillotomy  are  mentioned  in  literature.  Recently  two  of  Mosetig- 
Moorhof's  assistants,  Damianos  and  Hermann,  have  collected  150  cases 
of  this  kind  from  the  literature  of  the  past  sixty  years.  The  author  has 
observed  six  cases  of  alarming  hemorrhage  after  tonsillotomy, — none  of 
them,  however,  having  a  fatal  termination.  He  discovered  a  source  of 
hemorrhage  which  has  not  been  mentioned  up  to  the  present  time.  One 
of  the  theories  that  has  always  been  held  to  account  for  such  hemorrhages 
was  that  individuals  in  whom  they  occurred  after  operations  were  hemo- 
philics. In  the  cases  collected  by  Damianos  and  Hermann,  however,  there 
were  only  five  in  which  this  etiological  factor  was  present.  Of  the  eight 
fatal  cases  on  record,  hemophilia  was  only  a  contributing  cause  in  two. 
So  that  haemophilia  cannot  be  regarded  as  playing  an  important  role  in 
these  cases.  The  second  cause  of  severe  hemorrhage  is  the  wounding  of 
larger  or  smaller  arterial  branches.  In  this  connection,  the  author  speaks 
of  the  danger  mentioned  in  so  many  text-books,  of  wounding  the  internal 
carotid  artery  during  tonsillotomy.  As  a  matter  of  fact,  there  is  only 
one  authentic  case  on  record  in  which  this  artery  was  wounded  during 
this  operation. 

It  is  impossible  to  wound  the  internal  carotid  with  the  ordinary  tonsil- 
lotome,  and  in  order  to  injure  it  with  a  scalpel  the  operator  must  go  far 
back  of  the  faucial  pillars  or  be  very  careless.    It  has  been  claimed  by 


CURRENT  MEDICAL  LITERATURE 


M5 


Merkel  and  Demme  that  anomalous  positions  of  the  external  maxillary, 
the  lingual,  or  ascending  pharyngeal  arteries,  might  cause  hemorrhage 
during  tonsillotomy  or  tonsillectomy.  The  author  has  been  unable  to  find 
absolutely  authentic  records  of  injuries  of  either  of  these  vessels.  In 
some  cases  it  has  been  stated  that  the  hemorrhage  takes  place  from  the 
amputated  surface  of  the  tonsil.  The  anatomical  investigations  of  Zucker- 
kandl  explain  the  possibilities  of  such  hemorrhage.  The  tonsillar  artery, 
which  takes  its  origin  mainly  from  the  ascending  palatine,  and  at  times 
from  the  ascending  pharyngeal,  and  external  maxillary,  extends  to  the 
dense  fibrous  membrane  which  borders  the  tonsil  externally.  Only  after 
it  goes  through  this  firm  membrane  does  it  divide  into  small  branches 
which  supply  the  parenchyma  of  the  tonsil.  There  is,  therefore,  little 
danger  of  wounding  the  artery  before  it  divides  into  the  smaller  branches, 
unless  a  very  radical  operation  is  performed,  the  tonsil  being  pulled  for- 
ward strongly,  and  the  cutting  instrument  being  carried  too  far  back  of 
the  faucial  pillars.  The  majority  of  the  cases  of  persistent  hemorrhage 
following  tonsillotomy  cannot  be  explained  on  the  ground  of  cutting  some 
of  these  small  arterial  branches. 

Out  of  150  cases  collected  by  Damianos  and  Hermann,  there  were  only 
a  few  in  which  a  spurting  vessel  in  the  tonsillar  stump  was  seen.  The 
author  has  found  in  the  cases  observed  by  him,  that  such  persistent 
hemorrhage  may  not  only  arise  from  the  parenchyma  of  the  amputated 
tonsil,  but  from  the  neighboring  tissue,  particularly  the  faucial  pillars. 
The  author  describes  the  different  forms  of  hypertrophied  tonsils,  the 
so-called  submerged  tonsils,  those  that  are  adherent  to  the  anterior  or 
posterior  pillar  or  both,  and  those  that  are  almost  spherical  and  project 
well  out  from  the  pillars.  This  last  form,  especially  if  there  are  no 
adhesions,  is  the  most  favorable  for  operation.  There  is  very  little  danger 
of  hemorrhage  if  only  the  part  that  projects  beyond  the  faucial  pillars  is 
removed.  When  attempts  are  made  to  remove  partially  submerged  ton- 
sils, that  are  frequently  almost  covered  by  the  pillars,  with  the  ordinary 
tonsillotomy,  it  frequently  happens  that  parts  of  the  pillars  brought  into 
the  ring  of  the  instrument,  and  injured  when  the  tonsil  is  removed.  The 
author  has  found  that  in  just  such  cases  severe  and  sometimes  alarming 
hemorrhage  may  result. 

He  reports  six  cases,  in  all  of  which  the  hemorrhage  came  on  some 
time  after  the  tonsils  were  removed.  In  every  case,  after  freeing  the 
mouth  of  blood  clots  and  vomited  particles  of  food,  a  gaping  wound  was 
found  high  up  on  the  posterior  pillar  of  the  fauces.  The  hemorrhage 
always  came  from  this  point,  and  was  controlled  in  each  case  after  pro- 
longed pressure  with  the  right  index  finger,  wrapped  with  sterile  gauze. 

It  may  be  of  interest  to  give  a  brief  abstract  of  one  of  his  cases:  An 
enormously  hypertrophied  left  tonsil,  in  a  man  aged  sixty  years,  was 
removed  under  cocaine  anzesthesia  by  one  of  the  author's  colleagues.  The 
hemorrhage  during  and  shortly  after  the  operation  was  trifling,  and  was 
easily  stopped  with  cold  gargles.  Three  hours  after  the  operation  the 
physicians  were  summoned  to  the  patient's  home  and  found  him  in  a 
condition  of  complete  collapse  and  almost  pulseless.  Shortly  before  he 
had  vomited  enormous  quantities  of  blood.    As  in  the  author's  other 


146 


CURRENT   MEDICAL  LITERATURE 


cases,  the  bleeding  point  was  found  high  up  on  the  posterior  fold  of  mem- 
brane, which  had  been  wounded  during  the  operation.  The  patient  made 
a  good  recovery,  but  died  ten  months  after  of  an  extensive  lympho- 
sarcoma involving  the  glands  on  both  sides  of  the  neck. 

In  conclusion  the  author  highly  commends  compression  of  the  bleeding 
point  immediately,  with  the  finger  wrapped  in  gauze,  rather  than  wasting 
time  by  the  application  of  astringent  solutions  and  powders. 


Concerning  Primary  Cancer  of  the  Nasal  Cavities.    (Ueber  den  primaren 
Krebs  der  Nasenhohlc.) 

Donogany  and  Leuart.    Frdnkel's  Archiv,  Bd.  15,  Hft.  3. 

Primary  cancer  of  the  nasal  cavities  belongs  to  the  fairly  rare  forms  of 
nasal  diseases.  There  are  only  fifty-four  well-authenticated  cases  in  the 
literature  of  the  subject.  To  this  number  the  authors  have  added  seven 
cases  observed  by  themselves  in  Prof.  Navratil's  clinic  in  Budapest. 

Winiwarter's  general  carcinoma  statistics  comprise  548  cases,  includ- 
ing thirty  cases  of  cancer  on  the  external  surface  of  the  nose,  but  not  a 
single  case  in  the  nasal  cavities. 

In  Bonde's  154  carcinoma  cases  the  cancer  was  present  forty  times  on  the 
external  surface  and  twice  in  the  nostrils.  Gurlt  found  only  four  cases 
of  cancer  in  the  nostrils  in  10,000  cases  collected  by  him.  There  were, 
however,  out  of  this  number  of  cases,  fourteen  cases  of  sarcoma  (which 
is  not  considered  in  the  author's  paper)  in  the  nasal  cavities. 

Herzfeld  found  in  his  clinic  in  a  material  of  28,000  cases  only  one  case 
of  primary  cancer  in  the  nostrils.  Finder  found  in  the  40,000  cases 
treated  in  Frankel's  nose  and  throat  clinic  five  cases  in  the  nostrils. 

The  author's  conclusions  are  based  only  on  such  cases  in  which  the 
diagnosis  was  made  histologically.  The  cases  in  which  a  microscopical 
diagnosis  was  not  made  were  not  included,  because  it  could  not  be  defi- 
nintely  settled  whether  the  growth  in  the  nostrils  was  a  carcinoma  or 
sarcoma.  Seven  cases  of  primary  carcinoma  of  the  nasal  cavities  are 
reported  by  the  writers,  in  each  of  which  a  positive  diagnosis  was  made. 

In  the  first  case,  that  of  a  man  aged  fifty-four  years,  the  right  nostril 
was  filled  by  a  tumor  mass,  which  after  the  autopsy  was  found  to  be  a 
true  carcinoma. 

In  the  second  case,  that  of  a  woman  aged  fifty-two  years,  the  left  nostril 
was  the  seat  of  a  tumor  mass.  A  piece  removed  for  microscopical  exam- 
ination proved  the  diagnosis  of  carcinoma.  A  radical  operation  was  per- 
formed. This  consisted  in  an  incision  extending  through  the  lip  and 
along  the  lateral  nasal  wall  to  the  inner  angle  of  the  eye.  Then  the 
antrum  of  Highmore  was  opened  through  the  canine  fossa  and  was  found 
filled  with  a  tumor  mass  The  nostril  was  then  opened  into  through  the 
antrum,  and  the  whole  lateral  wall,  including  the  inferior  and  middle  tur- 
bina?  bones,  together  with  the  tumor  mass,  were  removed.  The  sphenoid 
and  ethnoid  sinuses  were  also  opened. 

There  was  no  recurrence  for  about  seven  months,  but  then  the  tumor 
again  entirely  filled  the  nose  and  the  patient  died  with  symptoms  of 
meningitis. 


CURRENT  MEDICAL  LITERATURE 


147 


In  the  third  case,  that  of  a  man  fifty  years  of  age,  a  radical  operation 
was  also  performed  for  a  carcinoma  in  the  right  nostril,  but  after  several 
recurrences  this  patient  also  died  with  cerebral  symptoms. 

In  the  fourth  case,  a  man  aged  fifty-four  years,  the  carcinoma  evidently 
sprang  from  the  middle  turbinate  of  the  right  nostril.  Operative  inter- 
ference was  refused. 

The  fifth-  case  was  that  of  a  woman  aged  thirty-eight  years,  who  had 
suffered  from  nasal  obstruction  and  hemorrhages  for  four  years.  On 
examination  of  the  nose,  the  right  nostril  was  found  entirely  filled  with  a 
tumor  mass  which  projected  out  externally.  The  region  of  the  right 
antrum  was  much  swollen.  On  account  of  the  poor  general  condition  of 
the  patient  an  operation  was  not  advised.  The  diagnosis  of  carcinoma 
was  made  by  the  excision  of  a  small  piece  of  the  growth. 

In  the  sixth  case,  that  of  a  woman  aged  forty  years,  the  right  nostril 
was  filled  with  an  irregular  reddish-gray  tumor  mass.  Severe  hemorrhage 
followed  the  slightest  touching  of  the  tumor.  A  piece  removed  for  micro- 
scopical examination  showed  that  the  growth  was  carcinoma.  The  patient 
refused  radical  operation. 

The  right  nostril  was  completely  filled  with  a  tumor  in  the  seventh 
case,  that  of  a  man  aged  forty-three  years.  A  radical  operation  (Bruns' 
osteo-plastic  resection  of  the  nose)  was  performed.  At  the  operation  it 
was  found  that  the  tumor  originated  in  the  antrum  of  Highmore.  The 
patient  made  a  good  recovery. 

In  conclusion  the  authors  state  that  ordinary  treatment  of  carcinoma  of 
the  nose  is  practically  hopeless.  Operative  procedures  offer  the  only  hope. 
In  the  favorable  cases,  where  the  growth  has  not  extended  into  the 
accessory  cavities,  involved  the  orbit  or  frontal  sinus,  an  endo-nasal 
operation  may  be  attempted.  The  radical  operation,  however,  is  indi- 
cated in  such  cases  and  offers  some  chance  of  success. 


PEDIATRICS 
Edited  by  Henry  L.  K.  Shaw,  M.  D. 

Some  Conditions  Which  May  Be  Mistaken  for  Meningitis. 

Baumann.      The  British  Journal  of  Children's  Diseases,  February,  1905. 

A  number  of  diseases  of  childhood  tend  to  assume  a  type  simulating 
meningitis,  and  the  difficulties  of  accurate  differential  diagnosis  are  often 
great  and  sometimes  insurmountable.  The  nervous  system  of  the  child 
is  very  unstable  and  is  readily  disarranged  by  comparatively  trivial 
ailments. 

The  author  classifies  meningitis  in  children  into  three  forms: 
(1)  Tubercular  meningitis,  which  is  usually  secondary  to  a  tubercular 
focus  in  some  other  part  of  the  body.  It  runs  its  course  in  about  three 
weeks  and  the  symptoms  vary  with  the  stage  of  the  disease.  One  or  two 
characteristic  symptoms  may  be  absent  and  the  disease  run  an  atypical 
course  which  obscures  the  diagnosis. 


148 


CURRENT  MKD1CAL  LITERATURE 


(2)  Posterior-basic  meningitis,  which  is  the  result  of  the  invasion  of 
the  cerebro-spinal  membranes  by  the  diplococcus  intracellulars  men- 
ingitidis and  may  occur  sporadically  or  epidemically. 

Vomiting  or  convulsions  and  opisthotonos  with  rigidity  of  the  limbs 
are  the  characteristic  feature  of  the  disease.  The  spasms  are  more  apt 
to  be  clonic  in  tubercular  meningitis.  The  pulse  is  generally  regular. 
The  child  lies  with  its  eyes  staring  in  marked  contrast  with  the  tightly 
clenched  lids  of  photophobia  in  tubercular  meningitis. 

(3)  Suppurative  meningitis  is  generally  a  secondary  infection  in  which 
the  convexity  of  the  brain  is  first  attacked.  The  onset  is  less  definite 
and  the  symptoms  are  frequently  masked  by  those  of  the  condition  which 
it  complicates.  Head  retraction  is  slight  and  may  be  entirely  absent, 
and  ocular  changes  are  uncommon.  The  disease  runs  it  course  in  a  few 
days,  terminating  in  death.  The  histories  of  nine  cases  in  the  Great 
Orrnond  Street  Hospital  for  Sick  Children,  which  were  wrongly  diagnosed 
as  meningitis  are  given,  in  which  the  cerebral  symptoms  simulated  th^t 
disease.  The  following  were  the  correct  diagnoses  of  these  cases :  ty- 
phoid fever,  lobar  pneumonia,  broncho-pneumonia,  influenza,  mastoid 
disease,  middle  ear  disease,  sarcoma  of  brain,  renal  disease  and  gastro- 
intestinal disturbance.  A  case  was  admitted  to  the  hospital  for  menin- 
gitis in  which  all  the  symptoms  abruptly  subsided  after  the  passage  of 
a  large  round  worm. 

Abscess  of  the  brain,  acute  polioencephalitis,  trichinosis,  retropharyn- 
geal abscess,  etc.,  have  all  been  mistaken  for  meningitis.  Cases  occur 
having  every  symptom  of  cerebral  irritation  in  which  a  diagnosis  of 
meningitis  is  given.  Then,  for  some  unknown  reason  the  temperature 
falls  and  the  child  recovers  completely.  These  cases  often  remain  unex- 
plained and  are  catalogued  in  hospital  records  as  "pseudo-meningitis." 
The  cases  reported  by  the  author  were  only  eventually  correctly  diag- 
nosed after  a  longer  or  shorter  period  under  constant  and  trained  obser- 
vation in  the  hospital.  The  difficulties  are  much  greater  to  the  general 
practitioner  who  sees  his  cases  only  at  intervals  and  often  has  to  rely 
upon  the  statement  of  unskilled  observers. 

The  points  emphasized  in  the  history  are  the  existence  of  some  acute 
infectious  disease,  such  as  influenza,  among  the  household,  the  presence 
of  tuberculosis  in  one  of  the  parents,  and  the  history  of  severe  headaches, 
which  accompanies  and  exists  during  somnolence.  The  author  attaches 
little  importance  to  Kernig's  sign,  tache  cerebrale,  head  retraction,  in- 
equality of  pupils  and  the  examination  of  the  blood.  The  more  impor- 
tant symptoms  are  the  condition  of  the  pulse,  examination  of  the  eyes 
and  ears,  while  the  lumbar  punctures  should  be  carried  out  as  a  matter 
of  routine.  Cloudiness  or  opacity  of  the  fluid  signifies  an  inflammatory 
process,  except  in  tuberculous  meningitis,  where  it  is  clear.  The  bac- 
teriological examination  is  of  the  utmost  importance. 

There  is  no  single  symptom  which  will  enable  us  to  differentiate  a  case 
of  meningitis  from  another  case  with  cerebral  symptoms.  A  careful  con- 
sideration of  the  symptoms  and  history  with  the  information  obtained 
by  the  physical  examination  should  be  made  in  each  case.  Meningitis 
should  definitely  be  assumed  only  when  the  symptoms  are  not  alone 
initial,  but  last  till  death. 


CURRENT  MEDICAL  LITERATURE 


149 


A  Further  Contribution  on  the  Bacteriology  and  Contagiousness  of  Dysen- 
tery in  Children.  (Neue  Beitr'dge  zur  Baktcriologie  und  Epidemio- 
logie  der  Ruhr  in  Kindesalter.) 

Jehle.    Jahrbuch  fur  Kinderheilkunde,  October,  1905. 

The  author  studied  thirty-six  cases  of  dysentery  in  which  the  Shiga- 

Kruse  bacillus  was  found  in  eight  and  the  Flexner  type  in  twenty-eight. 

Of  the  Shiga  type  five  primary  cases  were  admitted  in  the  Anna  Kinder 

Spital  in  Vienna. 

Three  secondary  cases  occurred  in  the  hospital,  one  of  which  was  in  the 
author  himself.  Four  of  the  children  died  and  the  prostration  was  ex- 
treme. The  Shiga  bacilli  were  found  regularly  in  the  stools.  The  blood 
serum  of  the  patients  agglutinated  the  Shiga  and  Kruse  bacilli.  The  Flex- 
ner bacilli  were  not  agglutinated.  No  other  secondary  infections  occurred, 
although  these  children  came  from  large  and  closely  housed  families. 
The  cases  in  which  the  Flexner  type  were  found  had  several  interesting 
features.  The  chief  etiological  factor  was  improper  food.  The  initial 
symptoms  were  severe  with  fever,  vomiting,  diarrhoea  and  collapse.  After 
one  or  two  days  there  would  be  a  rapid  improvement  and  most  of  the  cases 
made  a  complete  recovery.  The  Flexner  type  of  dysentery  bacillus  was 
found  in  all  the  cases  early  in  the  disease. 

The  agglutination  tests  with  original  Flexner  bacilli  were  positive  in  all 
the  cases  in  a  dilution  of  1  to  40  and  1  to  80.  These  cases  were  ex- 
tremely contagious.  The  secondary  cases  would  occur  from  three  to  five 
days  after  exposure. 

The  author  examined  a  large  number  of  summer  diarrhoea  stools  and 
never  found  any  dysentery  bacilli.  He  never  obtained  a  positive  serum 
leaction  with  Flexner  or  Shiga  bacilli  in  these  cases  of  ordinary  enteritis. 

As  a  result  of  his  research  the  author  makes  the  following  conclusions: 

Dysentery  is  not  an  uncommon  disease  in  children  and  sporadic  cases 
are  of  frequent  occurrence. 

The  sporadic  cases  are  often  caused  by  infected  food.  Breast  fed  babies 
after  taking  cow's  milk  for  the  first  time  may  be  infected. 

The  infecting  agent  may  be  one  of  the  several  types  of  dysentery  bacilli. 

The  Flexner  type  is  more  contagious  than  the  Shiga-Kruse  type,  but  the 
later  is  more  fatal.  In  the  stools  of  the  patients  are  found  only  one  type 
of  dysentery  bacillus  and  the  blood  serum  will  only  agglutinate  with  that 
type. 

In  dyspepsia,  cholera  infantum,  summer  diarrhoea,  no  dysentery  bacilli 
were  detected  and  the  serum  reactions  were  negative. 


The  Use  of  Antidiphtheritic  Serum  in  the  Treatment  of  Stomatitis  and 
Vulvo -Vaginitis  in  Children.  (L'Emploi  du  serum  antidiphtherique 
dans  le  traitement  des  stomatites  et  des  Vulvo-vaginites  de  L'En- 
fance.) 

Giorelli  and  Brinda.   Archives  de  Medicine  des  Enfants,  December,  1905. 

The  authors  consider  only  the  severe  forms  of  aphthous  and  ulcerative 
stomatitis  and  do  not  include  the  be  lign  cases  of  simple  catarrhal  stoma- 
titis or  those  due  to  the  specific  syphilitic  virus.    These  cases  are  notably 


CURRENT  MEDICAL  LITERATURE 


hard  to  treat  and  in  weak  scrofulous  children  may  terminate  fatally.  The 
etiology  of  ulcerative  stomatitis  is  obscure  and  no  one  organism  has  been 
found  responsible.  The  treatment  generally  employed  has  been  the  use 
of  chlorate  of  potash  both  locally  and  internally.  Nitrate  of  silver,  per- 
manganate of  potash,  formatine  and  chloride  of  calcium  have  all  been 
recommended. 

A  child  was  brought  to  the  dispensary  three  years  ago  with  a  very  severe 
case  of  ulcerative  stomatitis.  In  spite  of  applications  of  nitrate  of  silver 
permanganate  of  potash,  perchloride  of  iron,  and  bichloride  used  faith- 
fully for  several  weeks  no  marked  improvement  was  noted,  so  the  child 
was  admitted  to  the  hospital.  A  dose  of  antitoxin  was  administered 
and  there  was  a  rapid  recovery.  This  led  to  its  use  in  similar  cases  and 
the  histories  of  twenty-five  cases  are  given  in  full.  These  were  all  cases 
of  aphthous  and  ulcerative  stomatitis  and  there  were  no  cases  of  noma. 
Inoculations  from  these  cases  were  made  on  agar,  gelatine  and  bullion. 
Staphlyococci,  streptococci  and  the  pneumococcus  of  Frielander  were  the 
most  frequent  varieties  of  organisms.  The  Klebs-Loeffler  bacillus  was  not 
in  any  of  the  cases.  All  the  cases  made  a  rapid  recovery.  The  dose  given 
was  iooo  units,  repeated  every  second  or  third  day  if  necessary.  No  bad 
results  followed  in  any  of  the  cases. 

The  authors  decided  to  try  the  effect  of  the  serum  on  cases  of  vulvo- 
vaganitis.  This  is  not  uncommon  and  resists  the  ordinary  methods  of 
treatment.  In  discussing  the  etiology  of  this  disorder  the  author  insists 
that  most  of  the  cases  are  not  due  to  the  gonococcus.  The  discharge  is 
analogous  to  that  occurring  in  purulent  otitis  and  from  mucous  membranes 
in  children  who  are  weak  and  run  down.  Six  cases  of  non-specific  dis- 
charge are  reported  with  prompt  recovery  without  the  use  of  injections 
or  local  treatment. 

The  longest  case  was  only  under  treatment  for  two  weeks  and  in  that 
time  received  five  injections  of  iooo  units.  Four  cases  of  specific  discharge 
in  which  the  gonococcus  was  detected  were  treated  with  serum.  Three 
cases  made  a  complete  and  rapid  recovery  and  no  improvement  was  noted 
in  one  case.   In  none  of  these  cases  was  the  Klebs-Loeffler  bacillus  present. 

The  benefits  is  due  in  the  opinion  of  the  author  to  the  stimulation  of 
the  active  reparative  processes  of  the  organism. 

In  one  case  not  included  in  the  report  the  authors  injected  ten  cubic 
centimeters  of  a  physiologic  serum  without  any  amelioration  in  the 
discharge. 


Investigations  on  the  Serum  Sickness.   (Neuere  Beobachtungen  iiber  die 
Serumkrankheit.) 

Pirquet.    Jahrbuch  fur  Kinderheilkunde,  October,  1905. 

The  serum  sickness  is  not  a  process  limited  to  the  skin,  but  one  in 
which  almost  all  the  organs  are  affected.  The  symptoms  appear  from 
eight  to  twelve  days  after  the  injection  and  are  shown  by  fever,  eruption 
and  pain  in  the  joints  and  muscles.  The  eruption  presents  many  varia- 
tions. 


CURRENT  MEDICAL  LITERATURE 


A  few  of  the  symptoms  are  discussed  in  detail.  The  enlargement  of  the 
glands  appear  in  the  vicinity  of  the  injected  area  before  the  eruption 
occurs  and  in  many  cases  this  may  be  the  only  symptom.  In  severe  cases 
conjointly  with  the  eruption  occurs  a  general  oedema.  To  detect  this  it 
is  often  necessary  to  make  frequent  weighings.  It  may  reach  ten  per 
cent,  of  the  body  weight.  The  albuminuria  which  is  frequently  noted  is 
not  the  result  of  injecting  a  foreign  albumin  into  the  system,  but  is  the 
product  of  an  inflammatory  irritation  of  the  kidneys.  A  leucopenia  is 
cften  present  which  reaches  its  maximum  about  the  eighteenth  day.  In 
one  case  the  leucocytes  fell  from  14,640  on  the  sixth  day  to  880  on  the 
eighteenth  day.  Hamburger  has  proven  that  with  the  outset  of  the  sick- 
ness is  coincident  with  the  presence  of  precipitins  in  the  blood.  The 
incubation  period  after  a  first  injection  is  from  eight  to  twelve  days,  but 
it  is  much  shorter  after  a  reinjection  of  a  serum  from  the  same  species. 
If  the  reinjection  takes  place  within  three  months  the  serum  sickness  will 
occur  almost  immediately.  The  appearance  of  antibodies  in' the  blood 
marks  the  appearance  of  the  sickness.  If  antibodies  are  already  present 
the  symptoms  will  make  an  earlier  appearance. 

The  frequency  and  intensity  of  the  symptoms  depends  upon  the  kind 
and  amount  of  serum  used.  The  antitoxin  does  not  cause  the  sickness 
but  the  introduction  of  albumins  foreign  to  the  organism  are  responsible. 
No  precepitins  will  be  formed  from  serum  introduced  through  the 
alimentary  tract.  The  antitoxin  cannot  be  absorbed  or  taken  into  the 
system  through  the  alimentary  tract. 


MATERIA  MEDICA  AND  THERAPEUTICS 
Edited  by  Spencer  L.  Dawes,  M.  D. 

Clinical  Investigations  and  Experiences  with  the  Roemer  Pneurnococcus 
Serum  in  Croupous  Pneumonia.  (Klinische  Beobachtungen  und 
Erfahrungen  tnit  dem  Pneumococcen-serum  Roemer  bei  der  croup- 
dsen  Pneumonic) 

Kxauth.    Deutsche  medicinische  Wochenschrift,  1905,  31,  p.  452. 

The  author  considers  the  early  work  of  Fraenkel,  the  Klemperer 
brothers,  and  others  on  the  subject  of  pneurnococcus  immunity.  Romer's 
preparation  is  a  polyvalent  one,  and  consists  of  a  mixture  of  sera  of 
various  species  of  animals  which  have  been  treated  with  a  number  of 
cultures  of  pneumococci  isolated  from  infections  in  man.  This  serum 
has  been  used  for  three  years  in  the  eye  clinic  in  Wurzburg  in  the  treat' 
ment  of  pure  pneurnococcus  eye  infections  where  the  author  states  it 
has  given  excellent  results  in  ulceration  of  the  cornea.  Seven  cases  of 
croupous  pneumonia  in  the  Royal  Garrison  Hospital  at  Wurzburg  were 
treated  with  one  or  more  injections  of  twenty  cubic  centimetres  of  the 
serum.  The  author  states  that  there  were  no  unfavorable  or  harmful 
results  from  the  use  of  the  serum  in  these  cases.    The  pulse,  temperature, 


CURRENT  MEDICAL  LITERATURE 


respiration  and  general  condition  were  all  favorably  influenced.  A  rapid 
decided  fall  in  the  temperature  was  observed  in  but  one  case  when  the 
serum  was  given  early  in  the  course  of  the  disease.  In  the  other  the 
temperature  generally  fell  gradually.  Convalescence  pursued  a  normal 
course. 


Concerning  Alypin,  a  New  Local  Anesthetic.    (Ueber  Alypin,  ein  neues 
lo kales  Anastheticum.) 

Seeligsohn.    Deutsche  medicinische  Wochenschrift,  No.  35,  7905. 

The  author  has  been  using  this  new  local  anesthetic  in  his  clinic  and 
polyclinic  for  diseases  of  the  eye,  since  November,  1904,  and  gives  the 
results  of  his  studies.  His  experiments  were  made  as  follows :  a  one  and 
two  per  cent,  solution  of  alypin  was  dropped  into  a  large  number  of 
normal  eyes.  Immediately  afterwards,  patients  complained  of  a  burning 
sensation,  which  disappeared  after  one  or  two  minutes;  there  was  also 
some  hyperaemia,  but  there  was  no  anesthesia  produced  in  any  of  the 
cases.  As  was  discovered  later,  the  first  solutions  used  were  not  chemi- 
cally pure,  and  were  of  acid  reaction.  In  March,  1905,  the  author  obtained 
a  new  neutral  four  per  cent,  solution,  and  obtained  altogether  different 
results.  The  solution  was  first  used  in  normal  eyes,  then  compared  with 
cocaine,  thirdly  its  effectiveness  in  inflammatory  conditions  was  tried,  and 
finally  it  was  used  in  operations.  After  dropping  a  four  per  cent,  alypin 
solution  into  a  normal  eye,  some  patients  complained  of  the  burning 
sensation  and  others  did  not.  Anesthesia  was  produced  in  one  or  two 
minutes.  After  three  or  four  minutes  a  probe  could  not  be  felt.  In  the 
majority  of  the  cases  a  slight  hyperaemia  was  produced  which  disappeared 
in  a  few  minutes.  Anesthesia  lasted  from  ten  to  fifteen  minutes  in  some 
cases.  In  none  of  the  cases  did  a  dilatation  of  the  pupil  result  nor  were 
there  disturbances  or  commotion.  When  compared  with  cocaine,  a  four 
per  cent,  alypin  solution  was  dropped  into  one  eye  and  a  four  per  cent 
cocaine  solution  into  the  other.  It  was  found  that  complete  anesthesia 
did  not  occur  quite  as  soon  as  from  cocaine,  but  lasted  one  or  two 
minutes  longer.  Alypin  was  then  used  in  cases  of  keratitis  eczematosa 
of  children,  as  well  as  in  cases  of  acute  conjunctivitis,  iritis,  and  irido- 
cyclitis, and  it  was  found  that  in  these  cases  too,  anesthesia  resulted. 
The  author  then  employed  this  solution  for  the  removal  of  deep  seated 
foreign  bodies  and  found  it  very  effective.  It  was  just  as  effective  in 
other  operations  like  tenotomies.  Ten  minutes  before  the  operation  a 
few  drops  were  dropped  into  the  eye,  five  minutes  before,  a  few  drops 
more,  and  directly  before,  a  little  more.  Patients  did  not  complain  of 
any  pain.  The  solution  was  also  used  in  operations  for  preparatory 
iridectomy,  strabismus  operations,  in  one  case  of  antiglaueomatous  iridec- 
tomy, etc.  There  was  no  more  pain  experienced  in  any  of  the  cases  than 
when  cocaine  is  employed,  nor  were  there  any  cases  of  intoxication,  or 
increased  tension  such  as  cocaine  produces. 


Vol.  xxvii 


MARCH,  1906 


No  3. 


ALBANY 
MEDICAL  ANNALS 


Bfc&resses 

DELIVERED  AT  THE  CENTENNIAL  ANNIVERSARY 
OF  THE  MEDICAL  SOCIETY  OF  THE 
STATE  OF  NEW  YORK, 

Held  at  Albany,  January  30  and  31,  and  February  1,  1906. 

I.    THE  PLEA  OF  THE  PATIENT. 

By  GROVER  CLEVELAND. 

I  have  heard  a  story,  invented  in  a  spirit  of  frivolous  wag- 
gery, to  the  effect  that  once  upon  a  time  the  devil,  having 
undertaken  an  excursion  throughout  the  earth  for  alleged 
purposes  of  investigation,  met  with  all  sorts  of  adventures 
and  mishaps ;  but  that  the  culmination  of  all  was  not  reached 
until  he  fell  among  the  lawyers,  where  he  lost  his  tail.  So  far 
as  the  legal  fraternity  is  implicated,  I  am  supported  by  all 
my  brethren  in  the  profession  when  I  brand  this  fable  as 
absurd  and  libellous,  without  sense  or  even  the  cheapest  kind 
of  wit.  And  yet,  there  may  sometimes  be  a  feeling  of  loneliness 
and  forlornness  so  overwhelming  and  which  may  so  subdue  our 
reason  and  distort  our  imagination,  that  any  superstition  of  evil 
portent,  even  though  it  relates  to  the  mishaps  of  the  devil,  is 
apt  to  enter  our  minds.  I  will  not  confess  that  I  am  at  this 
moment  in  such  a  deplorable  predicament;  but  I  am  tre- 
mendously impressed  by  the  serious  position  I  occupy.  Con- 
fronted as  I  am  with  an  inexorable  and  unpitying  medical 
environment,  it  is  something  of  an  effort  for  me  to  entirely 
close  my  mind  to  the  old  story  of  the  devil  who  fell  among 
the  lawyers,  and  to  free  myself  from  every  tinge  of  apprehen- 
sion concerning  the  things  that  may  happen  to  the  lawyer 
who  to-night  has  fallen  among  the  doctors. 


154 


THE  PLEA  OF  THE  PATIENT 


It  is  well  enough  for  me  to  enter  upon  my  task  to-night 
with  a  determination  to  be  absolutely  frank  and  unreserved; 
but  the  reproachful  thought  now  vexes  me  that  I  have  done 
ill  in  hinting  even  in  a  tone  of  pleasantry  that  the  circum- 
stances surrounding  me  justify  the  least  feeling  of  loneliness 
or  forlornness  on  my  part.  I  will  not  forget  that  I  am  speak- 
ing in  the  city  of  Albany,  where  more  than  twenty  years  ago, 
during  a  short  residence,  I  received  at  the  hands  and  from 
the  hearts  of  its  people  such  kindness  and  consideration,  and 
where  I  formed  such  delightful  friendships,  that  through  all 
the  intervening  years  I  look  back  upon  my  brief  sojourn  in 
Albany  as  a  tired  and  wayworn  wanderer  might  recall  the 
restful  delights  of  a  shaded  spot  left  far  behind  in  his  weary 
travel.  Surely  I  could  have  no  better  or  surer  guaranty  of 
indulgence  and  support  than  is  afforded  by  the  steadfastness 
of  my  Albany  friends — the  living  still  kind,  and  the  dead  still 
giving  the  reassurance  which  comes  of  sacred  memories. 

Another  reason  why  I  should  be  brave  to-night  grows  out 
of  my  consciousness  of  a  professional  duty  I  have  to  dis- 
charge. I  appear  before  this  awe-inspiring  tribunal  holding 
a  brief  in  behalf  of  an  immense  army  of  comrades  as  well  as 
clients. 

For  the  purpose  of  our  argument,  let  us  divide  humanity 
in  two  sections — one  composed  of  a  few  doctors,  and  the 
other  embracing  the  many  millions  of  their  actual  or  pros- 
pective patients.  I  appear  for  myself  and  these  millions; 
and  I  claim  at  the  outset  that,  notwithstanding  our  large 
majority,  the  medical  section  of  mankind  has  in  one  way  or 
another  curtailed  the  opportunity  of  freedom  of  thought  and 
considerate  hearing,  to  which  we  are  entitled  by  "  the  laws 
of  nature  and  of  nature's  God."  We  acknowledge  that  the 
world  owes  this  minority  a  living.  With  a  generous  delicacy 
which  reaches  sublimity,  we  are  on  their  account  not  over 
obedient  to  the  laws  of  health;  and  we  sometimes  pay  their 
bills.  When  sick  we  submit  with  more  or  less  humility  to 
their  orders.  If  we  recover,  it  is  only  to  take  our  place  on 
the  waiting  list,  still  subject  to  further  service.  If  we  do  not 
recover,  it  is  left  to  us  to  do  the  dying. 

In  view  of  these  facts,  I  think  I  do  not  mistake  the  temper 
of  my  clients  when  I  represent  that  there  is  growing  up  among 
them  a  feeling  that  there  ought  to  be  less  mystery  and  high 


GROVER  CLEVELAND 


155 


and  mighty  aloofness  on  the  part  of  their  medical  advisers. 
We  have  long  been  wont  to  treat  with  a  kind  of  amused  tolera- 
tion the  names  in  pigeon  Latin  or  Greek,  given  by  the  doctors 
to  very  common  things,  and  to  diseases  which  already  had 
names  both  simple  and  significant.  All  this  seems  to  have 
much  increased  with  the  discovery  of  new  remedies,  and  the 
chase  after  new  diseases ;  and  this  increase  has  apparently 
been  accompanied  by  additional  mystery  and  additional  incli- 
nation on  the  part  of  our  doctors  to  remind  us  of  their  stately 
superiority. 

We  fully  appreciate  the  tremendous  advance  that  has  been 
made  in  medical  knowledge  and  practice  within  the  memory 
of  those  not  yet  old.  There  are  but  few  left  who  bear  the 
scars  of  blood  letting  which  depleted  the  veins  of  a  former 
generation.  In  these  days  the  fever-stricken  wretch  who  begs 
for  a  drop  of  water  to  cool  his  tongue  is  heard  with  more 
favor  than  was  the  rich  man  who  cried  out  to  Father  Abraham 
from  the  flaming  torments  of  the  bottomless  pit.  We  are  now 
told  of  the  discovery  of  germs  and  microbes,  more  or  less  deadly, 
countless  in  number,  of  every  conceivable  size  and  shape,  and 
given  to  habits  and  tastes  adjusted  to  every  emergency  of  their 
existence,  which  not  only  inhabit  the  earth  beneath  us  and  the 
atmosphere  about  us,  but  lurk  in  every  corner  and  cranny  of  our 
bodies  with  murderous  intent.  Another  marked  and  startling 
indication  of  progress  in  medical  knowledge  is  found  in  the 
sentence  .of  removal  and  destruction  lately  passed  by  medical 
science  upon  a  certain  annex  or  attachment  of  the  human 
body,  which  has  for  centuries  substantially  escaped  more 
serious  accusation  than  that  of  inactive  uselessness.  Its  de- 
tection in  conspiracy  against  life  and  health  has  stimulated 
our  doctors  in  such  hot  pursuit  that  the  man  who  carries  his 
appendix  about  with  other  personal  belongings  is  probably 
just  as  comfortable  if  he  has  never  heard  the  story  of  the  way 
the  devil  lost  his  tail. 

In  all  seriousness,  therefore,  I  desire  to  concede,  without 
the  least  reservation,  on  behalf  of  the  great  army  of  patients, 
that  they  owe  to  the  medical  profession  a  debt  of  gratitude 
which  they  can  never  repay,  on  account  of  hard,  self-sacri- 
ficing work  done  for  their  benefit,  and  for  beneficent  results 
accomplished  in  their  interest.  But  at  the  same  time  we  are 
inclined  to  insist  that,  while  our  doctors  have  wonderfully 


THE  PLEA  OF  THE  PATIENT 


advanced,  in  all  that  increases  the  usefulness  and  nobility  of 
their  profession,  this  thing  has  not  happened  without  some 
corresponding  advance  in  the  intelligent  thought  and  ready 
information  of  their  patients  along  the  same  lines.  We  have 
come  to  think  of  ourselves  as  worthy  of  confidence  in  the 
treatment  of  our  ailments;  and  we  believe,  if  this  was  accorded 
to  us  in  greater  measure,  it  would  be  better  for  the  treatment 
and  better  for  us.  We  do  not  claim  that  we  should  be  called 
in  consultation  in  all  our  illnesses ;  but  we  would  be  glad  to 
have  a  little  more  explanation  of  the  things  done  to  us.  We 
do  not  like  to  think  of  our  doctors  as  veiled  prophets  or  mys- 
terious attendants,  shut  out  from  all  sick-bed  comradeship 
except  such  as  comes  through  cold  professional  ministrations,  and 
irresponsive  to  our  need  of  sympathetic  assurance.  Nor  should 
it  be  considered  strange  if  thousands  among  us,  influenced  by  a 
sentiment  just  now  astonishingly  prevalent,  should  be  disturbed 
by  the  spectre  of  a  medical  trust,  and  like  all  who  are  trust 
affrighted,  should  cry  out  for  greater  publicity  between  physi- 
cian and  patient. 

I  am  authorized  to  say,  for  the  great  body  of  patients,  that 
they  are  naturally  proud  and  gratified  when  their  doctors  are 
scientific  and  learned.  It  is  a  great  comfort  and  satisfaction 
to  us  when  the  medical  erudition  accumulated  through  ages 
and  the  medical  study  of  centuries,  are  brought  to  bear  upon 
our  ailments.  In  an  unperverted  state  wre  have  no  tolerance 
for  uneducated  and  unscientific  pretenders  or  quacks,  who 
promise  to  cure  disease ;  and  we  have  no  faith  in  their  nos- 
trums and  haphazard  remedies.  Yet  these  nostrums  and 
remedies  are  bought  and  taken  by  hundreds  of  thousands,  and 
those  who  manufacture  and  sell  them  amass  fortunes.  And 
our  doctors  wonder  at  these  things,  and  charge  them  to  the 
ignorance,  degradation  and  superstition  of  those  who  should 
remain  their  loyal  patients.  This  is  a  hasty  conclusion,  not 
altogether  just  or  quite  adequate  to  the  solution  of  the  prob- 
lem. Perversion  of  judgment  and  vain  imagings  on  the  part 
of  patients  undoubtedly  enter  into  the  situation.  But  we  all 
know  that  the  sick  who  wait  and  longingly  hope  for  health 
are  peculiarly  susceptible  to  these  things,  and  that  fatiguing 
discontent  with  the  halting  results  of  a  mysterious  and  unex- 
plained course  of  regular  medical  treatment  leads  directly  to 
the  camp  of  quacks  and  charlatans,  who  not  only  cunningly 


GROVER  CLEVELAND 


157 


guarantee  speedy  recovery,  but  capture  the  imagination  and 
gratify  caprice  by  an  alluring  and  apparently  frank  explana- 
tion of  the  qualties  and  character  of  their  remedies  or  treat- 
ment. These  considerations  suggest  the  possibility  that  our 
doctors  themselves  may  contribute  in  a  remote  and  indirect 
way  to  a  condition,  irritating  and  disquieting  to  all  consci- 
entious practitioners,  and  threatening  harm  to  the  great  body 
of  patients. 

I  feel  that  I  have  very  freely  availed  myself  of  the  privilege 
which  a  generous  tribunal  accords  to  advocacy  and  have 
rather  bluntly  hinted  some  things  as  they  have  presented 
themselves  to  my  mind.  If  the  substance  of  what  I  have  said 
meets  with  your  dissent  I  beg  you  to  remember  that  much 
must  depend  upon  our  respective  points  of  view.  If  the  man- 
ner of  the  presentation  of  my  case  subjects  me  to  the  sus- 
picion of  perverting  the  privilege  of  free  discussion  to  the 
purpose  of  flippant  and  inconsiderate  treatment  of  a  serious 
topic,  I  hope  it  will  not  be  altogether  unavailing  for  me  to 
protest  that  I  have  not  deliberately  or  intentionally  sinned. 
I  yield  to  no  one  in  respect  and  admiration  for  the  medical 
profession.  I  have  formed  friendships  among  its  members, 
so  strong  and  so  warm  that  they  not  only  fill  a  large  place 
in  the  comfort  and  solace  of  my  life,  but  by  sentimental  asso- 
ciation lead  me  to  covet  the  good  opinion  of  the  entire  fra- 
ternity. 

In  these  circumstances,  I  am  glad  that  my  professional 
attitude  and  my  duty  to  my  clients  permit  me  to  turn  from 
an  advocate's  statement  of  grievances  to  a  more  congenial 
and  pleasing  branch  of  discussion. 

Of  course,  we  of  the  patient  class  as  an  aggregation,  can 
not  avoid  the  color  of  selfishness  in  our  estimate  of  the  rela- 
tionship that  should  exist  between  ourselves  and  the  medical 
profession.  As  a  general  proposition  this  quite  accords  with 
the  bent  of  human  nature;  and  this  is  accentuated  in  our  case 
by  the  tremendous  stakes  of  life  and  health  which  we  risk 
upon  such  relationship.  It  may  as  well  be  here  conceded  that 
when  life  and  health  are  pressed  upon  his  attention  by  their 
demands  for  protection  and  care,  every  individual  belonging 
to  our  class  will,  consciously  or  unconsciously,  regard  the 
highest  medical  learning,  the  most  important  medical  dis- 
coveries, the  utmost  refinement  of  medical  science  and  all 


158 


THE  PLEA  OF  THE  PATIENT 


that  there  is  or  can  be  in  medical  ministration,  as  mere  agencies 
which  should  be  working  together  for  the  one  great  end  of 
saving  his  life  and  curing  his  disease. 

I  have  used  the  words  "  working  together,"  because  they 
seem  to  be  suggestive  of  another  condition  in  which  the  great 
body  of  patients  are  more  generally  and  more  watchfully 
interested  than  at  first  glance  might  be  supposed.  We  nat- 
urally desire  that  everything  which  medical  science  has  taught 
should  be  within  our  reach,  in  our  times  of  need.  But  this 
is  not  all.  Nothing  can  divert  our  minds  from  the  belief  that 
the  free  course  and  glorification  of  medical  science,  so  far  as 
we  are  related  to  it,  is  largely  dependent  upon  the  harmonious 
opinions,  the  harmonious  fellowship  and  harmonious  ministra- 
tions of  its  office-bearers  whom  we  delight  to  honor  as  our 
doctors.  And  so  it  happens  that  we  have  appropriated  the 
words  "  When  doctors  disagree  "  as  defining  a  situation  not 
altogether  favorable  to  our  most  complete  realization  of  med- 
ical benefits.  We  are  told  that  sometimes  differences  have 
arisen  from  opposite  opinions  as  to  the  ethics  that  should 
govern  medical  practice.  WTe  disclaim  any  desire  or  intention 
to  meddle  with  these  ethics  so  far  as  they  may  be  above  and 
beyond  us.  But  we  can  not  after  all  escape  the  reflection 
that  patients  as  well  as  doctors  are  necessary  to  medical 
practice.  On  this  ground  it  should  not  be  thought  strange  if 
we  are  somewhat  alert  to  discover  how  our  interests  are 
affected  by  any  rules  of  medical  ethics  that  may  be  proposed. 
Clearly  we  are  only  entitled  as  patients,  to  ask  that  our  privi- 
lege be  not  curtailed  while  doctors  disagree,  that  we  be  not 
allowed  to  suffer  while  professional  punctilio  stands  aloof, 
and  that  we  be  not  put  in  jeopardy  by  ethical  quarrels. 

And  so  I  have  no  fear  of  sacrificing  the  interests  of  my 
clients,  nor  any  misgivings  as  to  the  rectitude  of  my  course, 
when  I  claim  the  relevancy  and  fitness  of  all  I  have  said  as  prefa- 
tory to  the  request  I  now  make  in  behalf  of  myself  and  the 
millions  of  patients  I  represent,  that  we  be  permitted  to  join  our 
doctors  in  the  congratulations  and  felicitations  that  befit  this 
occasion. 

We  celebrate  to-night  the  close  of  the  first  century  in  the 
life  and  honorable  achievement  of  the  Medical  Society  of  the 
State  of  New  York.  If  it  has  experienced  vicissitudes,  they  are 
as  nothing  when  compared  with  its  many  triumphs.    It  is  well 


GROVER  CLEVELAND 


159 


to  recall  them  all.  And  yet  I  believe  there  is  no  single  incident 
of  its  career  which  furnishes  greater  cause  for  satisfaction  and 
j.oy  to-night,  than  the  harmonious  unification  of  medical  organiza- 
tion within  the  Empire  State,  which  has  just  been  accomplished 
under  the  name  of  this  society. 

Upon  the  resumption  of  its  relations  with  the  American 
Medical  Association,  it  will  be  in  affiliation  with  a  national 
body  nobly  responsive  to  the  highest  and  purest  motives  of 
the  profession.  We  do  not  suspect  that  the  ethical  sentiment 
of  the  doctors  of  the  State  of  New  York  needs  prompting. 
And  yet  no  scheme  of  medical  ethics  could  more  delight  and 
satisfy  us  than  the  suggestive  and  advisory  statement  of  ethi- 
cal principles  which  the  national  organization  has  submitted 
to  its  constituent  State  branches.  This  statement  opens  with 
the  declaration  that  "  Physicians  should  not  only  be  ever 
ready  to  obey  the  calls  of  the  sick  and  the  injured,  but  should 
be  mindful  of  the  high  character  of  their  mission  and  of  the 
responsibilities  they  must  incur  in  the  discharge  of  momentous 
duties.  In  their  ministrations  they  should  never  forget  that 
the  comfort,  the  health  and  the  lives  of  those  entrusted  to 
their  care  depend  on  skill,  attention  and  fidelity."  It  declares 
that  "  The  physician  should  be  a  minister  of  hope  and  comfort 
to  the  sick,"  and  that  "  The  opportunity  which  a  physician 
has,  of  promoting  and  strengthening  the  good  resolutions  of 
patients  suffering  under  the  consequences  of  evil  conduct, 
ought  never  to  be  neglected."  The  truth  which  underlies  the 
real  gospel  of  the  profession  is  thus  announced :  "  There  is 
no  profession  from  the  members  of  which  greater  purity  of 
character  and  a  higher  standard  of  moral  excellence  are  re- 
quired than  the  medical ;  and  to  attain  such  eminence  is  a  duty 
every  physician  owes,  alike  to  the  profession  and  to  patients. 
It  is  due  to  the  patients,  as  without  it  their  respect  and  con- 
fidence can  not  be  commanded;  and  to  the  profession  because 
no  scientific  attainments  can  compensate  for  the  want  of  cor- 
rect moral  principles." 

Assuming  that  we  of  the  patient  class  are  admitted  to  the 
rejoicings  and  felicitations  of  our  doctors  to-night,  may  we  not 
be  permitted  to  express  the  wish  that  the  cup  of  our  hopes  and 
desires  may  be  completely  filled  by  the  adoption  on  the  part  of 
the  rehabilitated  Medical  Society  of  the  State  of  New  York,  of 
ethics  so  generous,  so  necessary  and  so  Christianlike? 


l6o  THE  STATE  AND  THE  DOCTOR 

I  can  not  close  without  suggesting  the  thought  that  on 
every  account  you  of  the  medical  profession  should  be  sympa- 
thetic, tender,  reverent  and  God-fearing  men.  You  can  not 
escape  contact  with  sickness  and  death,  with  dire  distress, 
with  anguish  too  deep  for  tears  and  with  mute  heartbreaking 
— all  appealing  to  your  ministrations.  And  you  can  not  avoid 
the  awful  thought  that  no  impious  hand  should  explore  what 
God  has  most  fearfully  and  wonderfully  made  the  abiding  place 
of  His  Holy  Spirit. 

Tread  lightly,  gentlemen,  for  you  have  to  do  with  temples 
of  the  Holy  Ghost. 


II.  THE  STATE  AND  THE  DOCTOR. 
By  ST.  CLAIR  McKELWAY,  LL.  D., 

Vice-Chancellor  of  the  Board  of  Regents  of  the  University  of  the  State  of  New  York. 

My  Friends  :  I  congratulate  you  on  the  attainment  by  the 
society  of  an  age  so  respected  and  so  long.  I  especially  con- 
gratulate you  on  the  condition  of  reunion  and  of  fellowship 
which  has  been  made  finally  effective  and  which  renders  this 
anniversary  significant  of  far  more  than  the  mere  age  of  your 
organization  which  it  attests. 

There  is,  perhaps,  a  propriety  in  my  addressing  you.  What 
you  think  of  yourselves  can  be  assumed.  The  effect  of  cul- 
ture, character,  competition  and  contention  on  a  profession 
from  which  there  is  no  appeal  except  to  God  and  to  the  under- 
taker can  be  imagined — and  is  evident. 

What  an  outsider  thinks  of  you  must  be  surmised.  Offi- 
cially I  am  an  outsider.  Sympathetically  and  by  your  kind 
indulgence  I  am  likewise  an  insider.  I  often  addressed  this 
organization  before  any  line  of  demarcation  was  drawn  in  it. 
I  subsequently  addressed,  with  polar  impartiality,  not  only 
the  organization  which  annually  meets  here,  but  also  your 
temporarily  separated  brethren  who  met  in  Manhattan,  which 
is  sometimes  incorrectly  called  New  York.  I  invariably 
espoused  the  cause  of  the  State  society,  before  the  State 
association.  I  did  not  hesitate  to  espouse  the  cause  of  the 
State  association  before  this  society.  Some  of  your  society 
would  rather  be  kissed  than  cuffed,  but  while  each  of  you 


ST.  CLAIR  MC  KELWAY 


161 


insisted  upon  being  right,  the  fact  that  your  lines  have  been 
reformed  on  the  basis  of  the  old  fellowship  shows  that  the 
final  right  has  been  ascertained,  and  that  lots  need  not  be  cast 
nor  disputation  multiplied  as  to  which  of  the  two  was  the 
more  or  the  less  right — or  wrong — at  the  time  of  separation. 

I  shall  hold  no  such  inquest.  I  shall  neither  suggest  nor 
provoke  taunts.  The  best  way  to  agree  is  to  agree ;  the  best 
way  to  maintain  agreement  is  not  to  review  or  to  revive  mis- 
understandings which  have  been  composed. 

I  am  free  to  say  that  all  doctors  who  meet  here,  and  all 
laymen,  rejoice  that  the  causes  of  separation  are  submerged 
in  the  fact  of  the  reunion  itself.  The  casuists  might  study 
these  causes.  The  study  might  furnish  a  text  or  a  pretext 
for  vivisection.  The  process  would  be  more  industrious  than 
benign.  The  conclusion  would  be  more  dogmatic  than  educa- 
tional. It  is  enough — and  it  is  gratifying — for  us  here  and 
now  to  know  that  where  there  were  twro  there  is  now  only 
one  society,  and  that  for  the  long  future  as  during  the  long 
past — prior  to  the  separation — the  physicians  and  surgeons  of 
the  State  of  New  York  represented  in  this  society  are  and  will 
be  one. 

Officers  Always  Representative  Men. 

Before  proceeding  to  any  debatable  topics  and  before 
indulging  in  any  polemical  suggestions,  permit  me  affection- 
ately to  reeall  the  pleasures  of  our  long  fellowship.  Your 
officers  now  are  representative  men.  Your  officers  in  the  past 
were  representative  men,  both  in  citizenship  and  in  medical 
science.  Who  here  can  forget  the  refined  presence,  the  simple 
nature,  the  profound  learning  and  the  steady  principle  of  Dr. 
Hun?  All  here  will  remember  the  subtle  wisdom,  the  tact- 
ful diplomacy,  the  strong  character  and  the  hypodermic  per- 
sonality of  Dr.  Gray,  the  great  alienist.  None  of  us  can  have 
failed  to  mourn  the  recent  loss  of  Dr.  Didama,  who,  full  of 
years  and  of  honors  from  his  profession  and  from  his  fellow- 
men,  lately  fell  on  sleep  in  his  home  city,  which  regarded  him 
as  her  most  venerated  son. 

None  of  us  here,  going  further  back,  can  ever  forget, 
while  memory  holds  a  seat  and  love  a  place  in  our  hearts, 
Jacob  S.  Mosher,  of  this  capital.  He  was  a  wit  among 
scientists  and  a  scientist  among  wits,  and  as  a  friend,  a  com- 


THE  STATE  AND  THE  DOCTOR 


panion,  a  helper  of  his  fellowmen,  the  memory  of  him  is 
blessed.  Nor  is  Wey,  of  Elmira,  or  Moore,  or  Rochester,  or 
many  a  former  officer  of  this  society,  lost  to  the  mind.  Their 
characteristics  are  cherished,  their  influence  is  still  pervasive, 
and  they  can  never  be  forgotten  in  the  gatherings  of  their 
brethren. 

I  shall  not  suggest  many  names  from  my  end  of  the 
State.  They  are  well  known  to  you,  and  hardly  need  sugges- 
tion. Some  of  them  were  among  my  companions,  and  to 
them  I  cannot  without  emotion  refer — they  were  my  dear 
friends,  and  they  were  yours.  We  all  know  that  Flint  and 
Sims  and  Hutchison  and  Delafield  and  Mitchell  and  Crane 
and  Chapman  left  upon  the  lives  of  their  colleagues  or  of  their 
pupils  an  influence  which  those  colleagues  and  those  pupils 
will,  in  turn,  transmit  to  their  successors,  in  coming  genera- 
tions. The  light  passes  from  hand  to  hand.  The  light  is 
never  put  out.    It  is  inextinguishable;  it  is  immortal. 

The  Accomplished  Reunion. 

I  do  not  know  under  what  conditions  you  have  accom- 
plished reunion.  I  feel  sure  the  conditions  were  candidly  can- 
vassed and  are  clearly  understood.  I  can  recall  with  dis- 
tinctness the  period  of  your  separation  and  I,  perhaps,  could 
technically  hint  at  the  questions  which  led  to  it.  I  know 
they  were  intense  questions.  I  know  that  the  differences 
which  they  aroused  were  sincere.  I  know  that  the  severances 
which  they  caused  were  acute  and  were  grievous.  I  am  sure 
that  the  respect  which  each  of  the  former  societies  had  for 
the  other  was  unimpaired.  We  will  do  well  to  remember  that 
those  who  went  off  from  us  did  so  without  bitterness,  and 
with  regret.  They  will  do  well  to  believe  that  those  who 
stayed  by  and  held  the  fort  felt  that  they  should  do  so  in 
order  to  be  faithful  to  those  with  whom  they  acted  and  to  the 
obligations  of  service  which  they  had  laid  upon  the  State 
and  the  State  on  them.  But  we  are  here  together  again 
to-day  and  we  are  here  to  face,  not  the  past  with  analysis  or 
writh  acrimony,  but  the  future  with  hope  and  confidence. 

Many  things  have  occurred.  The  average  estimate  of  life  has 
rjeen  lengthened.  The  list  of  diseases  regarded  as  incurable  has 
been  made  smaller.   The  percentage  of  mortality  from  difficult 


ST.  CLAIR  MC  KELWAY 


163 


diseases  has  been  greatly  lowered.  So  large  is  this  reduction 
that  the  revenues  of  your  profession  must  have  been  perceptibly 
impaired,  except  in  favored  instances.  Patients  are  fewer  in 
number.  Diseases  are  shortened  in  duration.  The  area  of  your 
lucrative  practice  and  the  period  of  complaints  which  make  your 
practice  lucrative  have  both  become  less.  You  may  yet  have  to 
imitate  the  wise  men  of  your  calling  in  the  East.  You  may  have 
to  charge,  not  for  making  persons  well,  but  for  keeping  them 
well.  Your  income  may  have  to  be  conditioned  on  the  preva- 
lence of  health  and  may  cease  to  depend  upon  your  restoration 
of  ill  patients  to  health.  The  wise  book  says :  "  Those  who  are 
whole  need  not  a  physician."  The  time  may  come  here,  as  it 
has  come  in  the  older,  and,  as  it  seems  to  us,  the  less  cultivated 
portion  of  the  world,  when  the  physicians  will  need  those  who 
are  well,  and  whom  he  keeps  well,  to  be  the  measure  of  his 
income  and  the  warrant  of  the  confidence  or  of  the  competence 
he  would  command.  Fancy  could  multiply  comedies  out  of 
what  may  seem  to  you  to  be  a  paradox,  but  the  paradox  of  one 
age  may  become  the  acknowledged  principle  of  another.  It 
often  has. 


Field  of  the  Specialist  Enlarged. 

Why  life  has  been  measured  with  more  profit  to  the  insur- 
ance companies  than  to  the  policy  holders  has  become  evident. 
Complaint  against  that  inequality  is  widespread.  But  why  the 
doctor  who  keeps  us  well  should  not  be  so  well  regarded  as  the 
doctor  who  makes  us  well,  after  we  have  made  ourselves  ill, 
might  be  sincerely,  instead  of  cynically  or  clinically,  asked.  This 
is  not  so  absurd  as  it  may  seem.  Your  profession  has  divided 
the  patient  into  compartments.  Your  profession  has  subdivided 
its  members,  into  specialists.  The  general  practitioner  still  ob- 
tains, and  many  of  them,  I  am  glad  to  say,  can  be  seen  here 
to-night.  But  he  is  accustomed  more  and  more  to  call  the 
specialist  into  consultation  with  him.  He  can  bring  to  the 
specialist  a  thorough  account  of  the  personality,  the  environment 
and  the  life  and  habits  of  the  patient.  The  specialist  can  bring 
to  him  an  accurate  knowledge  either  of  the  complaint  from  which 
the  patient  suffers  or  of  that  organ  of  the  patient  which  is  par- 
ticularly affected  by  such  complaint.  I  recall  Disraeli's  definition 
of  a  medical  consultation.    "  It  is,"  he  says  in  Lothair,  "  an 


164 


THE  STATE  AND  THE  DOCTOR 


occasion  on  which  the  consulting  physician  indorses  the  policy 
of  the  superintending  practitioner — and  changes  the  treatment." 

I  shall  seek  to  explore  none  of  the  mysteries  of  your  calling 
and  to  turn  up  none  of  the  secrets  of  your  prison  house.  If  "  I 
could  a  tale  unfold  whose  lightest  breath  "  would  accomplish  all 
the  dire  results  which  Hamlet,  in  his  soliloquy,  both  predicted 
and  feared,  I  would  not.  But  I  would  have  you  bear  in  mind 
that  you  must  seriously  consider  whether,  by  your  very  skill, 
you  may  not  be  undermining  your  own  practice  and  impairing 
your  own  revenue.  Of  course,  those  nations  which  we  flippantly 
call  "  heathen  "  are  indifferent  to  the  ailing,  impatient  with  the 
aged  and  almost  hostile  toward  the  dying.  So  were  the  Greeks. 
So  were  the  Romans.  So  is  not  modern  civilization.  There  must 
be  harmony  between  due  sensibility  to  suffering  and  the  pride 
and  power  commanded,  and  demanded,  by  health.  The  new 
dispensation  must  ameliorate  the  hardness  of  the  old;  but  must 
borrow  from  the  old  some  of  the  value  which  that  old  placed  on 
health,  for  the  sake  of  health,  and  on  the  usefulness  of  health 
itself  to  the  age  and  to  the  State.  And  your  own  profession 
must  realize  that  the  State — as  that  political  expression  is  un- 
derstood by  this  generation — takes,  not  your  quarrels,  not  your 
differences,  not  your  divisions,  not  your  scholastic  distinctions 
into  account,  but  your  patients,  both  as  citizens  and  as  sovereigns. 
The  State  recognized  different  schools  of  medicine  before  they 
recognized  one  another.  The  State  long  waited  for  now  legally 
recognized  schools  to  agree  with  one  another,  and  when  it  found 
that  they  did  not,  could  not  or  would  not  do  so,  then  the  State 
came  in  and  did  its  own  work  of  recognition.  That  accomplished 
more  than  was  at  first  realized. 

The  State-Made  Doctor. 

It  shifted  the  center  of  power  from  over  the  heads  of  doctors 
to  the  State  government.  A  doctor  thereafter  became  a  State- 
made  product.  He  remained  a  medical  college  pupil,  but  as  a 
doctor  he  became,  if  not  a  product,  then  at  least  the  creature,  of 
the  State.  New  York  well  nigh  led  off  in  this.  Other  States 
have  since  assumed  the  control  of  doctor-making  in  the  final 
stage.  The  tendency  among  many  States  is  indifferent  to  the 
ramifications  of  groups  of  your  calling  whether  they  flock 
together  or,  in  the  language  of  Dundreary,  "  flock  separately." 
As  already  said,  the  State  did  not  willingly  or  suddenly  or  vio- 


ST.  CLAIR  MC  KELWAY 


165 


lently  assume  control  of  the  making  or  of  the  recognition  of 
doctors.  The  State  gave  to  them  plenty  of  time  and  plenty  of 
hints  to  do  that  themselves.  Those  opportunities  were  not  availed 
of.  The  schools  which  the  State  recognized,  as  organized  facts, 
then  collectively  became  the  subject  of  State  consideration.  The 
State  established  for  all  intending  surgeons  and  doctors  a  uni- 
form degree  of  primary  instruction.  The  State  saw  to  it  that 
the  different  schools,  as  nearly  as  could  be,  established  a  uniform 
degree  of  direct  medical  instruction.  That  set  the  present  sys- 
tem going  in  this  commonwealth.  On  the  whole,  it  has  gone 
on  very  well.  It  is  not  ideal,  but  it  is  practical.  It  is  also  pro- 
gressive. It  carries  in  it  for  medicine  a  reasonable  assurance 
against  ignorance  and  for  patients  against  quackery.  If,  how- 
ever, patients  insist  on  preferring  quackery,  they  have  a  con- 
stitutional right  to  do  so,  but  they  must  prefer  it  openly.  It 
cannot  be  palmed  on  them  covertly,  under  State  auspices.  This 
is  a  great  gain. 

The  question  is  practically  settling  itself.  It  was  supported, 
and  it  was  opposed.  There  were  arguments  for  it,  and  there 
were  protests  against  it.  These  will  long  continue.  Some  things, 
however,  must  be  regarded  as  established.  The  State  is  and 
will  remain  the  guarantor  of  doctors.  Practitioners  or  colleges 
are  their  teachers,  and  will  remain  so,  but  the  State  will  be — 
to  speak  practically — the  final  doctor-maker,  and  its  stamp  must 
be  the  last  affixed.  Those  who  receive  its  stamp  will  be  the  only 
ones.  "  None  others  genuine  "  will  be  the  excluding  language,  or 
fact. 

The  present  issue  is  not  shall  this  be  undone.  It  will  never 
be  undone.  The  pressing  question  is,  shall  more  of  it  be  done 
than  is  already  done  ?  Here  is  where  the  State  must  again  come 
in.  Without  forecasting  its  action,  I  think  one  can  tell  where 
the  State  will  take  its  stand.  It  is  where  we  should  all  wish  the 
State  to  take  its  stand,  and  having  taken  it,  to  hold  it.  Nearly 
every  year  the  State  is  urged  to  recognize  some  new  division 
or  branch  of  alleged  medical  theory  or  practice,  in  addition  to 
those  already  recognized.  Whether  the  State  will  do  that  or  not 
is  not  for  you  nor  for  me  to  determine.  But  it  is  for  you  and 
for  me,  as  citizens  of  the  State,  to  consider,  and  by  our  con- 
sideration to  help  this  State  to  a  right  conclusion.  The  State 
should  not  and  never  will  lower  the  standard  of  primary  medical 
education.    It  should  not  appreciably  lower  the  standard  of 


4 


i66 


THE  STATE  AND  THE  DOCTOR 


specific  and  final  medical  instruction  for  those  for  whom  it  main- 
tains it. 

The  State  should  insist  upon  the  literary  and  clinical  require- 
ment of  that  instruction,  and  upon  the  final  examination  of  the 
steps  of  that  instruction,  under  State  auspices,  within  the  sub- 
jects to  which  each  school  is  limited  and  addicted. 

Incidentally  that  final  examination  is,  to  a  degree,  under  the 
supervision  of  the  Regents.  The  Regents  do  not  name  the  ex- 
aminers. They  make  selections  of  them  from  among  the  names 
submitted  to  them  by  the  three  medical  divisions  recognized 
by  State  law.  Nor  do  the  Regents  propound  the  questions. 
They  are  propounded  by  the  representatives  of  the  different 
schools  named  to  the  Regents.  The  examinations  are  rated  in 
the  usual  mathematical  and  impersonal  way,  which  is  admitted 
by  all  to  be  practically  just. 

Function  of  the  Board  of  Regents. 

The  pleas  made  to  the  Legislature  and  through  the  press  to 
the  Regents  and  the  politicians  for  additions  to  the  list  of  med- 
ical divisions  to  be  recognized  by  the  State  are  natural  and  are 
pathetic.  The  sincerity  of  these  appeals  is  manifest  and  should 
be  cheerfully  admitted,  but  they  should  really  be  addressed  to 
the  State.  They  cannot  properly  be  addressed  to  the  Board  of 
Regents.  That  board  simply  receives  orders  from  the  Legis- 
lature. That  board  has  respected  the  orders  it  has  thus  received. 
That  board  is  limited  by  those  orders.  That  board  never  sought 
those  orders ;  it  never  desired  them,  but  it  has  never  declined 
them.  It  has  simply  obeyed  them.  The  board,  legally  authorized 
and  protected  by  the  Constitution,  is  personally  named  by  the 
Legislature.  Its  policy  of  awaiting  the  orders  of  the  Legislature 
is  alike  loyal  and  logical.  You,  gentlemen,  represent  the  senior 
and  the  more  numerous  and  the  more  influential  school  of  med- 
ical theory  and  practice.  You  are  yourselves  authorized  to  meet, 
before  the  committees  of  the  Legislature,  all  applicants  for  further 
legislative  recognition  in  the  field  of  medicine.  It  is  to  the  Legis- 
lature and  not  to  the  Regents,  you  should  signalize  your 
proverbial  preference  of  peace  to  war  and  of  harmony  to  dis- 
cord. You  should  leave  to  the  Regents  the  execution  of  the 
will  of  the  State.  You  should  not  expect  of  the  Regents  the 
retardation  or  the  expansion  of  that  will ;  but  I  can  assure  you 


ST.  CLAIR  MC  KELWAY 


167 


that  the  Regents — as  I  have  said — will  favor  the  maintenance  of 
existing  elementary  educational  tests  for  intending  students  of 
medicine  as  a  preliminary  condition  to  the  commencement  of 
their  studies.  Should  new  applicants  seek  to  avoid  or  to  lower 
these  preliminary  tests  their  prayer  to  the  State  to  suspend  or 
to  reduce  or  in  any  substantial  degree  to  evade  these  tests  should 
not,  in  our  opinion,  and  I  am  sure  should  not,  in  your  opinion, 
be  granted,  except  on  conditions  to  be  clearly  understood.  Should 
new  applicants  meet  preliminary  tests,  their  claim  to  final  State 
examination  will  remain  for  the  Legislature  and  for  the  Governor 
to  settle,  and  for  the  Regents,  so  far  as  they  conscientiously  can, 
to  maintain  a  loyal  regard  to  the  ordered  will  of  the  State. 

I  have  set  forth  these  plain  facts  and  have  made  these  plain 
distinctions,  for  a  plain  reason.  The  Board  of  Regents,  of  which 
I  still  have,  for  a  short  time,  the  privilege  to  be  a  member  and 
the  presiding  officer,  has  been  urged  to  support  the  application 
to  the  Legislature  of  interests  and  of  organizations  which  claim 
a  medical  recognition  that  the  law  does  not  at  present  allow  or 
extend.  My  colleagues  and  myself  have  found  life  made  more 
lively  than  we  could  wish  by  appeals,  and  are  conscious  that  the 
appeals  themselves  have  behind  them  a  considerable  body  of 
sincere  opinion  and  of  earnest  sentiment.  We  have  been  just 
as  earnestly  urged  to  repel  this  sentiment  as  to  recognize  it ; 
just  as  earnestly  urged  to  oppose  it  as  to  favor  it. 

The  Privileged  and  the  Unprivileged. 

The  whole  situation  grows  out  of  the  State's  assumption 
of  the  conditions  to  determine  both  initial  and  final  educa- 
tional tests  in  medicine  and  in  surgery,  in  lieu  of  leaving,  as 
in  the  past,  the  determination  of  them  to  the  different  and 
to  the  differing  medical  schools  themselves,  which  were 
unable  co  agree  upon  them.  It  is  natural  for  those  benefited 
by  present  conditions  to  wish  to  retain  them  and  to  prevent 
others  from  sharing  them  with  them.  It  is  natural  for  those 
who  would  also  share  them,  but  who  do  not,  to  try  to  obtain 
them.  The  Board  of  Regents  is  thus  beset  both  by  the 
privileged  and  by  the  unprivileged.  It  is  made  very  con- 
scious of  the  existence  of  both  and  of  its  bombardment  by 
both.  We  shall  never  presume  the  State  will  reduce  its  pre- 
liminary educational  tests.    As  already  frankly  stated,  we  do 


i68 


THE  STATE  AND  THE  DOCTOR 


not  believe  the  State  should,  nor  can  we  presume  the  State 
will,  reduce  its  final  professional  educational  tests.  It  should 
require  every  one  to  know  the  how  and  the  why  of  what  he 
proposes  to  do  and  should  then  allow  him  medically  to  do 
nothing  else  under  States  auspices. 

Frankly,  should  the  State  do  less,  the  Board  of  Regents 
could  well  ask  the  Legislature  to  relieve  it  from  all  the  medi- 
cal work  delegated  to  it,  and  unasked  by  it.  Like  work,  how- 
ever, has  been  delegated  to  us  in  the  case  of  other  learned  pro- 
fessions. The  improbability  that  the  State  will  lower  its 
standard  is  as  plain  to  us  as  the  fact  that  the  State  should  not 
do  so. 

But  there  can  be  no  reason  for  supposing  that,  given  an 
equal  degree  of  preliminary  knowledge  and  given  an  equal 
standard  and  an  equal  period  of  scientific  education,  the  board 
will  be  inhospitable  to  any  new  claimants  for  medical  con- 
sideration by  the  State,  who  ask  for  what  is  just  and  fair. 

The  career  of  organized  medicine  has  been  marked  by  many 
advances.  It  has  been  signalized  by  many  enlargements. 
It  has  been  modified  by  many  classifications.  These  have 
taken  effect  upon  medical  and  surgical  study  and  practice. 
All  these  events  justify  the  supposition  that  evolution  has 
not  been  brought  to  a  stop  and  that  the  end  has  not  been 
written  against  any  branch  of  scientific  study  or  practice. 

I  know  these  questions  have  been  threshed  out  before,  but 
there  is  need  to  thresh  them  out  again.  That  must  probably 
be  done  this  very  winter.  Legislators  and  school  men  have 
been  urged  with  uncommon  vigor  to  lower  the  standards,  on 
the  one  hand,  so  as  to  let  in  the  ill-prepared,  or  so  to  enforce 
the  standards,  on  the  other  hand,  as  to  make  the  present 
beneficiaries  of  them  their  exclusive  possessors.  On  the  one 
hand  we  have  been  asked  to  vulgarize  the  standards ;  on  the 
other  hand,  to  monopolize  them.  The  State  has  the  power  to 
do  either.  I  confidently  predict  the  State  will  do  neither. 
No  steps  backward  have  been  taken  by  the  State  in  medical 
education.  Steps  forward  were  long  too  few  and  too  slow. 
At  certain  times  they  were  too  many  or  too  quick,  but  the 
average  maintained,  while  it  may  be  raised  or  made  less 
inelastic,  will  never  be  reduced,  and  that  average  here  is 
less  than  that  of  more  boastful  States. 


ST.  CLAIR  MC  KELWAY 


169 


A  Glimpse  at  Co-Education. 

There  is  a  series  of  propositions  which  grow  out  of  the  gen- 
eral statements  which  I  have  advanced,  but  which  have  a  rela- 
tion to  the  subject  we  are  directly  considering.  Institutions, 
in  New  York  for  instance,  on  private  foundations,  in  a  few 
instances,  illustrate  co-education.  State  institutions,  in 
Western  commonwealths,  illustrate  that  and  those  States  will 
not  recede  from  it.  Former  generations  of  voters  in  newer 
States,  for  reasons  of  economy,  introduced  co-education.  For 
reasons  of  progress  and  of  justice,  and  no  longer  merely  of 
economy,  they  have  carried  co-education  from  the  primary 
clear  through  the  university.  They  love  the  system.  Their 
fathers  and  their  mothers  were  educated  under  it.  This  gen- 
eration, gratefully,  loyally  and  proudly  maintains  it.  Our 
own  commonwealth  has  not  yet  provided  the  capstone  of  free 
university  education,  to  crown  the  foundations  of  free  primary 
and  secondary  education.  But,  right  or  wrong,  the  plea  is 
spreading,  that  our  own  commonwealth  should  do  so. 

The  commonwealth  is  richer  than  all  private  wealth.  From 
this  fact  grows,  and  is  growing,  the  belief  that  the  State 
should  freely  bring  within  the  reach  of  all  its  children  every- 
thing that  private  wealth  can  bring  within  the  reach  of  its 
beneficiaries.  "The  best  is  alone  good  enough  for  all."  This 
condenses  the  policy  of  the  Middle  Western,  Northwestern 
and  the  Pacific  States.  This  perhaps  prophecies  the  preg- 
nant purpose  of  the  awakening  South.  The  belief  is  gaining 
that  New  York  itself  will  come  to  the  substantiality  of  this. 
Some  of  us  may  not  live  to  see  it.  Some  of  us  may  make  our 
lives  bitter  by  the  futile  violence  of  unproductive  activity 
against  it.  But  it  will  come,  and  we  will  go,  and  the  memory 
of  us,  when  we  are  gone,  will  be  sweet,  in  proportion  as  we 
shall  have  foreseen  and  welcomed  the  larger  and  the  better 
day,  or  the  era  will  pass  us  by,  unhonored  and  unsung,  if  we 
carp,  and  we  will  die  disobedient  unto  the  Heavenly  vision. 
The  free  provision  of  the  highest  education  by  the  State  is,  I 
think,  ultimately  inevitable.  Whether  or  not  it  should  so  be 
provided  for  the  sexes  in  separate  institutions,  or  co-educa- 
tionally,  is  a  detail.    The  detail  is  not  important. 

This  has  a  relation  to  medical  education.  This  State 
insisted  on  prescribing  primary  standards  to  its  own  schools 


170 


THE  STATE  AND  THE  DOCTOR 


and  then  monopolized  the  control  of  intermediate  ones 
through  its  own  boards.  After  doing  both  it  reserved  to  itself 
the  licensure  of  medical,  legal,  dental,  pharmaceutical  and 
other  learned  practitioners.  Whatever  it  may  then  have  con- 
templated or  intended,  it  then  created  the  demand  it  should 
eventually  provide  and  control  the  institutions  themselves, 
whose  human  product  it  vises,  examines  and  licenses.  I  am  not 
unaware  of  the  amount  of  property  involved  in  private  owner- 
ship of  scientific  school  foundations.  Neither  am  I  unaware  of 
the  cost  of  the  maintenance  or  of  the  management  of  private 
foundations.  Nor  am  I  unaware  of  the  very  gradual  process  of 
public  opinion  and  of  public  action.  Generations  will  probably 
pass  away  before  the  State  will  completely  control  the  education 
of  the  children,  from  the  kindergarten  through  the  university; 
before  the  State  will  teach  and  train  as  well  as  make  doctors, 
just  as  it  now  finally  examines  them  and  exclusively  commissions 
them.  Nor  should  one  for  a  moment  conclude  that  there  will 
be,  or  that  I  would  advocate,  the  abolition  of  private  founda- 
tions. There  will  be  a  division  of  higher  learning  between  State 
foundations  and  private  foundations.  Such  a  division  already 
obtains  in  commonwealths  which  have  long  conducted  State  uni- 
versities. Nothing  essential,  however,  will  eventually  be  beyond 
the  reach  of  the  children  of  the  commonwealth,  at  the  hands  of 
the  commonwealth,  which  is  now  within  the  reach  of  the  chil- 
dren who  can  command  the  benefits  of  private  wealth.  There 
will  be  no  compulsion  or  confiscation,  but  there  will  be  discrimi- 
nation. The  State  must  eventually  put  within  the  reach  of  all 
what  private  endowment,  or  private  munificence,  now  puts  within 
the  reach  only  of  some. 

Development  That  is  Inevitable. 

My  friends,  whether  we  realized  it  or  not,  whether  we  fore- 
saw it  or  not,  this  became  inevitable  when  high  schools,  normal 
schools  and  normal  colleges  were  established  in  the  process  of 
public  education.  The  State  slowly  parted  with  the  idea  that  it 
was  bound  to  give  only  the  minimum  of  education  to  its  children. 
It  slowly  realized  it  was  bound  to  place  within  their  reach  more 
than  as  much  knowledge  as  would  keep  them  out  of  jail,  if 
they  acted  on  it,  and  justify  the  putting  of  them  in  jail,  if  they 
refused  to  act  upon  it.  The  State  slowly  grew  to  the  idea  that 
it  should  raise  the  schooling  of  its  children  by  its  own  hands ; 


ST.  CLAIR  MC  KELWAY 


at  its  own  cost ;  by  its  own  teachers,  from  the  minimum  to  a 
modicum  of  education.  Rut  when  the  people  were  providing 
the  modicum  of  education,  the  certainty,  at  some  time,  they 
would  provide  the  maximum  of  education  became  apparent.  The 
State  now  says  "  No  one  shall  be  a  doctor  or  a  lawyer  or  a 
dentist  or  a  pharmaceutist  or  an  accountant  until  I  shall  have 
examined  him  and  until  he  shall  have  been  commissioned  by  me." 
When  the  State  said,  that  with  the  approbation  of  the  callings 
or  of  the  professions  therewith  concerned,  the  State  gave  en- 
trance to  the  idea  that  it  might  control,  and  that  it  might  con- 
duct, institutions  of  its  own  like  unto  those,  from  which  are 
now  sent  up  to  the  State  graduates  upon  whom  it  stamps  its 
own  imprimature.  Only  those  whom  the  State  thus  authorizes 
and  credentials  can  deal  with  human  rights,  with  human  life, 
and  with  what  is  affected  by  an  intimate  relation  with  human 
rights  and  with  human  life.  There  can  be,  and  there  ought  to  be, 
a  degree  of  resistance  to  this,  for  resistance  to  this  will  be 
salutary.  Such  a  resistance  will  of  itself,  be  desirable  to  slow  the 
process  which  should  not  be  too  fast.  There  is,  and  there  will 
be,  denial  of  this.  The  denial  itself  will  be  desirable,  to  bring 
out  the  salutary  agitation  which  is  the  spiritual  and  intellectual 
and  moral  warrant  or  prelude  to  the  necessary  education.  Pro- 
test against  this  will  be  desirable  to  open  the  way  and  to  pre- 
view the  steps  necessary  to  the  establishment  of  this.  Protest 
will  give  to  beaten  objection  itself  the  satisfaction  of  knowing  that 
it  had  its  day  in  court,  of  knowing  that  it  was  not  brutally  over- 
ridden by  the  impact  of  unreasoning,  impatient  and  irresistible 
insistence. 

What  the  State  Has  Done. 

Much  that  I  have  before  spoken  to  you  in  former  years,  and 
written  about  you  in  past  times,  can  be  quoted  to  the  contrary 
of  this.  "  When  I  was  a  child  I  thought  as  a  child,  I  understood 
as  a  child;  when  I  became  a  man  I  put  away  childish  things." 
Since  then  I  have  seen  the  State  in  its  cities  establish  kinder- 
gartens and  high  schools  over  phrenetic  protests  against  both. 
I  have  seen  the  State  establish  normal  schools  and  normal  col- 
leges against  the  contention  that  "  To  teach  teachers  to  teach 
is  as  absurd  as  it  would  be  to  teach  mothers  to  nurse  or  children 
to  play."  Well,  the  mothers  of  the  overworked  poor  are  now 
taught  how  to  nurse ;  indeed,  their  children  are  even  nursed  for 
them  amid  clean  and  sweet  surroundings,  while  the  mothers  are 


172 


THE  STATE  AND  THE  DOCTOR 


away  at  hard  work  in  congested  city  centers.  To-day  the  chil- 
dren of  the  slums  are  gathered  in  kindergartens  or  in  city  play- 
grounds. To-day  they  are  tenderly  taught  even  how  to  play, 
instead  of  leaving  the  instinct  for  play  to  the  outcome  of  chance, 
amid  conditions  of  confusion  and  of  dirt  and  the  barbarisms 
which  combine  to  make  for  sin.  He  who  took  the  little  children 
in  His  arms  and  blessed  them  and  said  of  them  "  Of  such  is  the 
kingdom  of  Heaven  "  has  touched  city,  county,  State  and  national 
life,  and  the  human  heart,  with  His  sublime  spirit.  He  has  made 
much  of  our  life  the  almoner  and  exponent  of  His  life  to  many 
of  His  little  ones.  Very  significantly,  the  race  of  His  Mother, 
in  our  free  American  cities,  has  been  in  advance  of  other  races, 
to  take  its  children  in  its  arms  and  to  bless  them  with  the  bless- 
ing of  education,  tenderness  and  training;  putting  their  little 
feet  on  the  paths  of  right  endeavor  and  leading  them  tenderly 
over  the  steppes  of  elementary  learning  to  the  flowery  plains  of 
trained  culture. 

We  cannot  arrest  this  manifest  tendency  if  we  would.  Eventu- 
ally the  State  will  be  as  bound  to  complete  and  to  perfect  what 
it  begins,  as  the  moral  and  spiritual  law  itself,  in  pursuance  of 
which  the  State  acts,  is  bound  imperceptibly,  invisibly  but  omnipo- 
tently to  have  its  way  in  the  heart  of  things,  and  in  the  hearts 
of  men.  This  will  not  be  a  socialism  that  levels  down.  This 
will  be  the  spiritual  regnancy  which  levels  up.  Nor  will  the 
State  be  discouraged,  should  the  facilities  it  must  ultimately 
provide  be  at  first  availed  of  by  a  very  few.  A  splendid  hos- 
pital is  a  public  pride  and  a  public  benefaction.  It  is  not  a 
failure,  if  it  be  not  full  of  patients.  It  is  not  a  failure  if  it  does 
not  "  pay  "  in  the  things  of  the  market ;  it  is  an  expression  of 
the  things  of  the  spirit ;  it  makes  for  health  and  happiness  to 
the  suffering;  it  attests  the  justice,  the  altruism  and  the  love 
of  the  State  for  humanity  at  large. 

The  Claim  to  Free  Education. 

The  few  who  might  go  at  the  first  in  our  commonwealth 
to  such  colleges  or  such  universities — which  would  involve  the 
teaching  of  medicine  by  the  State — would  not  affect  the  duty 
of  the  State  to  provide  for  them,  and  the  few  at  first  who 
might  attend  would  not  long  deter  the  children  of  the  State 
from  availing  themselves  of  these  privileges  in  larger  num- 
bers.   As  the  State  is  richer  than  all  its  private  wealth  and 


ST.  CLAIR  MC  KELWAY 


173 


as  all  its  private  wealth  is'  protected  by  State  laws,  and 
bequeathed  at  all  only  by  State  permission,  and  as  all  State 
law  is  conditioned  on  State  justice  and  is  self-maintained  by 
State  strength  and  by  State  conscience,  so  should,  so  will, 
State  institutions  of  higher  learning  and  of  the  highest  learn- 
ing be  at  least  as  good  and  as  fine  as  any  like  institutions 
upon  private  foundation.  The  higher  supply  could  at  first 
be  limited  to  the  measure  of  the  higher  demand,  but  the 
demand  would  shortly  increase  and  the  supply  would  be 
correspondingly  augmented.  I  have  before  other  institutions 
in  the  past  enlarged  on  the  benign  factor  of  privation  as  a 
stimulus  to  the  soul  of  the  poor,  bent  on  getting  learning,  but 
I  am  now  satisfied  that  the  poor  child  in  the  rich  city  is  enti- 
tled to  free  education  to  the  limit  which  is  at  the  command  of 
those  not  poor. 

This  may  cost  a  season  of  protest  in  colleges  and  hospitals, 
and  may  cost  the  State  some  reviling  from  both  in  the  minds 
of  those  to  whom  private  foundations  are  a  form  of  wealth  or 
income.  That  is  natural ;  that  must  be  allowed  for ;  it  should 
not  be  forgotten,  however,  that  from  the  State  or  from  its 
municipalities  private  medical  foundations  already  receive  a 
large  measure  of  public  money.  They  undoubtedly  deserve 
it.  But  the  argument  against  State  ownership  and  State  con- 
duct of  hospitals  and  medical  colleges  could  better  be  urged 
by  others  than  by  State  beneficiaries  in  control  of  such  more 
or  less  subsidized  institutions.  State  institutions  of  this  kind 
need  not — as  already  said — displace  private  institutions  of  this 
kind.  There  are  colleges  and  universities  on  private  founda- 
tions in  commonwealths  maintaining  State  colleges  and  State 
universities.  There  could,  there  should,  there  will  be  hos- 
pitals and  colleges  upon  private  foundations,  should  this  State 
establish  others  on  its  own  foundations.  The  State  could 
have  relegated  all  higher  education  to  private  initiative  and 
support.  The  State  long  did  so.  But  refusing  longer  to  do 
so,  the  State  opened  the  way  for  itself  as  an  educator  from 
the  foundations  to  the  pinnacles. 

Government  Inexorably  Logical. 

Government  is  inexorably  logical.  Government  as  large  as 
that  of  New  York  State  may  be  halted  from  expansion.  It 
may  be  checked  by  temporary  considerations.    But  it  will  not 


174 


THE  STATE  AND  THE  DOCTOR 


long  be  halted  or  long  be  checked.  Government  is  the  ulti- 
mate of  public  opinion.  Public  opinion  in  the  end  is  expressed 
by  government.  The  laws  that  cross  that  public  opinion  are 
changed.  The  constitutions  that  stand  in  its  way  are  amended, 
or  are  interpreted,  in  line  with  it.  There  are  few  things  more 
slow  than  the  outcome  of  public  opinion  into  law,  within, 
around,  over  or  through  constitutions.  The  fathers — as  if 
deliberately — sowed  the  path  of  progress  or  of  change  with 
obstacles  so  as  to  check  the  process  of  change  itself.  But 
change  is  certain,  though  slow.  The  present  trend  of  progress 
is  manifest.  It  is  toward  the  doing  for  the  people  by  the  gov- 
ernment of  several  vital  things  which  government  has  hereto- 
fore been  disposed  to  leave  to  private  initiative  or  to  private 
combinati6ns.  The  liberty  thus  accorded  to  private  initiative 
or  private  combinations  has  been  abused.  The  shores  of  our 
time  are  grimly  lined  with  the  wrecks  of  character  and  of 
manhood  that  could  not  survive  the  pressure  of  inquiry  or 
live  in  the  white  light  of  impartial  justice.  Political  parties 
to-day  are  desperately  trying  to  evade  the  consequences  of 
their  own  defaults.  They  are  endeavoring  to  realign  them- 
selves around  sham  issues  in  mock  contention.  They  are 
falling,  in  many  quarters,  to  pieces,  under  the  destructive 
strain  of  a  systematic,  desperate  and  panic-stricken  insin- 
cerity. So  the  courtiers  of  King  Canute  in  vain  urged  him  to 
veto  the  incoming  ocean.  So  did  the  shivering  poltroon, 
pictured  by  the  French  artist,  in  the  beginning  urge  the 
Creator  "  to  conserve  chaos."  So  did  King  George  discard 
Pitt  and  Burke  and  lean  on  Lord  North,  only  to  lose  his 
colonies  and  to  make  the  bounds  of  freedom  wider  yet.  In 
the  light  and  under  the  force  of  the  steady  pressure  of  this 
ethical  time  toward  changed  and  better  conditions,  and  for 
new  and  purer  instrumentalities — a  pressure  which  can  be 
charged  wTith  dramatic  displacements  and  the  reversal  of 
many  long-established  propositions — under  the  light  and  force 
of  that  pressure  should  be  judged,  and  can  be  foreseen,  the 
manifest  destiny  of  the  State  to  take  much  of  the  higher 
education,  as  it  has  already  taken  nearly  all  of  the  primary 
and  secondary  education,  into  its  own  hands.  Complete  medi- 
cal education  under  State  auspices  may  on  these  accounts  be 
surely  predicted,  and  what  is  of  more  importance  may  be 
safely  advocated  and  gladly  accelerated  and  welcomed. 


THE  PRESIDENT'S  ADDRESS 


175 


III.    THE  PRESIDENT'S  ADDRESS. 
By  JOSEPH  D.  BRYANT,  M.  D., 

President  of  the  Society. 

It.  is  with  happy  realization  and  unalloyed  pleasure  that  I  desire 
you  all  to  join  with  me  in  greeting  this  moment's  existence  of 
the  medical  profession  of  the  State  of  New  York  with  glad 
recognition.  And  if  I  am  a  competent  judge  of  the  meaning 
of  the  hearty  cooperation  that  characterizes  the  efforts  of  ah 
concerned  in  reorganization  throughout  the  State,  and  of  the 
seeming  contentment  that  appears  to  distinguish  those  here 
assembled,  then,  indeed,  are  these  feelings  shared  to  the  fullest 
extent  by  every  one  coming  within  the  influence  of  the  sentiment 
and  labor  dominating  the  reorganization.  In  any  event,  I  beg 
to  assure  you  that  the  medical  profession  of  the  country  regards 
this  occasion  as  one  of  the  most  important  in  the  history  of  its 
existence. 

The  chastening  influence  of  earnest  contention  in  all  fields  of 
human  conflict  is  often  not  unlike  that  witnessed  in  the  common 
convulsions  of  nature:  the  air  is  made  the  clearer  and  the  purer 
thereby,  the  purposes  of  God  and  man  are  better  understood, 
and  corresponding  things  are  improved  and  established  upon  a 
better  and  firmer  basis. 

For  a  painfully  long  period  of  time  the  open  contention  existing 
in  the  medical  profession  of  this  State  has  robbed  the  profession 
of  the  significant  influence  in  medical,  and  public  matters,  freely 
accorded  to  much  less  beneficient  and  potent  bodies  of  men. 
Bodies  illy  inclined  to  salutory  measures,  and  encouraged  chiefly 
because  of  their  forceful  organization,  even  in  the  attainment  of 
self-seeking  aims,  have  badly  defeated  the  wholesome  endeavors 
of  the  disorganized  opposition  of  magnanimous  and  earnest  med- 
ical desire.  Too  often,  indeed,  in  the  past,  divided  medical 
counsel  or  half-hearted  medical  support  has  failed  to  beget  the 
respectful  consideration — on  the  part  of  those  in  authority — 
due  to  the  justice  of  a  cause  championed  by  the  medical  pro- 
fession. How  often,  in  fact,  has  it  happened  within  the  easy 
recollection  of  us  all  that  we  have  fittingly  been  told  by  those 
in  authority :  u  When  you  can  agree  among  yourselves,  then 
come  to  us  for  aid!"    This  reason,  or  excuse,  which  ever  it 


176 


THE  PRESIDENT'S  ADDRESS 


may  have  been,  can  no  longer  be  regarded  as  available  for  the 
diplomatic  purposes  it  has  served  in  the  past. 

The  enrolled  regular  physicians  of  the  State — not  less  than 
6,000  in  number — are  to-day  a  united  body  of  attentive  medical 
men,  laboring  in  common  for  commendable  interests  and  benefi- 
cent causes.  The  medical  profession  of  the  State  can  now  take 
hold  with  a  firm,  confident  grasp  in  support  of  wholesome  public- 
spirited  propositions,  and  of  medical  advance,  with  the  full  con- 
sciousness of  the  fact  that  their  united  desire,  or  their  confirmed 
opinion,  will  constitute  a  bulwark  of  moral  force,  not  to  be 
misjudged  or  indifferently  considered.  Please  note  the  fact,  my 
friends,  that  I  refer  to  general  medical  and  public  propositions, 
meaning  general  professional  and  public  duty,  not  private  or 
personal  propositions,  relating  more  often  than  otherwise  to 
private  or  personal  desire,  too  frequently  strongly  tinctured  with 
self-seeking  motives. 

So  long  as  the  medical  profession  shall  contribute  its  part  to 
the  interests  of  the  public  good,  the  public  servants  will  heed  its 
admonitions  and  respect  the  logic  of  its  appeals.  But  when  un- 
wise personal  desires  or  clanish  purposes  shall  proselyte 
patriotic  or  disinterested  efforts,  then  will  the  hold  on  public 
esteem  be  loosened,  and  medical  appeals  to  public  confidence  be- 
come of  much  less  avail  or  respectful  consideration  entirely  for- 
feited. In  every  community,  as  well  as  in  the  State  at  large, 
there  are  broad  and  fertile  fields  for  the  encouragement  and 
practice  of  general  and  special  good.  Therefore,  "  Be  yet  not 
weary  in  well  doing  "  as  the  reward  for  all  such  labor  as  this, 
is  munificent  and  ever  exercising  its  influence  in  behalf  of  those 
who  actively  foster  healthy  sentiments. 

But  a  moment  ago  it  was  remarked  that  the  membership  of 
the  Medical  Society  of  this  State  is  6,000.  These  figures  are  only 
approximate  and  are  used  at  this  time  as  an  easy  reckoning 
point  to  a  greater  membership.  Every  regular  physician  in  the 
State  should  be  a  member  in  good  standing  in  this  organization,, 
and  every  one  thus  enrolled  should  recognize  the  fact  that  he 
himself  is  as  potent  a  factor  in  the  affairs  of  the  organization  as 
is  any  other  member.  He  should  recognize  as  a  truth  that  he 
himself  is  an  active  unit — if  he  shall  choose  so  to  be — and  of  as 
much  importance  as  is  any  other  individual  unit  of  the  organized 
body.  And  when  he  shall  have  recognized  these  facts,  there  yet 
remains  another  of  far  greater  significance  to  be  known,  the  fact 


JOSEPH  D.  BRYANT 


177 


that  this  relationship  carries  with  it  profound  responsibility — the 
exacting  creator  of  onerous  duty,  fortified,  let  us  hope,  with 
abundant  love  for  just  causes ;  duty  to  ourselves  and  to  our 
professional  brother,  to  our  profession,  and  to  the  people  at 
large,  and  to  all  things  that  shall  glorify  our  calling  and  add  to 
the  enlightenment  of  the  world. 

The  present  status  of  this  medical  body  has  been  attained  only 
through  the  extraordinary  zeal  and  infinite  patience  practiced  by 
the  "  Joint  Committee  of  Conference,"  to  which  some  time  ago 
the  fortunes  of  the  independent  medical  bodies  were  mutually 
and  wisely  entrusted.  I  desire  to  say  at  this  time  that  although 
the  members  of  the  Committee  have  builded  slowly,  they  have 
builded  intelligently  and  for  all  time,  and  in  strict  accordance 
with  the  letter  of  the  law  regulating  such  matters.  Much  yet 
remains  to  be  accomplished  under  the  order  of  the  court  before 
the  control  of  the  affairs  of  the  great  body  can  be  relegated  by 
the  ad  interim  House  of  Delegates  to  the  completed  organization. 
There  is  no  doubt,  however,  that  a  year  from  this  time  you  will 
have  placed  under  your  fostering  care  the  fully  organized  body, 
the  successful  outcome  of  which  will  depend  on  the  exercise  of 
prudent  forbearance  and  counsel  and  just  action  on  the  part  of 
all  concerned.  In  this  connection,  I  desire  to  express  the  earnest 
hope  that  all  who  are  engaged  in  the  completion  of  this  great 
work  will  cooperate  promptly  and  cheerfully  with  those  now 
vested  by  the  court  with  the  construction  of  the  legal  frame- 
work required  for  the  purpose. 

At  this  time,  so  we  are  legally  informed,  only  the  report 
of  the  Joint  Committee  of  Conference  and  of  the  ad  interim 
House  of  Delegates  and  the  offering  of  a  resolution  of  con- 
tinuance of  power  are  in  order.  I  take  this  opportunity  of  an- 
nouncing these  facts  at  once  so  that  no  manifestation,  of  however 
commendable  zeal,  can  give  rise  to  encrouchment  on  the  time 
allotted  to  the  scientific  work  of  the  day.  If,  however,  there  be 
any  now,  or  hereafter,  who  may  desire  to  communicate  with 
the  ad  interim  House  of  Delegates  upon  any  matter  relating  to 
the  labor  in  their  charge,  please  do  so  freely  in  writing,  addressed 
to  the  Secretary  of  that  body,  and  I  can  assure  you  that  most 
respectful  consideration  will  be  given  the  contents  of  the  message. 

If  you  can  kindly  indulge  me  a  little  longer  I  will  read  a  com- 
munication that  should  interest  you  exceedingly  and  inspire 
within  you  a  feeling  of  profound  satisfaction : 


i78 


THE  PRESIDENT'S  ADDRESS 


"  Dr.  Joseph  D.  Bryant,  President,  Medical  Society  of  the  State 
of  New  York. 

"  Dear  Doctor :  I  have  the  honor  to  acknowledge  your  com- 
munication conveying  official  notice  that  the  final  details  of  the 
procedure  in  the  consolidation  of  The  New  York  State  Medical 
Association  and  the  Medical  Society  of  the  State  of  New  York 
have  been  completed.  I  beg  to  congratulate  you  on  this  consum- 
mation, which  has  been  long  desired  by  the  profession  of  the 
United  States.  Since  the  organization  formed  by  the  union  of 
these  two  societies  becomes  the  constituent  branch  of  the  Ameri- 
can Medical  Association  in  the  State  of  New  York,  I  beg  to 
extend,  in  behalf  of  the  American  Medical  Association,  a  cordial 
greeting  to  your  Society  and  a  welcome  to  the  councils  of  a 
united  profession. 

"  With  best  wishes,  I  am 

"  Very  sincerely  yours, 

"  Lewis  S.  McMurtry, 
"President,  American  Medical  Association." 

Finally,  I  have  the  great  pleasure  of  announcing  to  you  the 
delightful  fact,  that  the  Medical  Society  of  the  State  of  New 
York  will  be  fully  represented  in  the  "  Councils  of  a  United 
Profession,"  the  House  of  Delegates  of  the  American  Medical 
Association,  at  its  next  meeting  in  Boston.  And  in  this  connec- 
tion, may  I  not  venture  to  predict  that  every  member  of  the 
Society  will  hereafter  early  and  late  be  found  laboring  along  all 
the  lines  of  commendable  effort  to  promote  the  development  of 
the  new  order  of  things,  and  that  no  one  will  raise  a  willing  hand 
against  a  completed  consummation. 


HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 


179 


IV.    HISTORY  OF  MEDICINE  IN  THE  STATE  OF  NEW 
YORK  IN  THE  LAST  HUNDRED  YEARS. 

By  SAMUEL  B.  WARD,  M.  D. 

Mr.  President  and  Gentlemen  of  the  Medical  Society  of  the  State 
of  Nezv  York: 

The  statute  which  made  possible  the  incorporation  of  this 
Society  was  passed  by  the  Legislature  on  April  4,  1806.  The 
Society  was  organized  on  the  first  Tuesday  in  February,  1807, 
and  consequently  this  meeting  closes  the  one  hundredth  year 
of  its  existence. 

It  would  appear  that  at  that  time  medical  attention  was 
largely  directed  toward  climatology  and  atmospheric  and 
telluric  influences;  for  at  its  second  meeting  in  February, 
1808,  the  Society  offered  two  prizes  for  the  best  dissertations 
on  the  topography,  geology,  and  mineralogy  of  any  county 
in  the  State,  together  with  an  account  of  the  prevalent  dis- 
eases in  such  county.  The  addresses  of  President  John 
Rodgers,  in  February,  1813  and  1814,  are  also  largely  devoted 
to  the  influence  of  atmospheric  changes  in  producing  and 
modifying  disease,  and  it  is  surprising  how  ingeniously  and 
satisfactorily  he  accounts  for  almost  all  manner  of  complaints. 
For  instance,  "  Spotted  fever  appeared  after  cold  and  mois- 
ture united,  and  disappeared  when  warm  weather  came  on." 
And  again  14  In  our  bills  of  mortality  we  find  phthisis  pul- 
monalis  more  frequent  than  formerly.  The  modern  mode  of 
dressing,  particularly  among  young  females,  has  been  blamed  by 
some  as  a  great  cause  of  this  mischief;  but  the  state  of 
atmosphere,  and  the  greater  variations  of  weather  than  for- 
merly, have  given  a  greater  force  to  pulmonic  complaints." 
And  again  "  The  cold  and  moisture  disposes  to  scurvy,  as  on 
the  shores  of  the  Baltic  and  in  Holland." 

Again  in  181 5  attention  was  called  "to  that  section  of  the 
by-laws  which  requires  every  member  to  present  to  the 
Society  all  proper  information  respecting  the  geography  and 
topography  of  the  county  in  which  he  resides,  together  with 
an  historical  account  of  the  diseases  which  prevail  at  any 
season  of  the  year." 

Again  in  1819  President  John  Stearns  dwells  at  length  in  his 
annual  address  on  this  same  point,  although  he  characterizes 


l80  HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

as  absurd  the  theory  "  That  the  globe  possessed  living  facul- 
ties; the  mountains  were  its  respiratory  organs;  the  veins  of 
minerals  its  abscesses;  and  the  metals,  its  diseases."  But  he 
also  says  that  Mr.  Webster  has  brought  forward  enough 
facts  "  to  induce  a  belief  that  the  real  source  of  many  epidemic 
diseases  must  be  traced  to  the  interior  of  the  earth.  That 
subterraneous  fires  are  continually  decomposing  the  materials 
of  that  region,  and  occasionally  ejecting  their  gaseous  results 
into  the  atmosphere,  are  facts  corroborated  by  history,  and  by 
every  volcanic  eruption  on  its  surface  *  *  *  The  conjoined 
influence  of  the  celestial  bodies,  in  aiding  this  effect,  and  also 
in  the  production  of  earthquakes  and  volcanoes,  must  be 
admitted  by  all  who  adopt  the  Newtonian  theory  of  tides. 
Whether  this  influence  is  exerted  through  the  medium  of 
gravitation  or  of  electricity,  is  still  enveloped  in  the  arcana 
of  nature.  But  it  is  an  historical  fact,  that  such  phenomena 
are  succeeded  by  epidemic  pestilential  diseases,  and  probably 
produced  by  the  deleterious  -gas  which  accompanies  such 
eruption.  This  may  be  the  origin  of  those  epidemics  which, 
from  the  plague  of  Athens,  to  the  yellow  fever  of  New  York, 
have  been  the  subject  of  controversy  in  all  ages,  and  which 
some,  unable  to  explain,  have  therefore,  ascribed  to  a  Divine 
influence.    This  may  be  the  '  To  Theon  '  of  Hippocrates." 

A  third  prize  was  also  offered  in  1808  "  for  the  best  disserta- 
tion on  the  causes  and  best  method  of  preventing  and  of 
curing  the  typhus  mitior,  or  low  nervous  fever,  which  prevails  in 
different  counties  of  the  State." 

In  1809  a  committee  was  appointed  "  to  petition  the  Legis- 
lature for  a  law  to  prohibit  the  inoculation  of  the  smallpox 
in  this  State,"  and  in  1810  the  County  Medical  Societies  were 
requested  to  join  in  the  effort.  Vaccination,  although  only 
introduced  by  Jenner  in  1798,  had  manifestly  been  thoroughly 
accepted  in  this  State.  Not  a  word  is  found  in  the  printed 
transactions  on  this  subject  until  President  Romayne  in  1810 
refers  to  Jenner  as  having  "  taught  us  to  elude  a  loathsome 
and  often  fatal  disease,  the  smallpox."  In  other  parts  of  the 
country,  however,  vaccination  was  still  exciting  great  interest 
during  the  first  years  of  our  Society,  and  volume  I  of  the 
Medical  Communications  of  the  Massachusetts  Medical 
Society  contains  a  report  covering  over  50  closely  printed 
pages,  read  June  1,  1808,  and  signed  by  John  Warren,  Jack- 


SAMUEL  B.  WARD 


181 


son,  Dexter,  and  John  C.  Warren.  The  law  to  prohibit  inocu- 
lation was  probably  desired  because  the  Society  was  con- 
vinced of  the  superior  advantages  of  vaccination. 

President  Rodgers'  address  in  1815  was  devoted  to  "  puer- 
pural  "  fever  and  was  the  first  of  several  papers  in  our  Trans- 
actions devoted  to  that  subject.  He  admits  its  prevalence 
in  large  hospitals  and  says  that  this  "  has  induced  the  opinion 
with  some  that  it  was  a  specifically  contageous  disease."  In 
his  judgment  it  is  due  to  "  the  foulness  of  air  in  the  wards, 
added  to  the  collection  of  bad  air  under  the  clothing  of  the 
patients."  He  regards  it  as  belonging  to  the  genus  synochus  at 
first,  quickly  running  into  typhus;  advocates  light  bed-clothes 
and  the  admission  of  fresh,  cool  air,  with  the  administration 
of  cool  drinks  and  baths;  deprecates  routine  bleeding; 
strongly  advocates  ipecac  as  an  emetic  and  calomel  as  a 
purge ;  advises  milk  and  lime-water  as  a  diet,  and  during  con- 
valesence  wine  and  bitter  tonics. 

This  same  topic  is  the  subject  of  President  Eights'  address 
in  1832.  He  says  that  at  that  time  the  annals  of  medicine 
of  this  country  did  not  record  a  single  authentic  instance  of 
this  disease  appearing  as  an  epidemic.  Quoting  from  writers, 
mostly  foreign,  he  comes  to  the  conclusion  that  it  is  infec- 
tious ;  that  many  cases  occur  in  the  practice  of  one  physi- 
cian, or  nurse,  while  their  neighbors  escape;  and  that 
epidemics  of  scarlet  fever  and  erysipelas  are  synchronous. 
Curiously  enough  his  final  word  on  this  point  is  "  Puerperal 
fever  I  consider  in  all  cases  to  be  an  idiopathic  or  original 
disease."  As  to  treatment  he  says  "  It  is  a  true  remark,  that 
much  harm  is  done  by  bleeding  too  little,  but  seldom  by  bleed- 
ing too  much."  He  strongly  advocates  the  use  of  cathartics, 
hot  fomentations  to  the  abdomen,  diaphoretics  and  calomel, 
but  objects  to  blisters,  oil  of  turpentine  and  emetics. 

Dr.  Oliver  Wendell  Holmes'  celebrated  essay  on  this  same 
subject  was  read  before  the  Boston  Society  for  Medical 
Improvement,  and  printed  in  the  New  England  Quarterly  Jour- 
nal of  Medicine  and  Surgery  for  April,  1843.  Starting  with 
pretty  much  the  same  set  of  facts,  Dr.  Holmes  arrived  at  a 
precisely  opposite  conclusion  and  one  which  is  now  univer- 
sally accepted  as  correct.  Nevertheless  his  position  was  hotly 
and  acrimoniously  combatted  by  no  less  men  than  Professors 
Hodge  and  Meigs,  of  Philadelphia,  in  1852  and  1854.  Dr. 

5 


1 82        .   HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

Holmes'  paper  was  republished  in  1855  an<3  soon  thereafter 
began  in  this  State,  as  elsewhere,  to  have  its  good  effect  in 
preventing  this  dire  disease. 

The  annual  meeting  of  1818  was  notable  for  the  introduc- 
tion and  passage  of  a  series  of  resolutions  warmly  advocat- 
ing the  formation  of  an  American  Pharmacopeia  under  the 
auspices  of  the  several  incorporated  State  Medical  Societies 
and  medical  schools  in  the  country. 

The  annual  address  of  Dr.  Alexander  Coventry,  in  1824, 
shows  that  at  that  time  the  attention  of  the  profession  had 
been  definitely  called  to  the  fact  that  fevers  and  other  dis- 
eases were  often  due  to  purely  local  causes — were  endemic 
and  not  epidemic — were  due  to  filth  and  other  local  condi- 
tions. His  work  was  in  the  right  direction  and  characterized 
by  acute  and  accurate  observations.  He  visited  the  city  of 
New  York  in  1785  and  says,  "  I  confine  myself  to  some  obser- 
vations on  its  locality,  which  in  point  of  salubrity,  I  feel  war- 
ranted in  asserting  is  superior  to  any  city  of  magnitude,  of 
which  mention  is  made,  either  in  modern  or  ancient  history." 
"  The  citizens  of  New  York  at  that  time  bore  in  their  faces 
the  bloom  of  health  and  no  signs  of  endemic  disease  were 
discernible  in  their  looks."  Ten  years  later  business  called 
him  to  the  city  again,  and  he  found  that  "  The  inhabitants 
bore  the  marks  of  endemic  disease,"  which  he  attributes  to 
-  the  fact  that  "  many  acres  had  been  gained  from  the  sea,  and 
converted,  as  I  was  informed,  not  into  airy  land,  but  a  mass 
of  putrefiable  stuff,  with  which  the  most  noxious  swamp  in 
Genesee  could  not  compare."  In  1820  he  found  matters  still 
worse.  He  then  proceeds  to  warn  New  Yorkers  of  the 
inevitable  results  of  persisting  in  the  course  they  were  pursu- 
ing and  lays  out  an  interesting  sanitary  scheme  for  the  growth 
of  the  city.  This  involved  the  building  all  along  the  river 
front  of  a  wall  of  solid  masonry,  laid  in  waterproof  cement, 
the  space  behind  it  to  be  filled  in  with  primary  rock  or  clean 
ballast,  on  which  capacious  warehouses  could  be  erected,  and 
from  which  wharves  could  be  built  out  into  the  stream.  "A 
deep  and  wide  cut  in  the  direction  of  Canal  street,  from  river 
to  river,  so  that  the  tide  might  pass,  ought  to  be  made." 
Curiously  enough  he  recommends  that  the  sewers  be  all 
filled  up  and  "  every  perishable  substance  left  on  the  surface, 
where  it  must  soon  be  dried  by  the  sun,  or  be  removed  by  the 
scavenger." 


SAMUEL  B.  WARD 


183 


In  view  of  the  recent  discoveries  concerning  the  etiology 
of  vellow  fever  it  is  interesting  to  note  that  President 
Coventry  quotes  from  the  Revue  Medicate,  for  February,  1823, 
the  report  of  an  experiment  of  M.  Guyon,  of  Port  Royal,  Mar- 
tinique, "  M.  Guyon  put  on  the  shirt,  while  yet  warm,  of  a 
man  with  yellow  fever,  wore  it  two  hours,  inoculated  himself 
repeatedly  with  matter  from  blisters,  and  drank  the  black 
vomit ;  he  went  into  the  bed  soiled  with  various  excrement  of 
a  soldier  sick  with  yellow  fever  and  lay  in  it  for  six  and  a  half 
hours.  This  patient  died,  and  in  his  stomach  was  found  a 
large  quantity  of  black  matter,  yet  M.  Guyon  remained  in 
perfect  health.  It  would  be  a  waste  of  time  to  recapitulate 
the  innumerable  well-authenticated  proofs  of  the  non-con- 
tagious character  of  yellow  fever.'' 

During  the  first  twenty-five  years  after  the  introduction  of 
vaccination  this  method  of  protection  against  smallpox  appears 
to  have  grown  steadily  into  favor ;  but  at  about  that  time  anti- 
vaccination  cranks  seem  to  have  developed,  and,  as  you  all 
know,  the  genus  has  not  even  yet  become  entirely  extinct. 
In  1831  Dr.  Jonathan  Eights,  then  President  of  this  Society, 
devoted  his  annual  address  to  the  consideration  of  what  he 
called  "  Vaccina,  Cow  or  Kine-Pock,"  in  all  is  aspects.  His 
paper  is  almost  a  classic.  His  description  of  a  genuine  vac- 
cination is  admirable  and  he  points  out  definitely  how  the 
observer  may  distinguish  between  it  and  what  we  now  know 
to  be  a  streptococcus  or  staphylococcus  infection ;  and  his 
arguments  in  proof  of  the  protective  power  of  vaccination  and 
the  safety  of  the  procedure,  when  the  virus  is  properly  selected 
and  the  operation  properly  performed,  are  incontrovertible. 

With  the  session  of  1831  ended  the  first  quarter  of  a  cen- 
tury of  our  Society's  existence,  and  a  few  words  concerning 
the  progress  of  medical  education  during  that  period  may  not 
be  out  of  place.  Prior  to  1806  the  laws  regulating  the  prac- 
tice of  medicine  in  this  State  were  most  lax.  Almost  any  one 
who  could  induce  others  to  trust  him  was  at  liberty  to  practice 
our  art.  But  the  act  of  April  4,  1806,  authorized  the  qualified 
physicians  and  surgeons  of  each  county  to  form  themselves  into 
a  Society,  elect  officers,  make  needful  rules  and  appoint  a 
board  of  censors  to  examine  and  license  all  applicants  for  ad- 
mission into  the  profession  in  their  respective  counties.  The 
applicant  had  to  give  evidence  of  having  studied  for  three 


184         '  HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

years  with  some  practitioner  and  of  having  reached  the  age 
of  21  years. 

The  same  act  provided  for  the  formation  of  this  Society  and 
gave  it  the  power  to  appoint  a  board  of  censors  in  each  of  four 
districts,  into  which  the  State  was  divided,  with  like  powers 
to  license  candidates  who  might  pass  examinations. 

In  1818  the  Legislature  passed  an  act  increasing  the  term  of 
study  to  four  years  from  which,  however,  one  year  might  be 
deducted  if  the  student  had  pursued  classical  studies  during 
that  length  of  time,  after  the  age  of  16  years,  or  had  attended 
a  complete  course  of  lectures  in  all  the  branches  of  medical 
science  in  a  medical  college  of  this  State  or  elsewhere. 

The  next  important  law  was  that  of  1827  which  made  com- 
pulsory three  years  of  study,  and  attendance  on  two  complete 
courses  of  lectures  of  four  months  each,  the  last  in  the  col- 
lege by  which  he  was  recommended  to  the  Regents  of  the 
University.  1  He  must  also  file  a  copy  of  his  license,  or 
diploma,  in  the  county  clerk's  office  and  become  a  member  of 
the  County  Society  of  the  county  in  which  he  resided. 

At  that  time  there  were  but  20  medical  colleges  in  the 
United  States.  Of  these,  two  were  located  in  this  State — 
the  College  of  Physicians  and  Surgeons  in  New  York  city, 
and  another  of  the  same  name  at  Fairfield,  in  Herkimer 
county.  The  former  had  seven  professors  ;  the  latter  five.  Both 
schools  were  under  the  supervision  of  the  Regents  of  the 
University  and  their  diplomas  carried  the  same  right  to  prac- 
tice physic  and  surgery  as  did  the  licenses  granted  by  the 
boards  of  censors  of  the  State  and  County  Societies. 

For  many  years  prior  to  the  formation  of  this  Society  medical 
writing  was  devoted  almost  entirely  to  the  promulgation  of 
absurd  and  contradictory  theories  of  disease.  The  solidists  and 
humoralists  had  their  day,  to  be  succeeded  by  Boerhaave,  Cullen 
and  Brown.  As  late  as  1790  Dr.  Bush  enunciated  some  princi- 
ples concerning  which  we  quote  his  own  words :  "  This  system 
rejects  the  nosological  arrangement  of  diseases,  and  admits  only 
of  a  single  disease,  consisting  in  different  forms  of  morbid  ex- 
citement, induced  by  irritants  acting  upon  previous  debility.  It 
rejects,  further,  an  undue  reliance  upon  the  powers  of  nature," 
etc. 

In  his  introductory  address  before  the  Medical  School  of 
McGill  University,  delivered  September  19,  1905,  Dr.  A.  Jacobi 


SAMUEL  B.  WARD 


185 


most  truly  remarks  "  The  actual  progress  of  medicine  began 
when  the  influence  of  mere  theorizing  was  broken." 

Time  would  be  wasted  if  spent  in  an  argument  to  convince 
this  audience  that  medicine  is  one  of  the  natural  sciences,  in 
fact  the  most  difficult  and  abstruse  of  them  all,  and  that  it  can, 
like  all  the  rest  of  them,  be  built  on  a  secure  foundation  by  the 
inductive  method  only.  Facts  must  be  observed  and  observed 
repeatedly  and  with  the  greatest  care  to  avoid  the  introduction 
of  errors.  Grouping  these  facts  and  reasoning  upon  them  leads 
to  the  formulation  of  principles  and  general  laws.  It  is  note- 
worthy that  in  our  Transactions  not  a  single  theoretical  paper  is 
to  be  found.  Every  one  of  them  deals  in  the  observation  of 
facts  along  some  line  or  other.  It  is  true  that  the  conclusions 
were  not  always  correct ;  and  the  lesson  to  be  learned  from  these 
errors  is,  that  before  we  begin  to  reason  and  draw  conclusions, 
we  must  be  sure  that  our  supposed  facts  are  really  facts,  and 
that  they  are  all  the  facts  bearing  upon  the  subject  under  con- 
sideration. Probably  no  motto  has  led  to  a  larger  number  of 
erroneous  conclusions  than  post  hoc,  ergo  propter  hoc. 

During  this  quarter  of  a  century  one  notable  aid  had  been 
given  to  our  methods  of  diagnosing  disease.  It  was  in  1819  that 
Laennec's  great  work  on  auscultation  was  published  in  Paris. 
In  1821  it  was  translated  into  English  by  Dr.  Forbes,  of  London. 
The  claims  for  the  value  of  this  method  were  at  first  met 
with  indifference,  scepticism  and  ridicule  in  Europe;  but  Austin 
Flint1  says  "  The  writer  can  testify  that,  as  far  back  as  1832,  the 
facts  of  auscultation  entered  largely  into  medical  teaching." 
Skoda  published  his  monograph  on  auscultation  and  percussion 
in  1839;  but  as  late  as  1845  Dr-  Phillip,  of  Berlin,  ridiculed 
Skoda's  work.  Considering  the  inestimable  value  of  this  method 
of  diagnosis  and  its  constant  use  to-day,  it  certainly  seems 
extraordinary  that  so  many  years  could  have  elapsed  before  it 
gained  .iniversal  recognition. 

It  was  during  this  same  period  also  that  percussion  became 
really  useful,  in  connection  with  auscultation,  when  almost 
simultaneously  Skoda,  Piorry  and  Roy  introduced  the  mediate 
method.  The  dullness  of  hydrothorax  and  ascites,  and  the  reso- 
nance of  pneumothorax  and  tympanites  were  known  to  the  physi- 
cians  of  ancient  Greece.    Auenbrugger,  in  1761,2  published  the 

1  First  century  of  the  Republic,  p.  421. 

2  Inventum  novum  ex  Percussione  Thoracis  humani  et  signo  abstrusos  interni  Pectoris 
Morbos  detegendi. 


l86  '  HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

first  systematic  work  on  the  subject ;  but  it  attracted  little  atten- 
tion until  translated  into  French  by  Corvisart,  Napoleon's  physi- 
cian, in  1808,  with  some  comments  appended  by  himself.  Skoda 
retranslated  Corvisart's  translation  and  comments.  Auenbrugger 
was  familiar  with  immediate  percussion  only. 

It  was  during  this  quarter  of  a  century  also,  between  1825 
and  1832,  that  Dr.  Beaumont  made  his  observations  on  Alexis 
St.  Martin  and  gave  to  the  world  the  first  satisfactory  study  of 
stomach  digestion. 

Up  to  and  including  183 1,  our  Transactions  contain  nothing 
of  a  scientific  nature  save  the  annual  addresses  of  the  various 
presidents.  With  1832,  the  beginning  of  our  second  quarter- 
century,  the  volumes  increase  greatly  in  size,  contain  essays  to 
which  prizes  had  been  awarded  and  other  important  papers  read 
at  the  meetings;  much  the  same  general  form  as  the  recent 
volumes  with  which  we  are  all  familiar. 

The  two  important  papers  read  at  the  meeting  in  1832  were 
the  one  of  President  Eights  on  Puerperal  Fever,  already  re- 
ferred to,  and  the  prize  essay  on  Delirium  Tremens,  by  Dr.  James 
Conquest  Cross,  of  Lexington,  Ky. 

In  June  of  that  year,  Asiatic  cholera  made  its  appearance  in 
epidemic  form  in  Quebec,  and  spread  rapidly  over  this  part  of 
the  country.  In  1833  tne  tw0  important  papers  treated  of  this 
epidemic.  The  first  is  by  President  Thomas  Spencer.  He 
locates  the  first  epidemic  of  cholera  at  Jessore,  a  city  nearly  one 
hundred  miles  northeast  of  Calcutta,  in  181 7,  though  similar  ones 
"  had  been  described  by  Hippocrates,  Sydenham,  Morgagni  and 
a  host  of  other  distinguished  teachers,  and  practitioners  of  our 
art."  He  follows  Cullen  in  defining  cholera  as  "  vomiting  and 
frequent  purging  of  a  bilious  humor,  anxiety,  gripes,  spasms  of 
the  legs."  He  follows  Good's  Nosology  in  defining  diarrhoea 
serosa  as  "  watery  looseness."  The  dejections  almost  entirely 
liquid,  frequently  metastastic,  and  still  oftener  produced  by 
elaterium,  or  other  drastic  purgatives.  Sometimes  urinous, 
occasionally  tinged  with  blood."  He  regards  the  former  disease 
the  same  as  the  latter,  only  "  appearing  under  an  aggravated 
and  malignant  form,  as  an  epidemic."  He  admits  his  ignorance 
of  the  etiology  of  the  disease  and  says,  "  The  first  and  moving 
cause  of  this,  and  all  widespread  epidemics,  is  known  alone  to 
Him,  who  has  established  those  general  laws  by  which  universal 
nature  is  governed."    His  descriptions  of  the  clinical  history 


SAMUEL  B.  WARD 


187 


and  gross  post-mortem  findings  are  most  complete  and  accurate, 
and  his  manner  of  accounting  for  the  symptoms  most  ingenious. 
In  his  judgment  it  was  not  contagious,  but  depended  upon  "  the 
epidemic  influence,  intemperance,  filth,  poverty,  indigestible 
meals,  changes  from  heat  to  cold,  cathartic  drugs,  and  cholera 
reports,  producing  a  sympathetic  terror  of  the  population."  In 
the  same  volume  is  printed  the  report  of  Dr.  Lewis  C.  Beck, 
who  had,  the  previous  year,  been  commissioned  by  Governor 
Throop  to  examine  into  the  existing  epidemic.  He  found  that 
the  first  case  appeared  in  Quebec,  on  June  8,  1832,  and  that  the 
epidemic  originated  there  as  far  as  he  could  discover,  as  no 
previous  case  could  be  traced.  He  submits  facts  and  arguments 
to  prove  positively  that  cholera  is  neither  contagious  nor  in- 
fectious, and  agrees  in  general  with  President  Spencer  as  to  its 
exciting  causes. 

Numerous  other  papers  appear  on  the  subject  of  cholera,  all 
being  obliged  to  admit,  in  speaking  of  its  cause,  that  "  a  frank 
confession  of  ignorance  is  always  more  becoming  than  a  labored 
attempt  to  conceal  it."  The  contributing  causes,  already  above 
alluded  to  as  tending  to  reduce  resistance  in  the  individual,  are 
most  completely  pointed  out.  It  is  also  distinctly  concluded  that 
it  is  neither  contagious,  nor  infectious  through  fomites.  Dr. 
James  R.  Manley,  of  New  York  City,  in  a  paper  read  in  1835, 
lays  particular  stress  upon  this  point,  sets  forth  the  hardships 
which  have  been  the  results  of  certain  rigidly  enforced  but  per- 
fectly useless  regulations,  and  in  the  interest  of  humanity  begs 
that  they  be  abandoned. 

In  1849  a  second  epidemic  of  cholera  made  its  appearance  in 
this  State,  and  as  a  consequence  the  Transactions  for  that  year 
and  the  following  one  contain  several  papers  given  up  chiefly 
to  arguments,  pro  and  con,  as  to  its  being  contagious.  That  a 
sick  person  in  some  way  conveyed  it  to  the  well  was  clear ;  that 
it  was  nut  contagious  in  the  same  sense  as  smallpox  and  measles 
were,  seemed  equally  clear  to  the  majority,  but  no  one  as  yet 
hit  upon  the  proper  solution  of  the  difficulty. 

From  1830  to  1840  intermittent  and  remittent  fevers  appear  to 
have  been  quite  common  in  those  parts  of  the  State  where  low- 
lying  lands  were  being  turned  up  for  the  first  time,  and  several 
papers  treat  of  these  diseases.  Very  accurate  descriptions  are 
given  of  various  localities  where  the  diseases  were  prevalent, 
and  the  clinical  histories  of  cases.    In  1834.  Dr.  Alvin  Foord 


1 88        '    HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

read  the  Medical  Topographical  Report  of  the  County  of  Madi- 
son. His  paper  shows  that  at  that  time  quinine  was  recognized 
as  almost  a  specific,  although  we  are  warned  not  to  give  it  while 
the  tongue  is  still  coated  and  the  digestion  disordered ;  cold 
affusion  is  highly  commended  in  cases  attended  with  "  high 
excitement,"  and  he  calls  attention  to  the  fact  that  "  popular 
remedies  of  various  descriptions  were  employed  and  often  with 
entire  success.  *  *  *  When  no  inflammatory  disease  exists 
and  it  appears  to  be  continued  from  habit,  almost  any  remedy 
that  makes  a  strong  impression  upon  the  system  frequently  arrests 
its  progress,  and  thus  a  numerous  class  of  remedies  acquire  a 
reputation  as  specifics.  Many  of  these,  such  as  hanging  the 
disease  upon  a  tree,  by  tying  as  many  knots  in  a  string  as  the 
patient  has  had  paroxysms,  and  then  suspending  it,  have  their 
advocates  and  frequently  succeed.  Thus  it  appears  that  the  cure 
is  sometimes  effected  by  the  influence  of  the  mental  upon  the 
physical  powers,  a  circumstance  which  seems  to  have  been  too 
little  appreciated  as  a  remedial  agent  by  the  medical  profession. 
I  have  been  told  as  a  matter  of  fact  that  the  paroxysms  have 
been  arrested,  and  the  disease  cured,  by  the  subject  of  it  climbing 
up  stairs,  or  up  a  ladder,  feet  foremost,  and  descending  in  the 
same  attitude  that  he  went  up."  We  may  wonder  whether 
Mrs.  Eddy  here  discovered  the  germ  of  her  alleged  Science. 

The  first  paper  in  our  Transactions  on  the  subject  of  phthisis 
pulmonalis  was  the  prize  essay  for  the  year  1825,  by  Andrew 
Hammersley,  M.  D.,  published  in  the  volume  for  1835.  He 
says  "  The  prevalence  of  consumptive  mortality,  more  particu- 
larly in  this  country  and  in  Great  Britain,  has  long  been  a  theme 
of  unfeigned  regret  to  the  philanthropist,  and  a  cause  of  un- 
merited opprobrium  on  the  medical  profession."  To  show  the 
mortality  in  the  New  England  States,  he  quotes  from  the  printed 
lists  of  the  mortality  of  Portsmouth,  N.  H.,  from  1802  to  181 1, 
which  show  199  deaths  from  consumption  in  a  total  of  938,  or 
over  twenty-one  per  cent.  He  suggests,  however,  that  it  is  prob- 
able that  other  conditions  than  true  tuberculosis  were  included  in 
the  reported  cases  of  consumption.  His  paper  was  a  very  complete 
one  for  its  day  and  contains  some  points  still  of  interest.  Among 
the  causes  that  had  been  assigned  as  producing  phthisis,  he  in- 
cludes the  following:  ''It  was  either  some  acrid,  corroding 
humor  produced  in  the  brain,  and,  by  some  inexplicable  means 
falling  down  upon  the  lungs,  and  destroying  their  texture ;  or  it 


SAMUEL  B.  WARD 


was  the  existence  of  some  acrid  or  alkaline  substance,  or  some 
acrimony  of  the  blood,  depending  upon  certain  conjectural  chem- 
ical changes.  Even  animalculae  have  been  supposed,  by  their 
irritating  presence  in  the  pulmonary  tissue,  to  cause  this  disease." 
His  main  contention  as  to  the  pathology  is  "  the  existence  of 
tubercles  as  the  proximate  or  exciting  cause  of  phthisis  pul- 
monalis,"  and  he  warmly  contends  that  it  is  not  primarily  an 
inflammatory  disease,  and  never  to  be  treated  by  bleeding  and 
the  like.  He  points  out  distinctly  the  injurious  effects  of  certain 
occupations,  of  deprivation  of  sunshine  and  fresh  air,  and  the 
advantages  of  residence  in  a  dry,  clear  climate. 

It  was  in  1834  that  a  committee  of  three  was  appointed  to 
look  into  the  matter  of  the  care,  or  rather  the  neglect,  of  the 
insane  poor  of  the  State.  In  1835  this  committee  reported  a 
memorial  to  the  Legislature  praying  that  a  suitable  building  be 
erected  and  proper  care  instituted  "  of  this  unfortunate  portion 
of  our  population."  Thus  was  the  seed  planted  for  State  care 
of  the  insane ;  the  ripening  of  the  fruit  is  within  the  memory 
of  every  one  in  the  room.  About  this  time  several  papers  ap- 
peared in  our  Transactions  on  this  subject,  but  time  permits  of 
nothing  more  than  this  reference  to  them. 

For  some  years  after  1845  hydrotherapy  was  the  fad  of  the  day 
as  osteopathy  is  just  now.  The  most  extravagant  claims  were 
made  for  it  as  a  universal  panacea.  John  Balbirnie,1  one  of  its 
advocates,  says  of  it :  "  The  treatment  of  disease  now,  for  the 
first  time  in  the  various  epochs  and  fashions  of  medicine,  ex- 
hibits almost  universal  power,  clearness,  simplicity,  certainty, 
beauty — attributes  that  assimilate  it  to  the  operations  of  the 
Divine  hand.  The  water  cure  is  founded  on  a  rock,  and  all  the 
winds  and  waves  of  persecution  will  in  vain  assail  it."  In  com- 
menting on  this  and  other  fads,  of  which  the  history  of  medicine 
is  full,  Dr.  Bates  likens  the  regular  practitioner  to  the  fixed  star 
which  t  v inkles  only,  but  is  the  mariner's  permanent  and  reliable 
guide,  while  the  fad  is  the  comet,  attracting  the  attention  of  all 
the  world  for  a  short  time,  but  never  useful  and  soon  passing 
into  oblivion. 

In  his  address,  in  1848,  President  Blatchford  refers  in  enthu- 
siastic terms  to  the  organization,  the  preceding  year,  of  the 
American  Medical  Association  and  predicts  for  it  a  sphere  of 
usefulness  to  the  whole  continent — a  prophecy  which  subsequent 

1  Quoted  in  Dr.  Bates  paper.  Trans.  Med.  Soc.  S.  N.  Y.,  for  1847,  p.  31. 


I90  HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

events  have  fully  justified.  The  same  year  a  suggestion  was 
made  "  to  insist  upon  a  knowledge  of  the  French  language  (at 
least  so  as  to  read  it  readily)  as  a  prerequisite  to  granting  a 
degree."  This  is  a  clear  indication  of  the  supremacy  of  the 
French  school  of  medicine  at  that  time. 

President  Alexander  H.  Stevens,  in  1850,  gave  an  admirable 
address,  setting  forth  the  evils  of  the  neglect  of  the  laws  of 
hygiene,  the  immense  loss  of  life  and  of  money  thereby  entailed, 
and  urgently  recommending  the  establishment  of  a  State  Board 
of  Health.  During  the  following  years  several  good  papers  ap- 
pear on  this  subject,  and  a  standing  committee  on  hygiene  and 
medical  statistics  became  a  part  of  the  Society's  organization. 

At  about  this  time  homeopathy  began  to  flourish  and  many  of 
the  papers  in  our  Transactions  are  devoted  to  exposures  of  its 
extravagant  claims. 

As  early  as  1818  a  public  meeting  was  held  in  New  York  City 
looking  toward  the  establishment  of  a  school  for  the  instruction 
of  deaf-mutes,  patterned  after  the  Hartford  American  Asylum, 
which  had  been  organized  the  preceding  year  at  Hartford,  Conn., 
under  the  supervision  of  the  Rev.  Thomas  H.  Gallaudet.  In 
185 1  and  1852  Dr.  Peter  Van  Buren  read  papers  before  our 
Society  setting  forth  the  necessity  for  State  care  of  indigent 
deaf-mutes.  At  that  time  only  160  were  being  cared  for,  scarcely 
more  than  one-tenth  of  the  number  within  our  borders. 

The  first  mention  made  in  our  Transactions  of  the  use  of  an 
anaesthetic  in  midwifery  is  by  Dr.  George  R.  Burwell,  of  Buffalo, 
in  a  paper  read  in  1853.  His  statements  throughout  are  prac- 
tically those  that  are  accepted  to-day. 

The  year  1856  closes  the  second  quarter-century  of  our 
Society's  history.  During  that  period  medical  work  in  this 
State  was  characterized  by  the  systematic  observation  of  dis- 
eases then  prevalent — particularly  cholera  and  typhus — and  an 
effort,  by  getting  together  all  the  facts  and  reasoning  upon  them, 
to  arrive  at  their  causes  and  prevention.  The  popularizing  of 
this  method  was  of  prime  importance,  even  though  the  results 
were  not  as  yet  very  encouraging.  Our  Society  also  took  an 
active  part  in  directing  public  attention  to  the  very  important 
matters  of  establishing  a  State  Department  of  Public  Health  and 
institutions  for  State  care  of  the  insane  and  of  the  deaf  and 
dumb.  Its  influence  was  also  cast  in  favor  of  advancing  the 
standard  of  medical  education. 


SAMUEL  B.  WARD  191 

Our  Transactions  for  1858  contain  three  papers  on  cerebro- 
spinal meningitis,  which  had  only  a  short  time  before  appeared 
in  this  State  in  epidemic  form,  although  it  had  been  known  in 
France  for  some  twenty  years.  One  writer  hazards  the  opinion 
that  it  is  caused  by  malarious  exhalations ;  the  other  two  content 
themselves  with  giving  excellent  histories  of  cases,  without  specu- 
lating on  the  etiology. 

In  1859  a  committee  of  this  Society,  appointed  for  the  purpose 
of  considering  the  subject  of  vaccination,  reported  that  small- 
pox was  more  prevalent  than  at  any  time  since  its  prevention 
had  become  possible,  and  suggested  as  a  remedy  the  passage 
of  a  law  "  which  shall  authorize  and  empower  the  trustees  of 
each  of  the  several  school  districts  of  the  State  to  exclude  from 
the  benefits  of  public  instruction  all  who  have  not  been  vacci- 
nated." Thus  the  credit  of  originating  the  present  law  on  this 
subject  belongs  to  our  Society. 

The  Transactions  of  i860  contain  the  first  article  on  hypo- 
dermic medication,  by  James  D.  Sturdevant,  of  Rome.  He 
assigns  the  credit  of  the  discovery  of  this  method  to  Dr.  Alex- 
ander Wood,  of  Edinburgh,  who  published  his  paper  in  the 
Edinburgh  Medical  and  Surgical  Journal,  in  1856,  although  to 
Pravaz  undoubtedly  belongs  the  priority.  It  was  in  i860  also 
that  a  committee  was  appointed  to  urge  upon  the  Legislature  the 
appointment  of  a  State  Commissioner  of  Lunacy. 

Diphtheria  made  its  appearance  in  epidemic  form  in  this  State 
about  1858,  and  the  Transactions  of  1859,  and  several  years  fol- 
lowing, contain  articles  on  this  subject.  The  only  point  of  par- 
ticular interest  in  connection  with  them  is  that  there  was  still 
discussion  as  to  whether  it  was  or  was  not  contagious. 

Our  volume  for  1861  contains  the  history  by  Dr.  A.  G. 
Purdy,  of  Madison  county,  of  a  remarkable  case  in  which 
*  Her  physicians,  nurses,  parents  and  neighbors,  all  concur  in 
the  statement,  that  for  about  six  years  the  suppression  (of 
urine)  has  been  complete,  and  that  for  eight  weeks  past  she 
has  not  had  an  evacuation  of  the  bowels.  I  cannot  say  there 
is  no  deception  in  this  case,  but  think  the  above  statement 
substantially  correct."  These  conditions  were  accompanied 
by  a  peculiar  blackening  of  the  skin,  vomiting  and  expectora- 
tion of  pieces  of  charcoal,  and  the  like,  and  the  patient  was 
taken  to  New  York  city  and  there  exhibited  as  "  the  charcoal 
woman."    Our  volume  for  1863,  »  an  article  by  Dr.  Lewis  A. 


192 


HISTORY  OF  MEDICINE  IN   STATE  OF  NEW  YORK 


Sayre,  exposes  the  fraud  and  deception  on  the  part  of  an  hys- 
terical woman  with  the  connivance  of  her  physician. 

The  same  volume  contains  an  important  report  by  a  com- 
mittee of  which  Elisha  Harris  was  chairman,  urging  upon  the 
people  of  the  State  and  its  Legislature,  the  prime  importance 
of  systematic  drainage  for  New  York  city  and  many  other 
parts  of  the  State.  It  was  about  this  time  that  the  treatment 
of  peritonitis  with  enormous  doses  of  opium  came  into  vogue, 
having  Alonzo  Clark  as  its  warm  advocate,  and  Dr.  Henry  S. 
Downs,  of  New  York  city,  publishes  the  case  of  a  child  ten 
years  of  age  who  in  eleven  days  took  148  grains  of  morphia, 
besides  opium  in  other  forms,  without  the  slightest  symptom 
of  narcotism  being  produced. 

The  first  report  in  our  Transactions  of  a  successful 
tracheotomy  in  diphtheria  is  found  in  the  volume  for  1863,  by 
Dr.  William  Gilfillan,  of  Brooklyn. 

The  volume  for  1865  contains  two  articles  on  the  eye,  one 
by  C.  A.  Robertson,  of  Albany,  and  the  other  by  Henry  D. 
Noyes,  of  New  York,  and  these  mark  the  beginning  of  the  era 
of  specialties. 

In  1867,  at  the  instance  of  the  President  of  the  Society  for 
the  Prevention  of  Cruelty  to  Animals,  a  bill  was  introduced 
in  the  Legislature  asking  for  the  abolition  of  vivisection. 
Prof.  John  C.  Dalton  made  an  able  address  before  our  Society, 
and  a  committee  was  appointed  to  oppose  its  passage.  Some 
of  you  present  to-day  will  recollect  how  bitter  the  controversy 
was  and  how  long  it  lasted.  No  serious  impediment  has  ever, 
in  this  State,  been  thrown  in  the  way  of  this  most  important 
means  of  increasing  our  knowledge  of  physiology  and 
pathology,  although  in  1875  Bergh  vigorously  renewed 

his  attack. 

In  1867  the  dentists  of  the  State  assembled  at  Utica  for  the 
purpose  of  securing  legal  enactments  tending  to  regulate  their 
practice,  and  in  the  following  year  our  Society,  through  a 
committee,  memorialized  the  Legislature  on  the  subject.  You 
all  know  that  the  effort  was  eventually  entirely  successful. 

In  1865  Dr.  G.  J.  Fisher,  of  Sing  Sing,  began  the  publication 
of  an  article  on  diploteratology,  which  was  continued  in  the 
succeeding  three  volumes.  It  is  by  far  the  longest,  best 
illustrated  and  most  complete  paper  in  all  our  Transactions. 

Our  volume  for  1868  contains  a  report  of  delegates  sent  by 


SAMUEL  B.  WARD 


193 


this  Society  to  attend  the  first  International  Medical  Congress 
at  Paris  on  August  16,  1867.  The  account  they  gave  of  their 
reception  is  quite  amusing  and  not  at  all  flattering.  They 
concluded,  however,  that  there  was  enough  of  scientific  inter- 
est to  pronounce  the  meeting  a  success.  At  the  same  meeting 
Marey's  sphygmograph,  which  had  just  been  brought  to  this 
country  by  Dr.  E.  R.  Hun,  was  shown  to  the  Society  by  Dr. 
S.  O.  Vanderpoel.  The  first  mention  of  the  use  of  carbolic 
acid  and  of  glycerine  occurs  in  this  same  volume. 

In  1870  a  resolution  was  passed  by  the  Society,  and  a  copy 
ordered  sent  to  every  Medical  School  in  the  State,  expressing 
the  opinion  that  it  was  necessary  to  make  "  didactic  teaching 
and  clinical  instruction  in  insanity  and  all  other  cerebral 
and  nervous  diseases  obligatory  as  a  part  of  the  curriculum 
of  study."  In  the  same  year  an  effort  was  renewed,  which 
had  failed  in  the  three  preceding  years  to  secure  legislation 
making  compulsory  the  registration  of  births,  deaths  and 
marriages.  In  the  same  volume  is  published  a  paper  by 
William  J.  Orton,  of  Lisle,  urging  the  view  that  one  of  the 
causes  of  tuberculosis  was  probably  of  a  zymotic  nature,  as 
suggested  by  Dr.  Budd  and  others;  but  that  an  excess  of  phos- 
phorus in  the  system  was  probably  equally  essential. 

The  volume  of  1871  contains  a  paper,  quite  new  and  import- 
ant at  that  time,  by  Dr.  Joseph  G.  Richardson,  Microscopist 
to  the  Pennsylvania  Hospital,  on  the  recognition  of  the  elastic 
tissue  of  the  lung  in  the  sputum,  as  a  means  of  diagnosing 
pulmonary  tuberculosis.  The  article  is  noteworthy  also  as 
being  the  first  I  have  found,  in  a  careful  review  of  our  pub- 
lications, in  which  a  patient's  temperature  was  accurately 
noted  in  degrees  Fahrenheit.  He  says  of  a  tuberculous 
patient's  temperature,  "it  was  never  found  to  be  below  1010 
and  was  frequently  1040."  This  statement  reminds  us  of  the 
vast  aid  which  the  profession  received  at  about  this  time  from 
the  introduction  of  the  clinical  thermometer.  It  was  in  1870 
of  1871  that  my  friend,  the  late  Dr.  Lockwood  DeForest 
Woodruff,  soon  after  returning  from  a  visit  to  Europe,  pre- 
sented me  with  a  black  morocco  case.  On  opening  it  I  found 
it  to  contain  a  pair  of  clinical  thermometers — the  first  I  had 
ever  seen.  They  were  nine  or  ten  inches  long;  one  was 
straight,  for  use  under  the  tongue  or  in  the  rectum,  the  other 
bent  at  an  angle,  so  that  when  the  bulb  was  in  the  axilla  the 


194 


HISTORY  OF  MEDICINE  IN   STATE  OF  NEW  YORK 


stem  would  lie  flat  across  the  chest.  The  graduations  were 
not  on  the  glass,  but  on  an  ivory  scale  attached  to  each.  The 
stems  were  cylindrical,  and  the  very  fine  column  of  mercury 
was  not  magnified,  as  it  now  always  is,  by  a  convex  lens  front. 
They  were  not  self-registering,  but  had  to  be  read  while  still 
in  position ;  in  the  evening,  or  in  the  half  light  of  a  sick  room, 
and  especially  if  placed  in  the  rectum,  this  was  no  easy  matter. 
Still  I  remember  well  how  proud  I  was  at^eing  the  possessor 
of  the  best  instruments  of  the  kind  then  in  existence.  The 
cost  was  twenty  or  thirty  times  that  of  the  perfect  little  instru- 
ment of  to-day. 

The  publication  of  Wunderlich's  work  in  1869  (Die  Verhal- 
ten  der  Eigenwarme  in  Krankheiten)  gave  an  impetus  to  the 
study  of  the  relation  of  temperature1  to  disease,  and  he  and 
Liebermeister  deserve  full  credit  for  compelling  the  attention 
of  the  profession  to  this  most  important  aid  to  diagnosis, 
prognosis  and  treatment.  The  subject  was  not,  however, 
entirely  a  new  one,  for  Boerhaave  and  Van  Swieten  had  re- 
ferred to  it,  and  Currie  had  recommended  hydrotherapy  for 
the  relief  of  excessive  temperature. 

Before  1S72  the  practice  of  vivisection  had  by  degrees 
become  almost  obsolete ;  but  in  that  year  a  paper  was  read  by 
Dr.  A.  W.  Tupper  making  a  strong  plea  for  its  retention  in 
suitable  cases  and  claiming  that  there  were  many  more  such 
than  the  practice  of  the  day  would  seem  to  indicate. 

In  our  volume  for  1S74  appear  two  papers  by  the  late  Dr. 
S.  O.  Vanderpoel,  one  on  the  "  General  Principles  Affecting 
the  Organization  of  Quarantine  "  and  the  other  on  the  "  Trans- 
missibility  of  Yellow  Fever  and  Cholera."  His  views  were 
boldly  stated  and  supported  by  an  abundant  array  of  facts, 
though  not  in  accord  with  such  as  had  been  previously  gen- 
erally held.  He  contends  that  while  yellow  fever  is  undoubt- 
edly transmissible  it  is  not  contagious,  from  the  person,  as  small- 
pox is.  He  points  out  that  the  germ  is  frequently  confined 
to  the  holds  of  the  ships,  where  the  bilgewater  has  access, 
and  exerts  its  influence  only  after  the  hatchways  are  opened. 

1  Complete  information  on  this  topic  may  be  found  in  the  following : 

1  WUNDERLICH.  LoC.  cit. 

2  Berdoe.  The  origin  and  growth  of  the  healing  art.    London,  1893. 

3  Liebermeister.  Handbuch  der  Pathologie  des  Fiebers. 

4  Real.  Encyclopaedic  der  gesammten  Heilkunde. 

5  Lewinski,  W,  Deutsche  Med.  Wochenschrift.    1885.  p.  492 


SAMUEL  B.  WARD 


195 


He  points  out  that  it  "  may  be  carried  by  currents  of  air  for 
greater  or  less  distances  *  *  *  for  over  a  thousand  feet." 
He  also  points  out  the  fact  that  remaining  even  a  year  in  a 
cold  latitude  will  not  free  a  ship  from  the  germs  of  the  dis- 
ease, a  fact  communicated  to  him  by  the  late  Dr.  A.  N.  Bell, 
of  Brooklyn.  How  easily  all  this  is  explained  when  one  con- 
considers  the  stegomyia  and  its  natural  history.  With  reference 
to  cholera  he  says,  "  it  is  transmissible  and  contagious  from 
the  sick  to  the  healthy,  not  by  contact  with  the  bodies  of  the 
sick,  but  with  a  material  poison  thrown  off  from  their  bodies, 
and  capable  of  being  conveyed  to  a  distance."  He  claims  for 
the  production  of  this,  as  of  yellow  fever,  the  necessity  of  the 
presence  of  a  specific  germ.  "  The  poison  of  cholera  is  cast 
off  with  the  characteristic  discharges  of  the  alimentary  canal." 
"  For  the  immediate  transmission  of  cholera  impure  water  plays 
an  important  part." 

The  volume  for  1877  contains  a  valuable  paper  by  the  late 
Austin  Flint,  Sr.,  ably  advocating  the  theory,  not  by  any 
means  new,  that  pneumonia  is  an  essential  fever;  he  admitted 
his  ignorance  of  the  matcnes  morbi,  as  he  was  also  obliged  to  do 
in  the  case  of  typhoid,  but  distinctly  claimed  their  similarity. 
In  the  same  volume  a  paper  by  Dr.  E.  V.  Stoddard,  of  Roches- 
ter, urging  the  view  that  typhoid  fever  needed  for  its  pro- 
duction a  specific  germ  from  a  previous  case,  and  that  drink- 
ing water  was  the  usual  method  of  conveying  the  disease, 
show  that  even  at  that  late  date  these  questions  were  not 
entirely  settled. 

The  volumes  of  about  this  period  contain  a  large  number  of 
papers  on  the  use  of  various  drugs  in  different  diseases. 
Many  of  them  since  have  dropped  into  "  innocuous  desue- 
tude," such  as  baptisia  tinctoria  in  typhoid  fever;  but  our 
volume  for  1879  contains  a  warning  by  Dr.  A.  Jacobi  as  to 
the  dangers  of  the  indiscriminate  use  of  chlorate  of  potash, 
which  proved  most  useful.  The  same  volume  contains  a 
notable  paper  by  the  late  Dr.  Alfred  L.  Loomis  on  the  Adiron- 
dack region  as  a  health  resort  for  tubercular  patients,  which 
has  been  the  means  of  restoring  hundreds  and  thousands  of 
invalids  to  health  and  usefulness. 

The  year  1881  closes  the  third  quarter  century  of  our  Soci- 
ety's existence.  One  notable  thing  about  this  period  is  the 
rise  and  rapid  growth  of  the  specialties.    As  before  stated, 


I96  HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

the  first  paper  was  presented  in  1865;  the  volume  for  1881 
contains  fourteen  articles  by  specialists.  The  introduction  of 
the  sphygmograph,  which,  however,  has  not  in  practice  justi- 
fied the  claims  at  first  made  for  it;  and  the  coming  into  use 
of  the  clinical  thermometer;  marked  improvement  in  ophthal- 
moscopes and  laryngoscopes ;  the  first  International  Congress 
in  Paris;  continued  studies  of  contagious  and  transmissible 
diseases,  with  consequent  improvement  in  quarantine  meth- 
ods; differentiating  between  typhus  fever  and  typhoid;  in- 
cluding pneumonia  among  the  essential  fevers ;  an  endeavor 
to  show  that  pulmonary  tuberculosis  was  transmissible;  and 
the  introduction,  in  1880,  by  Dr.  Joseph  O'Dwyer,  of  intuba- 
tion of  the  larynx  to  replace  tracheotomy  in  diphtheria,  are 
among  the  notable  occurrences  of  this  period. 

In  1882  Austin  Flint,  Sr.,  presented  a  remarkably  able  paper 
calling  attention  to  the  great  importance  of  the  disappearance 
of  liver  dulness,  and  its  replacement  by  tympanitic  resonance, 
as  a  symptom  of  intestinal  perforation,  and  making  the  fol- 
lowing extraordinary  prediction:  ''Opening  the  abdominal 
cavity,  closing  the  perforation  by  proper  surgical  means,  and 
washing  out  all  irritating  matters,  it  is  not  highly  improbable 
will  be  a  method  sanctioned  by  its  successful  employment." 

The  first  reference  which  I  find  to  the  bacterial  theory  of 
tuberculosis  is  in  a  paper  read  by  Dr.  A.  Jacobi,  in  1884. 
Speaking  of  Hans  Buchner,  he  says,  "  In  his  belief  phthisis 
can  be  prevented  by  keeping  out  the  bacillus." 

An  excellent  paper  appeared  in  1886,  by  Dr.  Alfred  L. 
Loomis,  enforcing  the  importance  of  arterio-fibro-sclerosis  as 
a  general  disease  and  not  confined  to  the  kidneys  alone.  It 
was  not  put  forth  as  an  entirely  original  idea,  but  did  much 
to  draw  the  attention  of  practitioners  in  this  State  to  what  is 
now  universally  recognized  as  a  very  usual  and  very  import- 
ant condition.  In  the  same  year  our  first  paper  on  ulcerative 
endocarditis  appears,  from  the  pen  of  Dr.  H.  R.  Hopkins,  of 
Buffalo.  Like  the  preceding,  this  subject  was  not  new,  but 
the  affection  was  at  that  time  so  rarely  recognized  before 
death  that  the  article  was  most  timely  in  calling  attention  to 
it.  The  same  volume  contains  two  papers  on  the  subject  of 
the  bacteriological  examination  of  drinking  water,  one  by  Dr. 
William  Hailes,  and  the  other  by  Dr.  F.  E.  Martindale. 


SAMUEL  B.  WARD 


197 


What  is  now  a  routine,  everyday  process  was  twenty  years 
ago  in' its  infancy. 

In  1&87  Dr.  J.  O'Dwyer  read  a  valuable  paper,  detailing  the 
improvements  he  had  been  able  to  make  in  the  process  of 
intubation  of  the  larynx. 

As  late  as  1888  the  question  of  the  bacterial  origin  of  dis- 
ease was  still  considered  by  the  general  practitioners  as  so  far 
sub  judice  that  President  Alfred  L.  Loomis  thought  it  worth 
while  to  make  it  the  subject  of  his  anniversary  address,  and 
a  very  masterly  one  it  was— calm,  judicial  and  convincing.  In 
this  year  was  first  put  into  operation  in  our  Society  the  plan, 
which  has  since  worked  so  well  here  and  elsewhere,  of  having 
a  symposium  on  some  important  disease  of  general  interest, 
different  speakers  treating  of  it  from  different  points  of  view 
and  in  different  relations.  In  the  same  year  Dr.  J.  Leonard 
Corning  made  a  further  contribution  on  local  medication  of 
the  spinal  cord,  his  first  paper  having  been  published  in  1885. 
We  all  know  how  important  the  subject  has  recently  become. 

In  1889  a  valuable  paper  by  Surgeon  George  M.  Sternberg, 
U.  S.  A.,  recited  the  direct  proof  by  laboratory  experiments 
of  what  Austin  Flint  and  others  had  previously  regarded  as 
probable,  from  a  clinical  point  of  view,  that  lobar  pneumonia 
was  a  specific  infectious  disease.  In  the  same  year  another 
author  uses  the  phrase,  "  If  the  germ  theory  of  disease  is  a 
correct  one,  and  it  would  seem  to  be;"  and  this  was  only 
seventeen  years  ago. 

As  an  illustration  of  how  slow  the  human  mind  is  to  grasp 
the  full  meaning  and  importance  of  new  facts  and  especially 
to  act  upon  them,  we  may  note  that  in  1890,  sixteen  years 
ago,  Dr.  Paul  H.  Kretzchmar  read  a  paper  on  the  "  isolation 
of  consumptives,"  in  the  course  of  which  he  says :  "  We  know 
that  the  source  of  contagion  is  contained  in  the  sputa;  we 
also  knew  that  as  long  as  these  expectorations  remain  in  a 
moist  state  they  are  not  apt  to  infect  anybody,  but  that  the 
dry  sputa,  becoming  pulverized,  allowing  the  poisonous  germs 
to  be  carried  away  into  the  surrounding  atmosphere,  are  alone 
responsible  for  the  dissemination  of  the  disease."  Yet  even 
to-day,  in  many  localities,  the  precautions  which  naturally 
flow  from  these  simple  and  universally  admitted  facts  are  not 
enforced  with  anything  like  the  rigor  they  deserve. 

One  of  the  symposiums  in  1893  was  on  carcinoma  and  it 
6 


I98  HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

is  probable  that  the  interest  thereby  aroused  in  this  important 
subject  was  a  prime  factor  in  starting  the  elaborate  investiga- 
tions which  have  since  been  made  in  this  State. 

Our  volume  for  1892  contains  a  paper  by  Dr.  Carlos  F. 
MacDonald  giving  a  scientific  record  of  the  first  seven  cases 
in  which  the  death  penalty  was  inflicted  by  electricity.  His 
conclusions  have  been  justified  by  all  the  experience  which 
has  since  been  had,  and  this  method  is  now  admitted  to  be 
the  least  objectionable  which  has  yet  been  tried. 

In  the  symposium  on  diphtheria,  in  1894,  in  a  paper  on  its 
pathology,  by  Dr.  Thomas  E.  Satterthwaite,  appears  the  first 
reference  to  the  use  of  antitoxin.  He  gives  priority  to  Kossel, 
who,  in  March  and  April,  1893,  thus  treated  eleven  children,  with 
nine  recoveries,  although  "  these  cases  were  undoubtedly  severe 
ones."  In  the  same  symposium,  Dr.  A.  Walter  Suiter  is  the  first 
to  propose  that  "  the  State  Board  of  Health  should  undertake  the 
specific  diagnosis,  at  the  instance  of  the  attending  physician,  in 
all  cases  admitting  of  the  slightest  doubt,"  and  that  laboratories 
for  the  purpose  should  be  established  and  maintained  at  con- 
venient points  in  the  State. 

In  1896  Dr.  Willy  Meyer  presented  a  valuable  paper  containing 
some  original  observations  on  the  early  diagnosis  of  tuberculosis 
of  the  kidney,  a  subject  which  has  since  been  more  completely 
worked  up  on  the  lines  he  indicated. 

Our  volume  for  1897  is  a  notable  one  on  account  of  the  "  dis- 
cussion of  the  relation  of  impure  water  to  disease,  and  the  cure 
and  prevention  of  the  latter."  All  of  the  scientific  investigations 
since  that  date  have  added  little  to  what  is  there  stated  as  to  this 
relation,  and  the  methods  there  recommended  for  the  purification 
of  city  supplies  have  not  been  materially  improved  upon. 

The  first  paper  on  "  the  X-rays  in  Medicine  and  Surgery " 
appeared  in  1893 ;  and  in  the  same  year  Dr.  John  H.  Pryor,  of 
Buffalo,  called  attention  to  the  fact  that  of  the  13,000  annual  vic- 
tims of  pulmonary  tuberculosis  in  this  State  the  large  majority 
died  because  they  were  too  poor  to  afford  the  steps  necessary  to 
recovery;  that  it  was  the  bounden  duty  of  the  State  to  care  for 
them,  as  well  as  an  important  economy ;  and  plead  for  the  estab- 
lishment of  a  State  Hospital  for  incipient  cases  in  the  Adirondack 
region.  As  a  result  the  State  Senate  appointed  a  committee  to 
investigate  the  subject,  a  favorable  report  was  made,  and  the  next 
year  a  bill  was  introduced  establishing  such  an  institution.  As 


SAMUEL  B.  WARD 


199 


you  ajl  know  it  is  now  accomplishing  excellent  work  at  Ray 
Brook.  A  series  of  nine  papers  in  1900  on  "  State  Care  of  Tuber- 
culous Patients  "  contributed  largely  to  this  result. 

The  first  Tuberculosis  Congress  was  held  in  London  in  1901 
at  which  Koch  gave  utterance  to  opinions  which  startled  many  in 
the  profession  and  are  frequently  referred  to  in  the  succeeding 
volumes. 

Probably  no  better  tribute  could  be  paid  to  the  value  and  efficacy 
of  Jenner's  discovery  than  that  to  be  found  in  a  paper  in  our  vol- 
ume for  1903,  by  Dr.  P.  H.  Bryce,  Secretary  of  the  Provisional 
Board  of  Health  of  Ontario,  Canada.  He  says,  and  there  is  no 
reason  to  doubt  the  truth  of  the  statement,  that  "  until  the  last 
three  years  the  majority  of  living  physicians  in  America  and 
Canada  had  never  seen  a  case  of  small-pox,  and,  as  it  has  hap- 
pened, the  great  number  of  cases  that  have  been  seen  on  this  con- 
tinent recently  have  been  so  mild,  that  we  have  to  go  back  to  the 
days  of  Sydenham  in  the  seventeenth  century,  and  of  Van  Swieten 
in  the  eighteenth,  to  find  a  parallel  for  this  anomolous  type  of 
disease." 

The  last  twenty-five  years  have  seen  most  radical  and  important 
advances  in  both  the  science  and  art  of  medicine,  and  notably  in 
the  methods  of  preventing  disease  rather  than  of  curing  it. 

The  discovery  that  many  diseases  were  the  result  of  the  intro- 
duction into  the  body  of  minute  microscopical  organisms  —  pro- 
tozoa and  bacteria  — -  outranks  in  far-reaching  importance  any 
other  medical  discovery  of  the  Christian  era.  As  early  as  1849 
the  bacillus  of  anthrax  was  seen  in  the  blood  of  animals  dead  of 
splenic  fever.  In  1863  Raver  and  Davaine  proclaimed  this  or- 
ganism to  be  the  cause  of  the  disease,  but  it  was  not  until  1876 
that  Koch  isolated  and  cultivated  it.  Then  followed  the  discovery 
of  the  amoeba  dysenteriae  (1871)  by  Loesch;  of  the  spirillum  of 
relapsing  fever  (1873)  by  Obermeier ;  of  the  actinomyces  (1877) 
by  Bollinger;  of  the  gonococcus  (1879)  by  Neisser;  of  the  Plas- 
modium malariae  (1880)  by  Laveran ;  of  the  trypanosoma  evansi 
(1880)  ;  of  the  bacillus  of  malignant  oedema  (1881)  by  Koch; 
though  this  was  identical  with  the  ribrwn  septique  which  Pasteur 
had  seen  much  earlier;  of  the  bacilli  of  tuberculosis,  tvphoid  and 
cholera  (1883)  all  by  Koch;  of  the  bacillus  pneumoniae  (1883) 
by  Friedlaender,  by  whom  also,  working  with  Weichselbaum 
(1884)  the  diplococcus  pneumonias  was  shown  to  be  the  cause 
of  lobar  pneumonia,  aJthough  the  organism  had  been  previously 


200  HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 

isolated  by  Sternberg  and  Pasteur  (1881)  ;  of  the  organism  caus- 
ing diphtheria,  first  grown  in  pure  culture  by  Loeffier  (1884), 
though  it  had  been  observed  early  in  the  7o's  by  Klebs,  and 
hence  is  known  as  the  Klebs-Loeffler  bacillus ;  of  the  bacillus  pro- 
teus  (1885)  by  Hauser;  of  the  meningococcus  (1887)  by  Weich- 
selbaum  and  Jaeger;  of  the  bacillus  of  tetanus  (1889)  isolated 
by  Kitasato,  though  previously  observed  by  Nicalaier  (1885);  of 
the  proteus  fluorescens,  causing  .Weil's  disease  (?)  (1890)  by 
Jaeger;  of  the  bacillus  of  influenza  (1891)  by  Pfeiffer;  of  the 
bacillus  pestis  (1894)  by  Kitasato  and  Yersin ;  and  of  the  bacillus 
dysenteriae  (1902)  by  Shiga.  To  this  list  will  probably  be  added 
an  intracellular  protozoon,  described  by  Councilman,  (1904)  as 
causative  of  small-pox;  a  protozoon  by  Mallory,  (1905)  causing 
scarlet  fever;  and  the  spirocheta  pallida,  causing  syphilis  (?)  by 
Schaudinn  (1905).1 

To  Koch,  more  than  to  any  other  man,  belongs  the  credit  of 
having  initiated  scientific  proof  of  the  causative  relation  of  bac- 
teria to  disease.  He  first  showed  that  it  was  possible  to  isolate 
these  organisms  in  pure  culture,  to  cultivate  them  indefinitely,  to 
produce  in  healthy  lower  animals  a  given  infectious  disease  by 
the  injection  of  the  proper  pure  culture,  and  by  continuous  inocu- 
lation from  a  diseased  to  a  healthy  animal  to  continue  the  process 
at  will.  The  use  of  the  aniline  dyes,  first  suggested  by  Weigert, 
was  an  invaluable  aid  in  conducting  these  investigations. 

One  objection  advanced  against  the  germ  theory  of  disease  is 
the  fact,  which  we  must  all  admit,  that  while  the  opportunities  for 
investigating  the  acute  exanthemata  have  always  been,  and  still 
are,  most  abundant,  and  they  present  clinically  all  the  features 
commonly  attributed  to  germ  diseases,  yet  the  causative  germs 
have  not  been  isolated  and  demonstrated  to  the  satisfaction  of  all. 
I  do  not  suppose,  however,  that  there  is  anyone  in  this  audience 
who  does  not  believe  that  these  germs  will  also  be  discovered 
sooner  or  later  and  that  when  they  are,  the  reasons  for  the  delay 
will  also  become  perfectly  apparent. 

Not  long  after  the  establishment  of  the  germ  theory  of  disease 
came  the  most  important  therapeutic  discovery  of  antitoxins.  In 
December,  1890,  the  first  experiments  on  this  line  were  published. 

1  References. 

Lbopplbr.      Vorlesungen  aber  die  geschichtliche  Entwickelung  der  Lehre  von  Bacterien. 

Puschmann.    Geschichte  der  Medixin. 

Bbrdob.         The  origin  and  growth  of  the  healing  art. 


SAMUEL  B.  WARD 


20 1 


Time  forbids  our  going  into  details ;  but  the  saving  of  life  by  their 
administration  is  simply  incalculable.  To  Behring,  Roux  and 
Kitasato  most  of  the  credit  is  due. 

.  Nearly  all  of  the  other  important  advances  in  this  last  quarter- 
century  flow  from  the  discovery  of  the  bacterial  origin  of  disease. 
Among  these  we  may  mention  as  most  prominent  the  purification 
of  water  supplies  and  the  disposal  of  sewage ;  the  efforts  toward 
prevention  of  tuberculosis,  and  the  importance  of  its  early  diag- 
nosis ;  providing  of  antitoxins  by  the  State ;  and  municipal  control 
of  milk  supplies. 

But  good  work  has  been  done  in  other  directions  also.  The 
practitioner  has  been  furnished  an  invaluable  aid  in  combating 
disease  by  the  establishment  and  perfection  of  training  schools  for 
nurses.  Many  original  investigations  have  been  carried  to  suc- 
cessful issue  in  cerebral  localization  and  in  the  study  of  the  func- 
tions of  the  spinal  cord.  Diseases  of  the  blood  itself,  and  changes 
in  the  blood  accompanying  other  diseases,  have  been  carefully 
studied  and  no  one  can  successfully  practice  medicine  to-day 
without  aids  in  this  direction,  which  were  absolutely  unheard  of 
twenty-five  years  ago. 

Physiologists  have  long  had  in  their  laboratories  instruments 
for  measuring  the  pressure  in  the  cavities  of  the  heart  and  in  the 
blood  vessels.  The  first  portable  clinical  apparatus  for  measur- 
ing the  arterial  pressure  in  a  patient  was  devised  by  von  Bach  in 
1876.  The  instrument  has  been  improved  by  Riva-Rocci,  Jane- 
way,  Gaertnef  and  others,  and  in  one  of  these  forms  is  in  daily 
use  by  many  of  us.  It  still  remains  to  be  seen  whether  the  facts 
which  it  furnishes  are  of  sufficient  practical  importance  to  justify 
the  claims  that  have  been  made  for  it,  or  whether  it  will  suffer 
the  fate  of  the  sphygmograph. 

It  is  true  that  Finlay,  many  years  ago,  suggested  that  yellow 
fever  was  conveyed  by  the  mosquito.  But  theories  and  sugges- 
tions do  not  carry  much  weight ;  what  is  demanded  nowadays  is 
proof,  followed  by  practical  results.  The  whole  history  of  medi- 
cine tells  of  no  more  logical,  satisfactory  and  brillant  piece  of 
work  than  that  done  by  Reed,  Carroll,  Agramonte  and  the 
lamented  Lazear,  in  1901,  proving  beyond  cavil  that  the  stegomyia 
fascwta  is  the  intermediate  host  and  carrier  of  the  yellow  fever 
germ.  The  identity  of  the  germ  has  not  yet  been  discovered; 
but  all  the  details  of  its  transmission  have  been  laid  bare,  the 
disease  was  banished  from  Havana,  and  the  means  of  savin* 


202 


HISTORY  OF  MEDICINE  IN  STATE  OF  NEW  YORK 


thousands  of  lives  and  millions  of  dollars  made  perfectly  clear. 
Verily  we  have  great  reason  to  be  proud  of  belonging  to  a  pro- 
fession which  has  produced  such  men  and  such  results. 

It  seems  clear,  from  what  has  been  said,  that  the  past  century 
has  borne  more  fruit  in  our  profession  than  any  of  its  predeces- 
sors.   The  allegation  has  been  made  that  our  country  has  not 
contributed  to  the  advance  in  our  science  as  much  as  it  ought; 
it  certainly  must  be  admitted  that  it  has  not  yet  contributed  as 
much  as  either  Germany  or  France.    But  we  are  still  young;  we 
have  only  recently  turned  our  attention  in  this  direction ;  the  large 
majority  of  our  recent  graduates  have  hitherto  been  compelled  to 
devote  themselves  at  once  to  earning  a  livelihood ;  until  recent 
years  we  have  had  very  little  encouragement  or  pecuniary  aid 
from  the  government :  our  millionaires  have  long  been  most  gen- 
erous in  their  support  of  hospitals,  libraries  and  other  philan- 
thropic institutions,  but  only  recently  have  the  benefits  to  be 
reaped  from  scientific  investigation  appealed  to  them;  labora- 
tories have  now  been  started  all  over  the  country  in  which 
original  investigations  have  already  been  made;  young  men  are 
being  trained  in  scientific  methods ;  no  better  work  has  been  done 
anywhere,  at  any  time,  than  by  our  yellow-fever  commission  in 
Cuba ;  and  it  is  perfectly  safe  to  predict  that  the  future  will  pre- 
sent a  picture  of  which  our  successors  will  not  only  not  be 
ashamed,  but  of  which  they  will  have  every'  reason  to  be  very 
proud. 


EDITORIAL 


EMtoriai 

In  those  days  the  medical  and  surgical  sciences  were 
all  wrong,  if  we  may  believe  them  to  be  now  all  right. 
A  New  York  writer  has  said  that  more  lives  had  been 
destroyed  in  that  city  by  physicians  than  by  all  other 
causes  whatever. 

Virginians  at  the  school  of  medicine  in  Edinburgh 
had  organized  themselves,  a  few  years  before,  into  a 
Virginia  Society  "for  the  protection  of  the  profession 
against  quacks  and  impostors  who  had  degraded  the 
profession  by  mingling  with  it  the  trade  of  an  apothe- 
cary or  surgeon."  .  An  eloquent  petition  is  preserved 
addressed  "To  the  Honorable  the  Council  of  Virginia 
and  House  of  Burgesses,"  entreating  that  "laws  be 
passed  forbidding  the  intrusion  of  pretenders  into  the 
domain  of  the  authorized  practitioner,  thereby  dishon- 
ouring the  profession  itself  and  destroying  mankind." 
We  can  imagine  the  enormities  committed  by  the 
quacks  and  impostors  when  we  observe  the  methods 
of  the  legitimate  practitioner.  When  a  man  or  woman 
sickened,  the  doctors  sped  the  parting  guest, — taking 
from  him  his  very  life-blood,  by  cupping,  leeching, 
bleeding,  and  reducing  his  strength  by  blistering  and 
drenching.  Xature  was  sometimes  strong  enough  to 
give  battle  to  doctor  and  disease,  and  even  to  win  a 
victory  over  their  combined  forces.  But  in  old  age 
N'ature  prudently  retired  without  a  struggle. 

Mr3.  Rogbr  A.  Prtor. 

Tht  Moi'mr  of  Washington  attd  Her  Timts. 


*      &  * 


The  Centenar       ^C  ^lun^re^t^  anniversary  of  the  Medical 
of  the        Society  of  the  State  of  New  York,  celebrated  in 

State  Medical    Albany  on  January  ^oth  and  list,  and  February 
Society.  .  .  \.  '  . ,  .  °  .  J 

ist  last,  was  a  notable  occasion  for  more  reasons 

than  one.  It  was  not  only  the  visible  token  of  the  centennium 
of  existence,  but  opportunely,  and  fortunately,  represented  cer- 
tain conditions  and  advances  which  shall  remain  as  a  permanent 
record  of  the  modern  progressive  spirit.  The  addresses  pub- 
lished in  this  issue  of  the  Annals  when  read,  perhaps,  between 
the  lines,  reveal  the  catholic  status  of  our  long  too  mysterious 
science.    Affection,  not  awe,  is  the  emotion  now  inspired  by  the 


204 


EDITORIAL 


physician.  No  other  feeling  could  have  brought  Mr.  Cleveland 
to  his  former  home  at  the  call  of  his  own  physician  to  speak 
upon  the  broad  topic  of  consultation,  not  between  physicians,  but 
between  physician  and  layman.  One  hundred  years  ago  this  was 
not  possible.  There  was  then  too  much  guessing,  too  much  per- 
sonal assertion,  too  little  exact  knowledge.  Reference  to  Dr. 
Ward's  historical  sketch  is  enough  to  show  this.  Mr.  Cleveland 
describes  the  increased  intelligence  of  medical  matters  possessed 
by  the  layman  and  urges  further  confidence.  He  disapproves  of 
the  nod  and  the  grunt  of  mystery  symbolical  of  the  past.  He 
observes  and  seeks  to  stimulate  the  tendency  of  the  present. 

No  less  suggestive  is  Mr.  McKelway's  philosophical  discourse 
upon  the  relations  of  medicine  and  the  State.  From  long  serv- 
ice as  a  statutory  umpire  of  education,  he  brings  the  experience 
of  a  statesman  to  bear  upon  his  argument.  The  State  cannot 
busy  itself  with  individuals  or  with  empiricism,  but  must 
insist  upon  proper  regard  for  and  administration  of  all  settled 
questions  of  public  health.  The  State  will  require  physicians  to 
be  educated  to  meet  these  requirements. 

Finally,  as  another  step  toward  the  goal  is  the  announcement 
by  Dr.  Bryant,  the  President  of  the  Society,  of  a  united  profes- 
sion. Twenty-three  years  ago  disputes  arose,  as  disputes  usually 
arise,  not  upon  accepted  principles,  but  upon  points  upon  which 
honest  differences  of  opinion  may  exist.  The  trifling  character 
of  these  contentions  is  at  last  revealed,  and  the  State  Medical 
Society  again  represents  the  regular  profession  of  the  State. 

May  the  second  century  prosper  us  as  has  the  first ! 


%    *  * 


In  the  Trained  Nurse  of  February,  Miss  Kate 
TandWCareg    A.  Sherry,  R.  N.,  Matron  of  the  St.  Lawrence 
of  the        State  Hospital,  publishes  a  prize  essay  with  this 
title.    Miss  Sherry  mentions  some  requirements 
which  it  would  be  well  for  physicians  to  heed.    She  says,  "In 
our  dealings  with  the  insane  we  should  always  be  truthful,  strictly 
upright  and  straightforward/'    Miss  Sherry's  experience  has 
probably  taught  her  how  often  this  golden  rule  is  violated,  not 
in  the  hospital  for  the  insane,  but  by  the  friends  and  family  of  the 
patient;  and  how  often  it  is  her  duty  and  the  duty  of  her  asso- 
ciates, and  how  difficult  this  duty  is,  to  bring  assurance  and  con- 


LITTLE  BIOGRAPHIES 


205 


fidence  after  all  faith  has  been  lost  in  a  deeply  complicated  plan 
of  deceit.  It  is  not  beyond  reason  to  say  that  this  abuse  of  the 
patient  in  the  early  and  curable  stages  of  disease,  may  determine 
chronicitv.  As  to  the  outlook  in  insanity,  from  the  nurse's  stand- 
point, Miss  Sherry  states  that  "by  a  uniform  course  of  steady, 
unwavering  attention,  gentleness,  kindness  and  sympathy,  with 
the  skill  of  the  especially  trained  nurse,  the  insane  are  made  as 
happy  and  comfortable  as  possible,  and  improvement  or  recovery 
is  the  rule."'  To  attain  this  is  required  an  intimate  association 
with  the  insane,  "  in  order  to  study  carefully  their  manner  of 
thought  and  actions." 


Xittl:  JBtDflrapbtcs 

III.  JULIUS  CAESAR  ARANTIUS. 

ARANTIUS,  Julius  Caesar,  (Aranzio,  or  Aranzi  Dei' 
Maggi),  was  born  in  the  city  of  Bologna  about  the 
year  1530.  He  commenced  the  study  of  Anatomy 
at  a  very  early  age  under  his  uncle  Bartolomeus 
Maggius.  and  later  was  one  of  the  most  brilliant  students  of 
Vesalius.  His  degree  of  doctor  of  philosophy  and  surgery  was 
received  from  the  university  of  Bologna  and  in  1556  he  was  ap- 
pointed to  the  chair  of  anatomy'  and  medicine  at  that  same  school, 
a  position  which  he  held  until  his  death  in  1589. 

Arantius  is  described  by  all  who  write  of  him  as  a  man  of  re- 
markable energy,  laboring  with  unceasing  energy  on  any  sub- 
ject which  interested  him,  denying  himself  both  sleep  and  food 
if  opportunity  seemed  ripe. 

While  his  writings  are  not  many  they  are  of  the  greatest  in- 
terest, correcting,  as  they  do.  many  errors  of  other  students  of 
anatomv  and  forming  the  basis  of  many  future  discoveries. 
They  are:  "  De  Humano  Foetu  Opusculum,"  1564,  an  enlarged 
edition  of  which,  enriched  by  the  results  of  the  dissections  of 
several  pregnant  women  was  published  in  1579;  "  De  Tumoribus 
secundum  Locos  affectos,"  1581 ;  "  Observationum  Anatomaricum 
Liber,"  1587;  "In  Hippocratis  Librum  de  Vulneribus  Capitis 
Commentarius  brevis,"  1580;  "Consilium  de  Tumoribus  Articu- 
lorum"  1580.  At  the  time  of  his  death  he  was  engaged  on  a 
commentary  on  Hippocrates  on  the  diseases  of  women. 


206 


LITTLE  BIOGRAPHIES 


Arantius'  work  on  the  Foetus  was  the  first  in  which  the  sub- 
ject was  described  from  actual  observation  and  in  addition  to 
its  being  at  that  time  novel  in  its  views  is  remarkable  for  its 
accuracy  and  clearness.  In  it  he  describes  the  change  which 
the  uterus  undergoes  in  pregnancy  into  a  spongy,  thick,  lami- 
nated tissue  and  disproves  the  existence  of  any  bodies  in  the 
human  uterus  at  all  similar  to  the  cotyledons  described  by  the 
ancients  and  some  of  his  immediate  predecessors.  He  notes 
the  great  enlargement  of  the  blood  vessels  of  the  uterus  and 
describes  with  great  particularity  as  well  as  accuracy  their 
origins,  distribution  and  anastomoses.  He  supposed  that 
these  vessels  formed  the  placenta,  or  as  he  called  it  the  jecur 
uteri,  and  that  the  ovum  or  seed  shoots  out  arteries  and  veins 
into  the  substance  of  the  placenta  for  the  purpose  of  nourish- 
ment, as  plants  shoot  their  roots  into  the  ground  and  he  called 
the  placenta,  "the  liver  of  the  uterus."  He  disputed  the  com- 
munication between  the  maternal  and  fcetal  circulation,  de- 
scribed the  general  arrangement  of  the  trunks  of  the  umbilical 
vessels  and  their  branches,  denied  that  the  urachus  was  an 
open  canal  in  the  foetus  and  therefore  disputed  the  existence  of 
the  allantois,  described  very  accurately  the  position  of  the  foetus, 
the  foramen  ovale,  ductus  arteriosus  and  ductus  venosus  and 
showed  that  the  blood  after  birth  could  only  pass  from  the  right 
to  the  left  side  of  the  heart  through  the  vessels  of  the  lungs,  thus 
preparing  for  the  discovery  of  the  circulation  of  the  blood  by 
Harvey.  Of  all  these  things  Arantius'  descriptions  were  the 
first  or  the  best  that  up  to  that  time  had  been  written. 

Arantius'  observations  were  miscellaneous  and  it  is  difficult 
sometimes  to  say  just  what  he  did  discover  as  many  of  his  de- 
scriptions, like  those  of  his  predecessors,  are  not  sufficiently  per- 
fect to  make  it  certain  exactly  to  what  they  allude.  He  was 
the  first  to  describe  the  inferior  cornua  of  the  ventricles  of  the 
brain  giving  them  the  name  hippocampus;  the  taenia  semicir- 
cularis  and  its  connection  with  the  fornix;  extensor  indicis, 
coraco-brachialis,  constrictor  vaginae,  and  tensor  vaginae  fem- 
oris  muscles;  the  os  orbiculare;  and  the  levator  palpebrae 
superioris,  which  he  discovered  when  he  was  only  eighteen  years 
of  age.  The  little  masses  of  fibrous  tissue  on  the  aortic  and 
pulmonary  valves  which  are  still  called  after  him,  he  first  des- 
cribed, and  his  whole  account  of  the  muscles  of  the  arm,  tongue, 


PUBLIC  HEALTH 


207 


ear,  eye  and  abdomen  would  alone  prove  his  right  to  be  called 
a  great  anatomist. 

The  chapter  in  the  "Observations"  which  relate  to  "the 
method  in  which  the  blood  passes  into  the  left  ventricle  of  the 
heart"  shows  that  he  had  a  distinct  notion  of  the  circulation  of 
blood  through  the  lungs  and  his  arguments  might  have  estab- 
lished the  existence  of  that  part  of  the  circulation  had  he  not 
obscured  them  by  the  suggestion  that  the  office  of  the  mitral 
valve  was  to  prevent  the  air  from  passing  from  the  left  ven- 
tricle into  the  aorta.  His  description  of  the  choroid  plexus 
is  accurate  and  he  describes,  by  the  name  of  "the  cistern  of  the 
cerebellum,"  with  great  particularity,  what  we  now  call  the 
fourth  ventricle. 

He  made  many  improvements  in  surgery,  pointing  out  that 
herniae,  even  of  a  large  size  might  be  produced  by  a  dilatation 
without  any  rupture  of  the  peritoneum,  demonstrated  the  dif- 
ferences of  the  veins  affected  in  internal  and  external  hemor- 
rhoids, introduced  the  cutting  operation  for  fistula,  invented  a 
forceps  for  the  removal  of  nasal  polypi,  and  claims  to  have  first 
pointed  out  the  deformities  of  the  arch  of  the  pubes  as  a  source 
of  difficulty  in  childbirth  and  Sprengel  (Hist,  de  la  Medicin,  III, 
p.  418),  states  that  Arantius  introduced  the  Caesarian  operation 
into  Italy  and  practiced  it  with  great  success. 

Spencer  L.  Dawes. 

BIBLIOGRAPHY. 

Hamilton.    History  of  Medicine,  Surgery  and  Anatomy.  1831.    Vol  II.  pp.  79-80. 
Paobt.         Biographical  Dictionary,  1843,  Vol.  Ill,  pp. 234-336. 
Wilson        Human  Anatomy,  1844,  p.  480. 

Encyclopaedia  Britannica,  Vol.  I,  p.  800. 

Lexicon-Medicum.  1822,  pp.  73-74. 

Biographisches  Lexikon  der  hervdrragenden  arte.  Vol.  I,  p  18 1. 
Postal.        Historic  de  l'Anatomie  et  de  la  Chirurgie,  1770,  Vol.  II.  p.  a-17. 


Public  lbea!tb 

Edited  by  Joseph  D.  Craig,  M.  D. 

Department  of  Health— City  op  Albany,  N.  Y. 
Abstract  of  Vital  Statistics,  January,  1006. 


Deaths. 

1002       19x33       1004       1005  1906 

Consumption    17  30  I4  ^  I4 

Typhoid  fever   2  1  1  1  2 

Scarlet  fever   02000 

Measles  ■   00000 

Whooping- cough   0  4  0  1  0 


2Qg  PUBLIC  HEALTH 

Deaths,  continued.  19°'       '9<>3      '9°4      i9o5  1906 

Diphtheria  and  croup   3  0  1 

^  •  0  3  2  3  3 

Grippe   *  2 

Diarrheal  diseases   4  »  J  *  - 

„  0  10         16         21  15 

Pneumonia   y 

Broncho-pneumonia   3  3 

Bright'*  disease   M         10         x5         £  »7 

^leXy 8  8  9  13 

Cancer    J  g  - 

Accidents  and  violence   1  28 

Deaths  over  70  years   3*         29         32  4 

Deaths  under  one  year    10   «   20     

Total  deaths   W  «S3  135  181  145 

Death  rate   i6-59  18.01  15.89  21.30  17.06 

Death     rate     less  non- 

residents   IM*  ^  14.83  20.01  15-77 

Deaths  in  Institutions. 

1903  1904  1906  1«)6 
Kon-  Non-  Non-  .  Non- 
Resi-   reri-  Resi-     resi-  R«i-    rf*  Re«;  ro- 
dent   dent  dent     dent  dent    dent  dent  dent 

Albany  Hospital   5       3     "       4      8      0      7  7 

Albany  Orphan  Asylum   1       0      0       I  0 

?"»2040i^ 

County  House   3  J  »  - 

Home  for  Aged     °  °  °  '      o      o  0 

Home  for  Friendless   o  o  o  0      0      0      0  0 

Homeopathic  Hospital   o  o  o  o      I  O 

Hospital  for  Incurables   o  o  o  010  0 

House  of  Shelter   o  o  o  o      0      o      0  o 

Little  Sisters  of  the  Poor   2  o  i  2             o  j 

Penitentiary    •  0  °  °      \      °       '  J 

Public  Places   1  °  °  '      '      0  0 

Sacred  Heart  Convent   ,0000000 

St    Francis    De   Sales  Orphan 

Asylum   0      °      °  °      ?      °      !  0 

St.  Margaret's  House   *     *      «  °      »      0      *  \ 

St.  Peter's  Hospital   3       1       4  «       3  J 

St.    Vincent's    Female  Orphan 

Asylum   000.0000 

Births  at  term   ™ 

Marriages  

Still  births  i  

Bureau  of  Contagious  Diseases. 

1902      1903      I904      1905  1906 

Typhoid  fever   9  J  4  5  4 

Scarlet  fever   5  9  S  * 

Diphtheria  and  croup   4°  A4  £  g 

Chickenpox   5         12  5 


PUBLIC  HEALTH 


209 


Measles  

Whooping-cough 
Consumption  — 


Totals 


iqoa 

1903 

1904 

i9°5 

1906 

12 

10 

1 

10 

4 

I 

5 

2 

0 

0 

I 

5 

0 

4 

0 

79 

63 

28 

38 

39 

Contagious  Diseases  in  Relation  to  Public  Schools. 

Reported 


S  P. 


Death* 
D.        S.  P. 


Public  School  No.  1 
Public  School  No.  3 
Public  School  No.  4 
Public  School  No.  5 
Public  School  No.  12 
Public  School  No.  13 
Public  School  No.  21 
Public  School  No.  22 
Lady  of  Angels  


Number  of  days  quarantine  for  diphtheria : 
Longest   20  Shortest  

Number  of  days  quarantine  for  scarlet  fever : 
Longest   39  Shortest  


20 


Average. . . . 
Average   23 1/2 


Antitoxin. 

Cases  of  diphtheria  reported  •  •  9 

Cases  of  diphtheria  in  which  antitoxin  was  used   7 

Cases  of  diphtheria  in  which  antitoxin  was  not  used   2 

Deaths  after  use  of  antitoxin   0 


Plumbing  Inspections. 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  one 
hundred  and  seventy  six  inspections  made,  of  which  one  hundred  and 
fifteen  were  of  old  buildings  and  sixty-one  were  of  new  buildings.  There 
were  thirty-five  iron  drains  laid,  twelve  connections  with  street  sewers, 
seventeen  tile  drains  laid,  five  urinals,  two  latrines,  forty-eight  cesspools, 
forty-two  wash  basins,  thirty-six  sinks,  thirty  bath  tubs,  sixteen  wash 
trays,  one  butler's  pantry  sink,  two  trap  hoppers  in  yard,  eighty-six  tank 
closets,  three  slop  hoppers,  two  stable  wash  stands,  and  two  horse  troughs. 
There  were  sixty-nine  permits  issued,  of  which  fifty-six  were  for  plumbing 
and  thirteen  for  building  purposes.  There  were  sixteen  plans  submitted 
for  approval,  of  which  six  were  of  old  buildings  and  ten  for  new  buildings. 
One  house  was  tested  on  complaint,  with  peppermint  test.  There  were 
eight  water  tests.  There  were  twenty-seven  houses  examined  on  complaint 
and  one  hundred  re-examinations  were  made,  twenty-three  of  which  were 
found  to  be  valid  and  seven  without  cause,  and  there  was  one  violation. 


a  io 


MEDICAL  NEWS 


/IDefctcal  flews 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  por  the  Care  op  the  Sick  Poor. — Number  of 
new  cases  116;  classified  as  follows:  district  cases  reported  by  health 
physicians  4;  charity  cases  reported  by  other  physicians  50;  patients  of 
limited  means  56;  old  cases  still  under  treatment  42;  total  number  of 
patients  under  nursing  care  during  the  month  156. 

Classification  of  diseases  (new  cases)  medical  36;  surgical  7;  gynaeco- 
logical 7;  obstetrical  work  of  the  Guild  26  mothers  and  24  infants  under 
professional  care ;  dental  1 1 ;  eye  and  ear  1 ;  skin  3 ;  throat  and  nose  1 ; 
contagious  diseases  in  medical  list  5;  transferred  to  hospitals  1;  deaths  1. 

Albany  Hospital. — The  board  of  governors  have  elected  the  following 
officers  for  the  ensuing  year:  President,  J.  Townsend  Lansing,;  vice- 
president,  Charles  R.  Knowles;  secretary,  Gustavus  Michaelis;  treas- 
urer, Walter  Launt  Palmer;  superintendent  of  nurses,  Mrs.  Effie  Martin 
Simpson.  The  executive  committee  of  the  governors  consists  of:  J. 
Townsend  Lansing,  Charles  R.  Knowles,  Walter  Launt  Palmer,  Dudley 
Olcott  and  Albert  Vander  Veer,  M.D.  The  law  committee  is  Albert 
Hessberg,  chairman;  A.  Page  Smith  and  James  McCredie. 

Albany  Hospital  Training  School  for  Nurses. — At  a  meeting  of 
the  Alumnae  of  the  Albany  Hospital  Training  School  for  Nurses,  held 
February  15th,  it  was  decided  to  purchase  the  building  No.  351  Hudson 
Avenue,  Albany,  N.  Y.  for  a  Club  House. 

The  New  United  States  Pharmacopoeia. — Messrs.  Lea  Brothers 
and  Company  have  issued  a  carefully  prepared  leaflet  giving  an  alpha- 
betical list  of  the  important  changes  in  the  new  United  States  Pharma- 
copoeia. The  strength  of  each  preparation  listed  is  given  as  in  both  the 
new  and  old  U.  S.  P. 

A  free  copy  will  be  sent  to  any  physician. 

Army  Medical  Corps  Examinations. — Preliminary  examinations  for 
appointment  of  Assistant  Surgeons  in  the  Army  will  be  held  on  May  1st 
and  July  31st,  1906,  at  points  to  be  hereafter  designated. 

Permission  to  appear  for  examination  can  be  obtained  upon  applica- 
tion to  the  Surgeon  General,  U.  S.  Army,  Washington,  D.  C,  from  whom 
full  information  concerning  the  examination  can  be  procured.  The  essen- 
tial requirements  to  securing  an  invitation  are  that  the  applicant  shall 
be  a  citizen  of  the  United  States,  shall  be  between  twenty-two  and  thirty 
years  of  age,  a  graduate  of  a  medical  school  legally  authorized  to  confer 
the  degree  of  doctor  of  medicine,  shall  be  of  good  moral  character  and 
habits,  and  shall  have  had  at  least  one  year's  hospital  training  or  its 
equivalent  in  practice.  The  examinations  will  be  held  concurrently 
throughout  the  country  at  points  where  boards  can  be  convened.  Due 
consideration  will  be  given  to  the  localities  from  which  applications 
are  received,  in  order  to  lessen  the  traveling  expenses  of  applicants  a* 
much  as  possible. 


MEDICAL  NEWS 


an 


In  order  to  perfect  all  necessary  arrangements  for  the  examinations 
of  May  i,  applications  must  be  complete  and  in  possession  of  the  Surgeon 
General  on  or  before  April  i .  Early  attention  is  therefore  enjoined  upon 
all  intended  applicants. 

There  are  at  present  twenty-five  vacancies  in  the  Medical  Corps  of  the 
Army. 

Civil  Service  Examinations  for  the  State  and  County  Service. — 
The  State  Civil  Service  Commission  announces  examinations  to  be  held  on 
March  17,  1906,  for  the  following  positions: 

Architectural  Designer,  $25  to  $40  a  week;  Assistant  Engineer,  Onon- 
daga County  Service,  $50  to  $75  a  month;  Auditor  of  Highway  Accounts, 
State  Engineer's  office,  $3.50  to  $4.00  a  day;  Building  Inspector,  $5  a 
day  when  employed;  Chief  Engineer,  Onondaga  County  service,  $1,200; 
Dentist,  State  Charitable  Institutions,  fees  not  exceeding  $40  a  month; 
Highway  Inspector,  Erie  County  service,  $3  a  day;  Nurse,  Monroe 
County  Hospital,  $240  to  $300  and  maintenance;  Orderly,  Monroe 
County  Hospital,  $360  and  maintenance;  Page,  State  and  County  offi- 
ces, $25  to  $35  a  month;  Physician,  Sixth  Grade,  $900  and  maintenance; 
Stenographer,  $600  to  $1,500,  open  to  men  only;  Watchman,  Onondaga 
County  service,  $600;  Woman  Officer,  State  Institutions,  $360  and 
maintenance;  Special  Agent,  Commission  in  Lunacy,  $5.00  a  day;  Trans- 
fer Tax  Clerk,  Queens  County  service,  $1,000. 

The  last  day  for  filing  applications  is  March  12th.  Application  forms 
and  detailed  information  may  be  obtained  by  addressing  the  Chief  Ex- 
aminer of  the  Commission  at  Albany. 

The  New  York  Medical  Journal  which  lately  incorporated  with  it  the 
Philadelphia  Medical  Journal  has  recently  issued  a  handsome  edition  in 
commemoration  of  the  amalgamation  of  the  Medical  News  with  it. 

The  Society  "of  Internes,  Troy  Hospital,  has  been  organized  with  Dr. 
Francis  Scott  (A.  M.  C,  1905),  resident  surgeon,  as  secretary. 

Watervliet  Medical  Society. — A  Medical  society  has  been  formed  in 
Watervliet  with  Dr.  Lansing  Van  Auken  (A.  M.  C,  '92)  as  president; 
Dr.  Robert  J.  O'Brien  (A.  M.  C,  '02)  as  vice-president;  Dr.  Archie  I. 
Cullen  (A.  M.  C,  '02)  as  secretary.  Efforts  are  being  made  to  secure  a 
hospital. 

Medical  Association  of  Troy  and  Vicinity. — At  the  annual  meeting  of 
this  association  Dr.  Hermon  C.  Gordinier  (A.  M.  C,  '86)  was  elected 
president;  Dr.  Reuben  H.  Irish  (A.  M.  C,  '97),  vice-president;  Dr. 
Edward  W.  Becker  (A.  M.  C,  97),  secretary. 

Personals —Dr.  Thomas  H.  Cunningham  (A.  M.  C,  1900)  of  Glens 
Falls,  N.  Y.,has  been  appointed  attending  surgeon  at  the  Parks  Hospital 
Glens  Falls,  N.  Y. 

—Dr.  C.  Howard  Travell  (A.  M.  C,  94)  is  at  No.  <?7  Fourth  Street 
Troy,  N.  Y. 

—Dr.  Frank  H.  Hurst  (A.  M.  C,  '95)  is  at  Guilderland,  N.  Y. 


212 


IN  MEMORIAM 


— Dr.  Sidney  F.  Rogers  (A.  M.  C,  '82)  of  Cohoes,  N.  Y.,  was  pain- 
fully injured  February  5,  1906,  by  being  thrown  from  his  carriage. 

—Dr.  William  M.  Dwyer  (A.  M.  C,  05)  has  started  practice  at 
Amsterdam,  N.  Y.,  where  he  has  been  appointed  city  physician. 

Married — Slocum-Evans.  On  Wednesday,  January  17,  1906,  at 
Tottenville,  Staten  Island,  N.  Y.,  Clarence  Jonathan  Slocum  (A.  M.  C, 
'97)  of  Pleasantville,  N.  Y.,  and  Elvira  Gwendolyn  Evans  of  Totten- 
Tflle,  N.  Y. 

— Van  Buren-McTague.  On  Monday,  February  19,  1906,  at  Albany, 
N.  Y.,  Dr.  James  Harvey  Van  Buren  (A  M.  C,  '05)  of  Jefferson, 
N.  Y.,  and  Miss  Lillian  McTague  of  Albany. 


Deaths— Dr.  Thomas  G.  Wright  (A.  M.  C,  96)  of  Troy,  N.  Y.,  died 
February  10,  1906,  at  his  home  after  a  long  illness  following  a  relapse 
of  typhoid  fever.  Dr.  Wright  was  surgeon,  Company  D,  2d  Regiment 
National  Guard,  with  the  rank  of  first  lieutenant. 

—Dr.  William  M.  White  (A.  M.  C.  '86)  died  at  Amsterdam,  N.  Y., 
December  29,  1905,  aged  50  years. 


IN  MEMORIAM 

Selwyn  A.  Russell,  M.  D. 

The  death  of  Dr.  Russell,  which  occurred  on  January  10,  1906,  at  his 
home  in  Poughkeepsie,  N.  Y.,  was  announced  in  the  Annals  of  February. 
Dr.  Russell  had  been  an  instructor  in  the  Albany  Medical  College,  had 
had  long  and  varied  hospital  experience,  had  traveled  widely  and  was 
well  known  by  a  great  many  friends  in  different  places.  The  Annals 
has  desired,  in  consequence,  to  publish  something  more  than  a  mere  state- 
ment of  his  death.  The  peculiar  circumstances  under  which  this  occurred 
have  been  described  in  the  Poughkeepsie  Daily  Eagle,  and  from  this  sketch 
and  sympathetic  appreciation  of  Dr.  Russell's  character  the  following 
extract  is  taken : 

"  The  prominence  of  Dr.  Selwyn  A.  Russell,  the  high  regard  in  which, 
he  was  held  by  all  who  knew  him,  and  the  publicity  which  he  was  always 
willing  to  give  of  his  own  views  as  to  the  treatment  of  cases  of  illness, 
make  it  seem  eminently  proper  that  something  more  should  be  given  to 
the  public  than  the  appreciative  but  rather  meager  notices  published 
about  his  death  in  the  newspapers.  Dr.  Russell  was  a  man  of  the  highest 
culture  and  warmest  sympathies.  He  had  studied  medicine  not  only  in 
the  Albany  Medical  College,  but  also  abroad,  had  had  years  of  experience 
in  hospital  work  in  Albany,  Utica  and  Poughkeepsie,  and  had  been  in 
successful  private  practice  both  in  Albany  and  Poughkeepsie.  During 


IN  ME MORIAM 


213 


the  past  few  years  he  had  spent  a  great  deal  of  time  investigating  the 
various  methods  of  cure  without  medicine,  mental  science,  Christian  Sci- 
ence, and  faith  cure,  and  had  come  to  regard  them  as  of  much  importance 
in  the  treatment  of  disease.  He  read  a  paper  on  Christian  Science  a  few 
years  ago  at  Vassar  Institute  and  attracted  a  large  audience  and  pro- 
voked much  discussion.  It  was  also  one  of  his  favorite  doctrines  that 
disease  was  unnecessary  and  could  generally  be  avoided  by  right  living. 
He  held  in  common  with  many  other  physicians,  that  nine-tenths  of  the 
people,  poor  as  well  at  rich,  eat  too  much,  and  he  was  rather  given  to 
prescribing  meager  diet  for  his  patients.  He  was  nevertheless  not  a  dis- 
believer in  the  use  of  medicines  in  all  cases,  and  was  a  believer  in  mind 
cure  for  all  cases. 

"  Dr.  Russell  was  out  not  much  more  than  a  week  ago,  and  the  first  inti- 
mation of  his  illness  came  from  one  of  his  children,  who  said  Sunday 
morning  that  he  had  a  sick  headache.  Sunday  afternoon  a  telephone  mes- 
sage came  to  Dr.  Guy  C.  Bayley  at  Vassar  Hospital  that  Dr.  Russell 
would  like  to  see  him.  There  was  no  intimation  that  he  was  ill  and  Mrs. 
Bayley  accompanied  her  husband,  supposing  they  were  going  to  make  a 
social  call.  When  they  reached  Dr.  Russell's  home  Dr.  Bayley  found  Dr. 
Russell  in  a  state  of  collapse,  so  extremely  weak  that  it  seemed  unlikely 
that  he  could  live  through  the  night.  He  telephoned  at  once  for  Dr.  Tut- 
bill.  They  could  find  no  symptoms  of  organic  disease,  but  learned  that  Dr. 
Russell  had  taken  no  nourishment  for  about  a  week.  Whether  he  was  ex- 
perimenting upon  himself  or  treating  himself  by  fasting  for  some  ailment 
not  then  apparent  is  not  known.  A  trained  nurse  was  at  once  summoned 
and  the  doctor  was  given  nourishment  every  hour  in  the  effort  to  save  his 
life,  but  it  was  too  late. 

"There  have  been  reports  that  Dr.  Russell  had  pneumonia  and  pleurisy, 
but  Dr.  Tuthill  says  this  was  not  the  case.  .  It  seems  not  too  much  to  say 
that  Dr.  Russell  was  a  martyr  to  his  beliefs,  or  perhaps  to  his  desire  to 
obtain  more  knowledge  by  testing  one  of  his  theories.  He  was  not  a  very 
strong  man  and  the  test  proved  too  severe  for  his  constitution. 

"Dr.  Russell  was  born  in  Jay,  Essex  County,  N.  Y.,  February  12,  185 1. 
He  was  graduated  at  the  Albany  Medical  College  in  1877,  after  which  he 
spent  two  years  as  resident  physician  at  the  Albany  Hospital,  and  then 
until  1883  served  on  the  staff  of  the  Utica  State  Hospital.  The  next  year 
he  spent  in  Europe,  returning  in  1884  to  Albany,  where  he  entered  private 
practice  until  1888,  when  he  made  a  trip  around  the  world.  In  1891  he 
took  a  position  on  the  staff  of  the  Hudson  River  State  Hospital,  resigning 
a  number  of  years  ago  to  practice  his  profession  in  this  city. 

"  Dr.  Russell  was  twice  married  and  leaves  besides  his  widow  two  chil- 
dren by  his  first  wife.  He  was  a  member  of  the  Presbyterian  Church, 
often  an  active  participant  in  its  meetings  and  an  active  worker  in  every- 
thing believed  to  be  for  the  uplifting  of  the  people.  He  often  read  papers 
cr  took  part  in  the  discussion  at  Vassar  Institute,  and  occasionally  con- 
tributed articles  to  the  Eagle,  always  interesting,  instructive  and  able. 
Many  people  will  sincerely  mourn  his  loss." 

7 


214 


CURRENT   MEDICAL  LITERATURE 


Current  /fcefcical  Xtteraturc 

REVIEWS  AND  NOTICES  OF  BOOKS 

Pyschiatry.  A  Text-Book  for  Students  and  Physicians.  By  Stewart 
Paton,  M.  D.,  Associate  in  Psychiatry,  The  Johns  Hopkins  Uni- 
versity, Baltimore;  Director  of  the  Laboratory,  The  Sheppard  and 
Enoch  Pratt  Hospital,  Towson,  Maryland.  Philadelphia  and  Lon- 
don :  J.  B.  Lippincott  Company,  1905. 

Dr.  Paton's  book  is  an  example  of  the  unfortunate  modern  practice 
of  quotation,  particularly  prevalent  in  the  United  States,  and  in  the  United 
States  particularly  characterized  by  deference  to  foreign  writers.  It  is 
possible  that  such  a  book  was  needed  to  reveal  the  extent  to  which  this 
practice  might  be  developed,  and  the  difficulties  to  which  it  may  lead. 
There  is  surely  no  credit  to  American  medicine  in  an  unquestioning 
acceptance  of  any  statement  made  by  any  author,  provided  he  lives  some- 
where in  Europe  and  expresses  his  thoughts  through  the  medium  of  a 
foreign  language.  And  yet  it  seems  necessary,  now-a-days,  for  the  alienist 
to  cross  the  sea,  get  some  foreign  flavor  and  discharge  what  is  so  easily 
acquired  upon  the  innocents  who  stay  at  home.  American  readers  have 
a  right  to  demand  that  books  placed  before  them  for  their  information 
should  reveal  some  independence  of  thought  and  some  originality.  This 
question  was  once  raised  in  the  deliberations  of  a  committee  upon  the 
award  in  a  competition  of  prize  essays.  One  writer  urged  that  his  collec- 
tion of  reported  cases  was  the  most  complete  in  existence.  His  claim  was 
rejected  as  it  was  based  upon  clerical  and  not  medical  work. 

Dr.  Paton's  book  is  characterized  by  an  abundance  of  quotations  and 
a  deficiency  in  decision,  which  reduces  its  value.  Furthermore  it  is  so 
technical  in  description  and  so  philosophic  in  tone  that  the  student  or 
practitioner,  for  whom  it  is  stated  to  have  been  written,  would  find 
difficulty  in  comprehending  the  author's  meaning.  For  example,  a  highly 
educated  physician,  a  specialist  in  another  department,  opened  the  book 
at  random,  and  read  as  follows:  "The  vigility  of  the  attention  is  a  term 
used  by  some  clinicians  to  indicate  the  fact  that  the  direction  of  the 
stream  of  energy  is  dirigible.  The  tenacity  refers  to  the  length  of  time 
during  which  the  current  sets  in  a  given  direction.  Decrease  in  vigility 
(Hypovigility)  is  noted  in  various  conditions.  It  is  a  common  symptom 
of  fatigue,  as  a  consequence  of  which  stimuli  stronger  than  those  normally 
needed  are  required  to  direct  and  augment  the  flow.  The  influence  of 
various  drugs,  particularly  opium  and  the  bromides,  may  also  be  productive 
of  similar  results.  The  tenacity  or  persistence  of  the  attention  is  pro- 
foundly afTected  in  various  forms  of  alienation.  Not  only  is  this  true 
in  well  marked  psychoses  but  frequently  also  in  various  functional  neuroses 
— hysteria  and  neurasthenia.  Not  uncommonly  vigility  and  tenacity  are 
both  afTected,  giving  rise  to  a  condition  called  1  aprosexia.' "  The  reader 
did  not  know  what  this  meant. 

Exception  may  also  be  taken  to  the  author's  plan  of  treatment  in  so 
far  as  he  recommends  isolation  of  the  patient  from  his  friends.    "  Only 


CURRENT  MEDICAL  LITERATURE 


exceptionally  should  he  be  permitted  to  see  members  of  his  own  family 
or  friends,  as  such  interviews  are  frequently  followed  by  a  renewal  of 
the  symptoms."  This  is  undoubtedly  true  in  many  cases.  It  should  be 
remembered,  however,  that  insane  patients  are  susceptible  to  slight  influ- 
ences, that  the  removal  from  home  has  been  accomplished  with  a  wrench 
often  intensifying  the  symptoms,  that  strange  faces,  strange  surroundings, 
strange  manipulations  are  not  necessarily  conducive  to  mental  rest, 
especially  when  the  mind  is  in  a  state  of  apprehension.  There  is  often 
undoubted  need  of  removal  from  home,  which  is  usually  delayed  too 
long,  but  if  the  patient  may  be  reassured  by  frequent  visitations  of 
friends  that  he  has  not  been  abandoned  to  whatever  whim  of  management 
the  physician  adopts,  and  that  the  opportunity  for  appeal  is  offered,  a 
distinct  help  is  given,  confidence  takes  the  place  of  distrust,  the  active 
conditions  are  ameliorated  and  the  chance  for  recovery  enhanced.  The 
fact  of  the  matter  is  that  the  modern  spurt  in  psychiatry  is  too  impersonal. 
Laboratory  methods  of  exploration  are  prominent.  There  is  too  much 
science  and  too  little  human  sympathy. 


Pathology  and  Morbid  Anatomy.  A  Text-Book  of  Pathology  and  Path- 
ological Anatomy.  By  T.  Henry  Green,  M.  D.,  F.  R.  C.  P.,  Con- 
sulting Physician  to  Charing  Cross  Hospital,  London.  New  (ioth) 
edition.  Thoroughly  revised  by  W.  Cecil  Bosanquet,  A.  M.,  M.  D., 
F.  R.  C.  P.,  Assistant  Physician  to  Charing  Cross  Hospital.  Octavo, 
606  pages,  348  engravings  and  a  colored  plate.  Cloth,  $2.75,  net. 
Lea  Brothers  &  Co.,  Publishers,  Philadelphia  and  New  York,  1905. 

The  tenth  edition,  revised  from  the  tenth  English  edition,  of  this  well 
known  text-book  of  pathology  presents  numerous  changes.  These  are 
especially  noticeable  in  the  selections  on  animal  parasitology  and  those 
dealing  with  immunity  to  infectious  diseases.  An  excellent  chapter  on 
auto-intoxication  and  nutritional  diseases  has  been  added.  There  are 
also  numerous  additional  illustrations.  The  clear,  simple  style  and  com- 
prehensive scope  renders  the  book  of  special  value  to  the  medical  student 
and  the  busy  physician.  r.  m.  p. 

International  Clinics.  Edited  by  A.  O.  J.  Kelly,  A.  M.,  M  D.,  Philadelphia, 
Vol.  Ill,  Fifteenth  Series,  1905.  J.  B.  Lipincott  Company,  Phila- 
delphia. 

The  articles  comprising  this  volume  naturally  divide  themselves  into 
two  groups,  especially  prepared  original  -rticles  upon  the  one  hand, 
and  a  citation  of  clinical  cases  upon  the  other.  The  leading  article  of  the 
former  group  is  entitled  "  The  Therapeutic  uses  of  the  Rontgen  Rays,  or 
Radiotherapy,"  by  George  C.  Johnson,  M.  D.,  of  Pittsburgh,  who  treats 
the  subject  in  considerable  detail  under  the  following  sub-heads: 

1.  Physiologic  action  of  the  Rontgen  Rays. 

2.  Technic  of  Radiotherapy. 

3.  Radiotherapy  in  diseases  of  the  skin. 

4.  Radiotherapy  in  melignant  diseases. 


CURRENT  MEDICAL  LITERATURE 


In  conclusion  he  says  "  the  whole  subject  is  embraced  in  the  word 
'technic'  In  common  with  every  known  therapeutic  agent,  the  powers 
Of  x-rays  may  as  easily  be  manifested  for  harm  as  good.  What  is  needed 
at  present  is  not  more  x-ray  therapy,  but  more  intelligence." 

Another  instructive  article  of  the  didactic  style  is  by  Albert  Robin, 
M.  D.,  of  Paris,  on  "The  Action  of  Metallic  Ferments  on  Metabolism, 
and  their  Effects  in  Pneumonia."  His  conclusions  are:  I.  That  metals 
(n  extreme  subdivision  are  capable  of  remarkable  physiologic  action,  out 
of  all  proportion  to  the  amount  of  metal  used.  2.  That  such  metals  acting 
in  doses  which  therapeutics  considered  heretofore  as  ineffectual  and  useless, 
by  making  a  profound  impression  on  some  of  the  clinical  processes  of 
life,  whose  deviations  are  connected  with  many  morbid  conditions,  are 
probably  destined  to  take  an  important  place  among  the  remedies  of 
functional  therapeutics. 

To  us  the  greater  value  of  the  volume  consists  in  the  report  of  clinical 
lectures,  illustrated  by  the  histories  of  actual  cases,  together  with  the 
post-mortem  findings  in  fatal  ones.  Such  lectures  are  those  on  "Addison's 
Disease,"  delivered  by  Edward  F.  Wells,  M.  D.,  at  the  Cook  County 
Hospital,  Chicago,  and  "  Primary  Carcinoma  of  the  Hepatic  Duct,"  by 
Doctors  Weber  and  Mitchels,  of  London.  Charming,  indeed,  is  the  style 
of  Daniel  R.  Brower,  M.  D.,  L.  L.  D.,  also  of  the  Cook  County  Hospital, 
Chicago,  in  his  neurological  clinic;  one  experiences  a  true  pleasure  and 
profit  in  following  his  varied  cases.  Surely  this  is  the  age  of  clinical 
instruction,  both  for  the  undergraduate  and  for  the  busy  practitioner 
alike.  h.  d.  c. 


A  Manual  of  the  Practice  of  Medicine.  By  A.  A.  Stevens,  A.  M.,  M.  D., 
Professor  of  Pathology  in  the  Woman's  Medical  College  of  Pennsyl- 
vania, and  Lecturer  on  Physical  Diagnosis  at  the  University  of 
Pennsylvania.  Seventh  edition  revised.  i2mo  of  556  pages,  illus- 
trated. Philadelphia  and  London :  W.  B.  Saunders  &  Company, 
1905.    Flexible  leather,  $2.50  net. 

This  well  known  work  which  has  passed  through  seven  editions  in 
about  twelve  years  was  written  as  a  guide  for  students  "  with  the  hope 
that  it  may  serve  as  an  outline  of  Practice  of  Medicine,  which  shall  be 
enlarged  upon  by  diligent  attendance  upon  lectures  and  critical  observa- 
tions at  the  bedside."  With  this  end  in  view  it  has  served  its  purpose 
admirably  and  will  probably  continue  to  do  so  in  the  years  to  come.  It 
is  only  intended  as  a  summary  of  the  subject,  but  as  a  summary  it  is 
excellent,  presenting  the  chief  points  of  the  various  diseases  clearly 
and  usually  accurately;  there  is  always  danger  however  of  students  mis- 
taking the  purpose  of  such  a  book. 

All  of  the  more  extended  works  upon  the  subject  "have  been  freely 
consulted  in  the  preparation  "  of  this  book  which  shows  the  same  care  as 
is  evident  in  the  earlier  editions. 

It  is  unfortunate  that  the  section  on  cutaneous  diseases,  which  logically 
hardly  has  a  place  therein,  should  not  be  as  accurate  as  the  other  sections. 

c.  k.  w.,  jr. 


CURRENT  MEDICAL  LITERATURE 


217 


MEDICINE 

Edited  by  Samuel  B.  Ward,  M.  D.,  and  Hermon  C.  Gordinier,  M.  D. 

A  Fatal  Case  of  Stokes-Adams  Disease  with  Autopsy,  Showing  Involve- 
ment of  the  Auriculo-ventricular  Bundle  of  His. 

Alfred  Stengel.    American  Journal  Medical  Sciences,  December,  7905. 

The  author  names  the  foilowing  symptoms  that  characterize  the  disease : 
(1.)  Slow  pulse,  the  rate  falling  temporarily  or  permanently  to  30,  20 
or  even  less ; 

(2.)  Cerebral  attacks,  such  as  vertigo,  syncope  or  epileptiform  seizures, 
unconsciousness ; 

(3.)  Pulsation  of  the  veins  in  the  neck  exceeding  in  rate  the  pulsation 
of  the  arteries,  two-fold,  three-fold,  or  more. 

He  points  out  the  resemblance  between  this  condition  and  "heart  block." 

The  literature  as  to  the  origin  of  the  condition  whether  nervous  or 
muscular  in  origin,  is  reviewed  and  conclusions  made  by  His  and  others 
that  it  is  muscular  in  origin.  His  has  proven  this  possible  by  describing 
a  muscular  bundle  extending  from  the  right  side  of  the  interauricular 
septum  to  the  interventricular  septum  immediately  before  the  pars  mem- 
branacea.  Physiological  and  anatomical  evidence  points  to  this  bundle  as 
the  pathway  of  the  stimulus  to  contraction.  It  has  been  shown  that  when 
this  bundle  is  severed,  the  auricles  and  ventricles  cease  beating  at  the 
same  rate. 

Erlanger,  by  a  specially  devised  curved  needle,  acting  as  a  clamp,  was 
able  to  reach  the  bundle  of  His.  The  amount  of  pressure  could  be 
regulated  by  means  of  a  thumbscrew  and  complete  or  partial  constriction 
could  be  established.  The  result  of  such  compression  was  to  produce  first, 
occasional  failure  of  the  ventricular  contraction;  next,  a  ratio  of  the 
auricular  to  the. .ventricular  beats  of  two  to  one,  three  to  one,  four  to  one, 
and  finally  complete  heart  block  in  which  the  ventricles  contracted  inde- 
pendently of  the  auricular  rhythm.  Sometimes  at  the  moment  when  com- 
plete heart  block  was  established  the  ventricle  ceased  to  beat  for  periods 
vrrying  from  a  few  seconds  up  to  55  seconds.  Erlanger  explains  this  as 
probably  resulting  from  the  fact  that  a  certain  time  is  necessary  after 
complete  severance  of  the  connection  between  auricles  and  ventricles  for 
the  development  in  the  ventricle  of  its  inherent  rhythmicity. 

The  author's  case  is  as  follows : 

J.  B.  Male,  age,  57  years.  His  personal  history  was  negative  save  that 
he  had  drunk  considerable  beer. 

Present  illness  began  without  warning  about  two  and  one-half  years 
before.  He  suddenly  fell  backward  and  became  unconscious  for  a  few 
moments.  He  recovered  quickly  and  was  well  for  three  months.  Then 
he  had  another  attack.  These  attacks  became  more  frequent  and  except 
in  the  first  attack  he  always  fell  forward.  Some  times  he  would  not  lose 
consciousness  but  would  feel  giddy  for  a  few  minutes.  At  other  times  his 
legs  and  arms  would  become  spasmodically  rigid.  Nothing  seemed  to 
influence  attacks.  He  lost  in  weight  and  grew  steadily  weaker.  He  never 
had  oedema  or  dyspnoea. 


2l8 


CURRENT  MEDICAL  LITERATURE 


Patient  entered  hospital  September  19,  1905,  and  his  condition  was  as 
follows:  Well  built  man.  No  cyanosis  or  jaundice.  Marked  pulsation 
in  epigastrium  and  veins  of  neck.  Radial  arteries  somewhat  thick  and 
pulse  36,  equal  and  tension  slightly  raised.  Lungs  show  well  marked 
emphysema.  Apex  beat  in  fifth  interspace  just  outside  mid-clavicular  line. 
There  is  a  systolic  thrill  at  apex.  Cardiac  dullness  extends  from  the 
third  space  above  to  the  sixth  rib  below  and  from  midsternum  on  right 
to  a  point  just  outside  the  mid-clavicular  line  on  the  left.  There  is  a  harsh 
systolic  murmur  at  the  apex  transmitted  to  the  axilla.  It  is  also  heard  at 
the  base.    Second  pulmonic  sound  not  accentuated. 

Urine  showed  few  hyaline  and  granular  casts,  otherwise  normal. 

September  23.  Patient  began  to  have  attacks  but  they  were  mild  in 
character,  beginning  with  a  momentary  pallor,  then  a  flushing  or  cyanosis 
and  slight  tremor  of  the  arms.  After  the  attack  the  face  was  pale  and 
gradually  the  color  returned.  The  pulse  stopped  beating  for  a  few  seconds 
during  some  of  the  attacks.  After  the  attack  the  pulse  rate  increased  for 
a  time,  then  subsided  to  a  steady  rate  of  16  to  18.  The  pulsation  of  the 
veins  of  the  neck  continued  during  as  well  as  between  attacks  at  from 
80  to  100. 

During  the  next  few  days  the  attacks  became  more  frequent  and  more 
severe.    Pie  died  on  the  27th. 

During  the  last  few  days  a  condition  of  complete  heart  block  was  seem- 
ingly present.  The  auricular  and  ventricular  pulsations  were  entirely 
independent.  Between  the  paroxysms  the  pulse  rate  was  from  18  to  26 
and  the  venous  rate  from  80  to  140.  The  latter  rate  was  sustained  during 
and  between  the  seizures,  while  the  pulse  beats  ceased  for  periods  varying 
from  20  seconds  to  two  minutes  and  10  seconds  just  before  attacks  and 
rose  to  from  90  to  140  immediately  after  the  seizure.  In  the  intervals 
the  radial  pulse  was  regular  and  fairly  strong.  Various  heart  stimulants 
were  given  without  effect. 

Autopsy. — The  heart  was  hypertrophied  but  the  muscle  was  unaffected 
by  any  degeneration  or  sclerotic  change  excepting  in  the  very  limited  area 
of  the  middle  portion  of  the  auriculo-ventricular  bundle.  There  was  a 
patch  of  atheroma,  sclerotic  and  white,  on  the  anterior  mitral  leaflet 
towards  its  base  and  aortic  edge.  It  extended  to  the  endocardium  exactly 
over  the  bundle  of  His  where  this  band  passes  from  the  ventricle  to 
the  auricle. 


A  Case  of  Stokes- Adams  Syndrome ,  with  Necropsy. 

A.  Rendle  Short.    The  Lancet,  January  6,  1906. 

The  author  briefly  reports  the  case  of  a  painter  aged  50  years  who 
entered  the  Bristol  General  Hospital,  August  27,  1905,  complaining  of 
fits.  His  personal  history  was  negative  and  his  present  trouble  began  18 
months  before,  when  he  had  influenza.  Since  then  he  complained  of  head- 
aches and  giddiness.  His  first  fit  occurred  June  12,  and  has  had  them 
occasionally  ever  since.  They  came  on  without  warning.  He  would  sud- 
denly become  giddy  and  become  unconscious.    He  never  bit  his  tongue 


CURRENT  MEDICAL  LITERATURE 


219 


and  was  not  drowsy  after  the  attack.    For  several  months  had  a  dis- 
charging ear,  and  also  complained  of  sciatica  in  the  right  leg  and  hip. 
On  admission  his  condition  was  as  follows : 

A  powerfully  built  man  whose  physical  examination  was  negative  save 
his  heart. 

The  pulse  at  the  wrist  was  twelve,  very  irregular  in  force  and  fre- 
quency. The  tension  was  high  and  artery  thickened.  Later  in  the  day  the 
pulse  rate  was  forty-four  and  the  apex  beat  was  always  the  same  as  the 
pulse  at  the  wrist.  At  this  time,  however,  the  venous  pulse  in  the  neck 
was  sixty.  The  apex  beat  was  in  the  fifth  interspace  and  in  the  nipple 
line.  There  was  a  soft  systolic  murmur  at  the  apex  and  a  systolic  murmur 
at  the  base  also  heard  in  the  neck.  The  aortic  second  sound  was  accentu- 
ated. On  the  29th  the  pulse  at  the  wrist  was  forty-four  and  venous 
pulse  sixty.  While  being  examined  he  had  a  fit.  He  began  to  turn  his 
head  slowly  and  stiffly  to  the  right;  the  eyes  also  deviated  to  the  right. 
There  were  no  clonic  spasms  of  the  head,  the  eyes  or  limbs.  He  was  quite 
unconscious.  The  face  became  bluer  and  bluer  and  the  respirations  were 
quick  and  deep.  The  attack  lasted  thirty  seconds  and  ended  by  his  draw- 
ing up  his  legs  and  trying  to  sit  up.  He  then  suddenly  regained  conscious- 
ness and  was  not  in  the  least  confused.  The  next  day  the  patient 
suddenly  stopped  breathing,  became  unconscious,  got  very  blue  and  died. 

Necropsy. — Brain  meninges  were  very  cedematous  and  the  pia  vessels 
were  full.  The  brain  was  soft  and  watery.  No  abscess  or  neoplasm  was 
found.  The  heart  was  not  dilated.  Lungs  were  congested.  The  left 
ventricle  was  a  little  hypertrophied.  The  mitral  valve  flaps  were  thickened 
and  the  chordae  tendineae  were  thick  and  shortened.  The  endothelium 
and  musculi  papillares  showed  white  fibrous  patches  of  thickening,  which 
were  quite  superficial.  The  heart  muscle  showed  a  few  scattered  patches 
of  fibrosis  not  well  marked. 

Dr.  Short  bases  his  diagnosis  on  the  fact  that  the  venous  pulse  in  the 
neck  and  the  "ventricular  and  radial  pulses  were  asynchronous  owing  to 
the  characteristic  "  heart  block "  of  the  Stokes-Adams  syndrome.  Not 
having  at  that  time  realized  the  importance  of  the  auriculo-ventricular 
band  of  His  in  these  cases,  the  author  unfortunately  did  not  submit  it 
to  microscopical  examination. 


Concerning  the  Pathology  and  Clinical  Diagnosis  of  Acute  Endocarditis. 
(Zur  Pathologic  und  klinischen  Diagnose  der  Endocarditis  acuta.) 

A.  Sch/bert.    St.  Pctersburgcr  mcdicinischc  IVochcnschrift,  1905,  No.  41. 

The  writer  summarizes  the  findings  of  fifty  autopsies  in  the  City 
Hospital  of  Riga,  Russia.  Anatomically,  endocarditis  may  be  classified 
a?  verrucouse  or  ulcerous ;  bacteriologically,  as  strepto-staphylo-pneumomy- 
cotica,  and,  clinically,  as  rheumatic  and  septic,  or  benign  and  malignant. 
The  bacteriological  classification  is  probably  at  the  present  time  the  most 
satisfactory  on  account  of  the  possible  uses  of  antisera,  although  some 
difficulty  is  presented  here  by  the  bacteriological  perplexities  of  acute 
rheumatism. 

The  clinical  diagnoses  of  these  fifty  cases  were  classified  as  follows: 


220  CURRENT  MEDICAL  LITERATURE 

In  seventeen  endocarditis  was  given  as  the  cause  of  death,  and  in  the  other 
thirty-three  cases  there  were  certain  other  prominent  clinical  manifestations, 
which  were  given  as  valvular  disease  in  nineteen,  hemiplegia  in  three, 
acute  nephritis  and  sepsis  in  two,  tuberculosis,  pneumonia,  and  lympho- 
sarcoma each  in  one,  and  four  patients  were  moribund. 

There  were  several  other  prominent  conditions.  Oedema  was  present 
in  seventy  per  cent,  and  was  nearly  always  referred  to  the  lower  limbs. 
The  pericardium  was  involved  nineteen  times,  and  in  thirteen  of  these 
the  condition  was  that  of  hydropericardium  containing  from  1,000  to  1,500 
cubic  centimetres  of  fluid.    In  ten  per  cent,  fibrous  pericarditis  was  present, 
and  in  one  case  was  found  chronic  adhesive  pericarditis.    In  sixteen  cases 
fluid  was  found  in  the  pleura  in  quantity  from  1,000  cubic  centimetres  up. 
The  peritoneum  was  free  in  all  of  the  fifty-one  cases.    The  exudations  in 
the  pericardium  and  in  the  pleura  were  generally  free  from  bacteria,  and 
were  regarded  as  of  bacterio-toxic  origin.    This  suggests  an  analogy 
with  the  synovial  exudates  of  acute  rheumatism.    In  seventy-two  per  cent, 
of  the  cases  the  valves  participated  seventeen  times  in  an  acute  inflamma- 
tion, and  nineteen  times  in  a  chronic  condition.    When  one  valve  only 
was  involved  it  was,  in  the  majority  of  instances,  the  aortic,  which  was 
diseased  twentv-one  times  as  against  five  times  of  the  mitral  alone. 
Enlargement  of  the  heart,  for  the  most  part,  on  account  of  hypertrophy 
with  or  without  dilatation  of  one  ventricle,  was  found  more  extensively 
in  recurring  cases  than  in  the  recent  ones,  and  was  noted  altogether  in 
thirty-one  instances.    Complications  in  the  lungs  assumed  generally  two 
forms;  croupous  pneumonia  was  found  in  eleven  cases  and  infarcts  were 
fcund  in  five.   The  croupous  pneumonia  was  associated  with  the  Frankel- 
Weichselbaum  diplococcus.  Thus  it  appears  that  when  pneumonia  is  second- 
ary to  endocarditis  the  microbic  origin  of  the  two  conditions  is  not 
identical.    Nephritis  appeared  in  three  forms:  first,  as  diffuse  nephritis, 
usually  of  hemorrhagic  character;  secondly,  as  miliary  embolic  nephritis, 
and   thirdly,  as  an  infarct.    The  spleen  appeared  usually  as  an  acute 
splenic  enlargement  in  eighty  per  cent  of  the  cases.    Five  cases  contained 
two  large  infarcts,  and  one  an  abscess.    In  the  liver  passive  congestion 
of  mechanical  origin  was  occasionally  noted.    The  last  organ,  which  is 
represented  bv  a  distinct  lesion  in  endocarditis,  is  the  brain.  Hemiplegia 
speared  in  three  cases  as  the  principal  symptom.    In  six  other  cases  a 
local  lesion  was  found  in  the  brain  at  autopsy.    The  blood  revealed,  as  a 
rule    a  high  degree  of  anaemia.    The  number  of  red  corpuscles  was 
diminished  and  of  the  leucocytes  increased.    The  bacteriological  examina- 
tion  showed   that   streptococci   predominated,    sometimes   mixed  with 
staphylococci.    The  pneumococcus  came  next  in  point  of  frequency,  and 
occasionallv  the  pyocyaneus  was  found. 

A  review  of  these  fifty  cases  of  endocarditis  brings  into  especial  prom- 
inence the  fact  that  certain  clinical  symptoms  not  definitely  attributable 
to  disease  of  the  heart  frequently  predominate.  The  conditions  in  the 
lungs,  the  kidnev,  the  spleen,  the  brain,  and  the  histological  and  bacterio- 
logical states  of  the  blood  point  to  other  diseases  than  endocarditis,  but 
the  diagnosis  need  not  be  made  especially  difficult  on  this  account  if  the 
relation  of  these  diseases  to  endocarditis  is  remembered. 


CURRENT   MEDICAL  LITERATURE 


221 


PATHOLOGY  AND  BACTERIOLOGY 
Edited  by  Richard  Mills  Pearce,  M.  D. 
Assisted  by  Charles  K.  Winne,  Jr.,  M.  D.,  and  Leon  K.  Baldauf,  M.  D. 

A  Study  of  the  Bacteriology  of  Pertussis,  with  Special  Reference  to  the 
Agglutination  of  the  Patient's  Blood. 

Martha  Wollstein.    Journal  of  Experimental  Medicine,  1905,  VII,  335. 

Investigations)  upon  the  subject  of  the  etiology  of  pertussis  by  means  of 
microscopical  and  cultural  studies  of  the  sputum  have  resulted  in  the 
finding  of  various  observers  of  protozoa,  staphylococci,  streptococci,  diplo- 
cocci  and  of  bacilli.  The  last  may  be  divided  into  three  groups :  First, 
a  motile  baccillus  growing  "  colon-like "  upon  all  ordinary  media  and 
forming  endogenous  spores;  second,  a  bacillus  growing  as  a  small  poled 
bacillus  upon  agar,  Loeffler's  serum,  and  gelatin,  and  in  broth;  third,  an 
"  influenza-like  "  bacillus  growing  only  on  haemoglobin-agar  and  not  stain- 
ing by  Gram's  method.  The  latter  organism  was  first  described  by 
Spengler  in  1897,  and  later  by  Jochman  and  Krause  in  1901  and  1903; 
in  the  latter  year' they  found  it  in  sixty  samples  of  pertussis  sputum  and  in 
the  lungs  of  twenty-three  pertussis  cases  who  died  of  broncho-pneumonia. 
It  was  not  found  in  cases  of  ordinary  broncho-pneumonia  nor  in  sputum 
from  other  than  pertussis  cases.  To  this  organism  has  been  given  the 
name  of  B.  pertussis. 

Working  as  a  Fellow  of  the  Rockefeller  Institute  for  Medical  Research 
Wollstein  has  studied  the  sputum  from  thirty  cases  of  persussis,  and  the 
agglutination  reactions  of  the  patient's  blood  with  the  bacilli  isolated. 
After  a  paroxysm  of  coughing  the  sputum  was  obtained  in  a  sterile  recept- 
acle and  washed  in  several  changes  of  sterile  peptone  water,  after  which 
cultures  were  made  on  haemoglobin-agar  plates,  made  by  mixing  placental 
blood  with  melted  agar.  Smears  from  the  sputum  were  strained  by  Gram's 
method  and  With  dilute  carbol  fuchsin.  Some  cocci  were  found  in  the 
smears  but  were  always  much  less  numerous  than  a  bacillus  having  all  the 
characteristics  of  B.  pertussis.  From  twenty-nine  cases  of  the  thirty 
examined  a  bacillus  was  isolated  culturally  which  agreed  in  all  features 
with  Spengler's  bacillus.  These  were  short,  plump,  ovoid,  with  rounded 
ends  and  growing  on  the  blood-agar  plates  as  small,  transparent,  dew-drop 
like  colonies  not  surrounded  by  a  haemolytic  zone  like  that  found  around 
the  pneumo-  and  staphylo-coccus  colonies.  No  growth  took  place  on  the 
ordinary  media.  The  bacilli  are  not  motile.  Other  organisms  found  were 
identified  as  pneumococci,  streptococci  in  long  chains,  micrococcus'  catarrh- 
alis  and  pseudo-diphtheria  bacilli. 

Agglutination  tests  were  made  with  all  the  varieties  of  bacilli  isolated 
form  each  case.  In  no  instance  did  the  Gram  positive  bacillus  give  any 
reaction  with  the  serum  of  the  child  from  which  it  was  isolated.  The 
influenza-like  organisms  reacted  with  the  serum  of  the  children  in  dilutions 
of  1 :20o  and  occasionally  in  1 1500.  The  tests  were  made  macroscopically 
with  salt  solution  suspensions  and  controlled  with  the  microscope.  The 
reactions  were  always  highest  and  most  complete  with  homologous  serum, 
but  the  various  strains  of  the  bacillus  all  reacted  with  every  pertussis  blood 


222 


CURRENT   MEDICAL  LITERATURE 


examined  in  dilutions  of  1:100  at  least.  Control  tests  were  made  with 
normal  blood  but  were  either  negative  altogether  or  in  dilutions  higher 
than  i  :ioo. 

The  blood  serum  of  ten  pertussis  cases  was  tested  with  the  influenza 
bacillus  but  all  gave  negative  reactions  in  dilutions  higher  than  i  :20.  In 
three  cases  in  which  the  influenza  bacillus  was  isolated  from  the  sputum 
the  blood  gave  a  positive  reaction  with  the  B.  influenzae  in  dilutions  of 
1:100,  but  reacted  with  the  bacillus  isolated  from  the  pertussis  cases  in 
1 :20  dilution  only. 

Rabbits  were  artificially  immunized  and  their  serum  reacted  positively 
1 :5oo  as  a  maximum. 

The  bacilli  were  found  with  the  greatest  ease  early  in  the  attack,  i.  e., 
when  the  cough  had  persisted  about  two  weeks  and  the  whoop  was  just 
established.  Two  cases  were  examined  before  the  whoop  began,  but  showed 
no  bacilli ;  these,  however,  were  easily  isolated  at  a  later  examination.  The 
bacilli  continued  very  numerous  in  the  sputum  throughout  the  paroxysmal 
stage,  in  several  cases  even  when  the  attack  was  eight  weeks  old.  In  one 
case  the  bacilli  were  isolated  once  a  week  for  seven  weeks,  and  the 
child's  blood  reacted  in  a  dilution  of  1:100  three  months  after  the  onset 
of  his  cough.  Two  cases  whose  serum  had  given  a  positive  reaction 
(1:200)  during  the  paroxysmal  stage  did  not  react  four  months  after  the 
onset. 

All  animal  experiments  were  negative  as  to  the  production  of  sickness  or 
death,  except  emaciation  ensued  after  repeated  injection  over  a  prolonged 
period  of  time. 


A  Contribution  to  the  Study  of  Epidemic  Cerebrospinal  Meningitis. 
Wm.  J.  Elser.    The  Journal  of  Medical  Research,  1905,  XIV,  89. 

The  writer  reports  the  results  of  careful  bacteriological  and  pathological 
studies  based  on  one  hundred  and  thirty  cases  of  epidemic  cerebro-spinal 
meningitis.  In  one  hundred  and  nine  cases  a  positive  bacteriological  diag- 
nosis was  made  during  life  by  examination  of  the  spinal  fluid  either  by  means 
of  cultures  or  stained  coverslip  preparations.  In  many  instances  cultures 
and  smears  had  to  be  repeated  several  times  before  the  results  were  posi- 
tive. In  five  the  bacteriological  diagnosis  was  not  established  during  life, 
but  the  diplococcus  meningitidis  was  isolated  in  pure  culture  at  autopsy. 
Of  the  sixteen  negative  cases  twelve  were  examined  but  once;  four  were 
examined  twice.  It  is  probable  that  repeated  examinations  of  these  would 
have  diminished  the  number  of  failures.  A  few  of  the  negative  cases 
may  have  been  instances  of  tuberculous  meningitis  which  were  not  so 
recognized.  Failures  were  more  common  in  cold  weather  which  would  seem 
tc  indicate  that  the  meningococcus  is  extremely  sensitive  to  cold.  On  the 
other  hand  in  two  cases  the  organism  was  isolated  from  bodies  which  had 
been  kept  on  ice  for  forty-eight  hours. 

Mixed  infections  with  other  organisms  were  infrequent.    The  pneumo- 


CURRENT   MEDICAL  LITERATURE 


223 


coccus  together  with  the  meningococcus  was  found  during  life  in  two 
cases,  and  the  diagnosis  of  mixed  infection  was  confirmed  at  autopsy.  In 
both  cases  the  meningococcus  was  the  more  numerous.  In  one  case  the 
streptococcus  was  found  in  cultures  from  the  spinal  fluid,  but  a  second 
examination  failed  to  reveal  this  organism.  In  several  cases  the  staphy- 
lococcus albus  was  found  in  the  spinal  fluid  but  from  the  evidence  the  writer 
considers  them  as  contaminating  organisms  and  not  concerned  with  the 
causation  of  the  meningitis.  In  no  case  was  any  organism  found  in  the 
spinal  fluid  when  the  meningococcus  was  absent. 

As  a  rule  the  spinal  fluid  was  examined  early  in  the  disease,  but  in  one 
case  the  meningococcus  was  isolated  culturally  as  late  as  the  thirtieth  day. 

Nothing  material  is  added  to  our  knowledge  of  the  morphology  or  biology 
of  the  organism  studied,  but  the  writer  emphasizes  the  fact  that  the 
meningo-coccus  is  always  promptly  decolorized  by  the  Gram  method,  and 
that  at  no  time  was  chain  formation  ever  observed.  The  culture  medium 
found  most  reliable  was  a  mixture  of  ascitic  fluid,  one  part,  and  ordinary 
bouillon  or  agar,  two  parts,  ( Werthheim's  media)  • 

The  results  of  animal  inoculations  confirm  these  of  previous  investi- 
gators. The  white  mouse,  as  a  rule,  reacted  to  intraperitoneal  injections, 
death  occurring  within  twenty-four  or  forty-eight  hours;  subcutaneous 
injections  were  negativve,  and  rabbits  and  guinea  pigs  were  far  less 
susceptible. 

The  results  of  the  blood  cultures  made  during  life  and  reported  by  the 
writer  are  particularly  interesting.  For  the  details  of  this  part  of  his  work 
one  is  referred  to  the  original  article  as  it  does  not  lend  itself  to  satisfactory 
abstracting;  the  results  only  will  be  given  here.  Blood  cultures  were  made 
of  forty-one  cases  in  which  a  positive  bacteriological  diagnosis  had  been 
made  upon  the  spinal  fluid.  In  these,  positive  results  were  obtained  in  ten 
cases  or  approximately  twenty-five  per  cent.  Many  difficulties  were  met 
with  in  carrying  out  a  proper  technique  for  such  cases,  and  the  writer  states 
that  he  believes  that  if  they  were  successfully  overcome,  the  invasion  of  the 
blood  by  the  meningococcus  would  be  found  to  occur  more  frequently  than 
his  results  indicate.  Though  the  cultures  were  usually  made  early  in  the 
disease,  in  one  case  the  organism  was  recovered  as  late  as  the  twenty- 
fifth  day.  They  were  usually  present  in  small  numbers.  This  method  of 
examination  was  proven  to  have  no  diagnostic  value  beyond  that  of  spinal 
fluid  examinations.  The  result,  however,  suggests  that  it  is  of  value  in 
prognosis  where  the  organism  is  found,  as  in  only  two  of  the  ten  cases  did 
recovery  occur.  On  the  other  hand  failure  to  demonstrate  the  organism 
in  the  biood  has  no  prognostic  significance  as  negative  results  were 
obtained  in  seventeen  fatal  cases  and  in  fourteen  which  recovered.  In 
twenty-two  cases  cultures  were  made  from  the  nose  or  from  the  nose  and 
throat  and  meningococci  were  found  in  six  of  them.  More  or  less  character- 
istic Gram  negative  cocci  were  found  in  the  majority  of  smears  made  from 
the  nose  or  throat.  Though  usually  found  early  in  the  disease,  in  one  case 
the  organism  was  cultivated  from  the  throat  as  late  as  the  twenty-third  day. 
Though  unwilling  to  make  positive  statements  in  regard  to  it,  the  writer 
believes  that  his  results  indicate  a  primary  infection  of  nose  or  throat  in 
these  cases. 


224 


CURRENT   MEDICAL  LITERATURE 


Cultures  from  urine,  herpetic  fluid  and  the  fluid  aspirated  from  a  swollen 
knee-joint  were  in  all  cases  negative. 

The  meningococcus  was  demonstrated  in  cultures  or  smears  from  the 
brain  in  every  autopsy  in  which  this  organ  could  be  examined.  Pathological 
examination  of  the  brain  and  cord  did  not  reveal  anything  which  has  not 
been  heretofore  described.  Focal  hemorrhages  were  seen  in  two  cases 
of  twenty-two  examined,  and  thrombosis  of  the  superior  longitudinal  sinus 
in  four  cases. 

The  accessory  sinuses  were  normal  in  all  the  cases.  Slight  mucopurulent 
rhinitis  was  seen  in  seven  cases,  and  marked  acute  purulent  rhinitis  in  only 
three  cases.  Muco-purulent  or  purulent  bronchitis  was  present  in  fourteen 
cases  and  broncho-pneumonia  in  four  cases.  Bacteriological  examination 
of  all  organs  except  the  brain  was  very  unsatisfactory.  Though  frequently 
seen  in  smears,  the  meningococcus  was  isolated  only  once  from  the  nose 
and  lungs  at  autopsy.  The  writer  regards  the  pneumococcus  or  strepto- 
coccus, which  were  nearly  always  present,  as  being  of  more  value  than  the 
meningococcus  in  causing  the  pulmonary  complications. 

Purulent  otitis  media  was  found  in  two  cases,  in  one  of  which  the 
meningoccus  was  found,  and  from  another  middle  ear,  which  appeared 
normal,  the  organism  was  recovered  in  pure  culture. 

An  acute  sero-purulent  or  purulent  pericarditis  was  found  in  five  cases; 
the  amount  of  fluid  was  very  slight  and  it  was  practically  free  from  fibrin. 
None  of  these  cases  were  recognized  clinically.  In  two  of  them  menin- 
gococci were  found.  In  one  case  small  ulcers  were  found  on  the  auricular 
surface  of  the  mitral  valve.  These  were  regarded  as  mechanical  erosions 
following  small  endocardial  hemorrhages  and  are  suggested  as  possibly 
the  basis  of  chronic  valvular  disease  in  cases  recovering  from  meningitis. 
Cultures  from  the  heart's  blood  in  five  cases  were  sterile. 

Acute  nephritis  was  present  in  three  cases  ;  in  one  it  was  haemorrhagic 
in  type.  Cultures  were  sterile.  In  one  case  only  was  the  organism  isolated 
from  the  spleen.  Cutaneous  haemorrhages  were  seen  in  only  a  few  of  the 
autopsy  cases,  but  haemorrhages  into  the  serous  membranes  were  present. 

Thymus  and  lymphoid  structures. — The  findings  varied  considerably  in 
different  cases.  The  characteristic  hyperplasia  of  status  lymphaticus  was 
present  in  six  of  the  eight  cases  of  fulminant  meningitis  which  came  to 
autopsy,  and  was  most  marked  in  the  four  most  acute  cases.  The  seventh 
and  eighth  cases  showed  extensive  chronic  disease  of  other  organs  which 
was  sufficient  to  account  for  the  rapidly  fatal  issue.  The  writer  considers 
that  status  lymphaticus  is  an  important  factor  in  determining  the  rapidly 
fatal  result  in  epidemic  meningitis.  As  the  condition  was  present  in  over 
one-fourth  of  the  cases  examined  post  mortem,  he  also  suggests  that 
it  is  an  important  predisposing  factor  in  the  causation  of  the  disease  in  as 
much  as  the  enlarged  lymphoid  structures,  commonly  present  in  the  naso- 
pharynx in  such  cases,  not  only  facilitate  the  lodgement  on  the  menin- 
gococcus in  the  nose  and  throat  but  also  favor  their  entrance  into  the 
system. 

During  the  time  covered  by  these  investigations  nineteen  cases  of  sporadic 
non-tuberculous  meningitis  wrere  examined,  of  which  fourteen  came  to 
autopsy.    Of  these,  two  were  primary,  and  were  both  due  to  the  pneumo- 


CURRENT  MEDICAL  LITERATURE 


225 


coccus.  Of  the  secondary  cases,  four  were  due  to  the  same  organism,  six 
to  the  streptococcus,  and  in  two  the  cause  was  undetermined.  Of  the  five 
cases  upon  which  no  autopsy  was  held,  all  showed  the  pneumococcus  in 
pure  culture  in  the  spinal  fluid,  but  owing  to  incomplete  pathological 
examination,  it  is  not  known  whether  the  cases  were  primary  or  secondary 
meningitis. 


On  the  Presence  of  Certain  Bodies  in  the  Skin  and  Blister  Fluid  From 
Scarlet  Fever  and  Measles. 

Cyrus  W.  Field.    The  Journal  of  Experimental  Medicine,  1905,  VII,  343. 

About  a  year  ago  Mallory  described  certain  protozoon-like  bodies  which 
he  found  in  skin  obtained  at  autopsy  from  cases  of  scarlet  fever,  but  he  was 
unable  to  find  such  bodies  in  skin  obtained  during  life.  More  recently  Duval 
has  reported  finding  similar  bodies  in  blister  fluid  from  scarlet  fever 
patients. 

The  writer  details  some  control  work  along  similar  lines.  He  has 
examined  from  numerous  scarlet  fever  and  measles  patients  sections 
of  skin  taken  both  during  life  and  after  death,  as  well  as  material 
from  cases  of  diphtheria  which  had  had  an  antitoxin  rash  before 
death  and  of  diseases  unassociated  with  an  eruption.  His  results  were 
as  follows:  In  sections  of  skin  obtained  after  death,  in  all  of  the  fifteen 
cases  of  scarlet  fever  Mallory  bodies  were  found ;  in  one  of  them  they  were 
found  in  skin  removed  twenty-four  hours  postmortem,  though  they  were  not 
found  in  skin  removed  from  the  same  patient  only  five  minutes  after  death. 
No  bodies  were  found  in  the  skin  removed  during  life  from  twenty-four 
cares  of  scarlet  fever.  These  bodies  were  found  in  the  material  from  three 
of  the  four  autopsies  upon  measles  patients,  but  were  not  found  in  any  of 
the  fourteen  measles  cases  during  life.  The  specimens  of  skin  from  the 
antitoxin  rashes  and  from  the  cases  of  disease  without  rash  were  negative 
both  before  and  after  death. 

Blister  fluid  caused  by  the  action  of  aqua  ammoniac  fortior  upon 
the  skin  of  eighteen  patients  with  scarlet  fever  and  fourteen  with 
measles  were  examined;  in  all  of  the  latter  and  fourteen  of  the 
fomei  the  bodies  were  found.  Jn  material  Item  one  normal  individual 
and  from  seventeen  cases  of  various  cut-meous  diseases,  varying  from 
eczema  to  smallpox  and  including  eight  cases  of  antitoxin  rash,  the  bodies 
were  found  only  in  four  of  the  latter,  and  in  these  the  blistering  fluid  had 
been  left  on  the  skin  for  a  much  longer  period  than  usual  and  the  conse- 
quent irritation  was  more  intense.  The  bodies  were  much  less  frequent 
in  the  material  from  these  sources  than  in  that  from  the  cases  of  measles 
and  scarlet  fever.  In  the  latter  the  bodies  could  be  demonstrated  in  the 
fluid  derived  from  both  normal  skin  and  that  showing  tha  eruption,  but  in 
that  from  normal  skin  longer  action  of  the  blistering  fluid  was  necessary 
and  the  bodies  were  much  less  numerous. 


226 


CURRENT   MEDICAL  LITERATURE 


The  blister  fluid  was  examined  by  making  smears  as  of  blood  and  stain- 
ing by  means  of  various  of  the  ordinary  haemotological  methods.  A  modi- 
fied Hasting's  stain  or  Giemsa's  stain  was  ordinarily  employed.  In  such 
preparations  bodies  of  various  kinds  are  found,  but  those  in  which  the  most 
interest  centers  are  the  ones  which  have  the  appearance  of  protozoa,  many 
of  them  resembling  closely  the  extra-cellular  forms  of  the  malarial  para- 
site. These  bodies  which  average  in  size  from  three  to  seven  microns  in 
diameter,  have  a  pale  blue  protoplasm  containing  one  or  more  granules 
resembling  bits  of  chromatin  in  their  staining  reaction.  Four  times  these 
granules  were  seen  arranged  about  the  periphery  of  the  cell  with  fine  lines 
running  to  the  center,  which  gave  them  the  appearance  of  a  malarial  rosette. 
In  moist  spreads  or  smears  the  appearance  was  also  very  suggestive  of 
protozoa. 

The  origin  of  these  bodies,  or  bodies  indistinguishable  from  them,  was 
clearly  made  out.  Leucocytes  were  very  numerous  in  the  moist  spreads, 
particularly  in  those  made  with  material  from  the  acute  exanthemata. 
When  these  smears  were  watched  in  a  warm  chamber  at  thirty-seven 
degrees  centigrade  the  pseudo-podia  of  the  leucocytes  were  seen  to  break 
off  and  assume  in  a  short  time  a  round  form,  each  fragment  contain- 
ing one  or  more  granules,  and  resembling  very  closely  individual 
cells.  Bodies  of  the  same  nature  were  found  in  an  emulsion 
of  leucocytes  in  hypotonic  salt  solution  which  had  been  left 
in  the  thermostat  for  some  hours.  Similar  appearances  to  the  above  were 
seen  in  the  stained  preparations,  all  transitions  in  morphology  and  staining 
reactions  from  normal  leucocytes  to  the  protozoon-like  bodies  being  seen 
in  abundance. 

Fields'  conclusions  are  in  part  as  follows : 

I  believe  that  the  bodies  found  in  sections  of  skin  from  cases  of 
measles  and  scarlet  fever  are  part  of  the  protoplasm  of  the  epithelial  cells 
which  has  been  so  changed  in  its  chemical  nature  that  its  staining  reaction 
differs  from  that  of  the  surrounding  protoplasm.  The  small  round  extra- 
cellular bodies  found  in  the  living  patients  may  arise  from  degenerating 
cells,  but  I  cannot  demonstrate  this  origin  with  certainty. 

It  would  seem  that  if  these  bodies  of  Mallory  were  protozoa  they  would 
have  been  found  in  sections  from  both  the  living  and  the  dead  skin  of 
scarlet  fever  and  measles,  as  they  were  found  in  the  blister  fluid.  Their 
absence  is  certainly  more  suggestive  of  a  degeneration  than  of  a  protozoon. 
This  view  is  also  borne  out  by  the  fact  that  they  were  not  found  immed- 
iately after  death,  but  were  present  in  another  speciman  from  the  same 
case  removed  twenty-four  hours  later. 

It  would  seem  probable  also  that  the  bodies  found  in  the  blister  fluid 
were  the  products  of  degeneration  and  cytolytic  activity,  because  they 
were  found  in  the  antitoxin  rashes  as  well  as  in  the  cases  of  scarlet  fever 
and  measles. 

It  certainly  cannot  be  stated  that  none  of  these  bodies  is  a  protozoon, 
but  it  can  be  positively  stated  that  a  great  majority  of  them  arise  from 


CURRENT  MEDICAL  LITERATURE  227 

degenerating  cells;  and  in  many  cases,  I  think,  it  is  not  possible  to  differ- 
entiate a  degeneration  products  from  protozoa  by  morphology  and  staining 
reastions. 

The  bodies  found  in  blister  fluid  resemble  very  closely  those  granular 
bodies  found  in  blood  under  certain  conditions  and  seen  in  vaccine  lymph 
and  in  emulsions  of  tissues  and  in  exudates.  I  think,  therefore,  that  they 
are  for  the  most  part,  if  not  wholly,  products  of  degenerating  tissue  cells 
and  of  leucocytes,  and  within  certain  limits  specific  to  scarlet  fever  and 
measles. 


7 he  Occurrence  of  Bacterium  Pneumoniae  in  the  Saliva  of  Healthy 
Individuals. 

W.  D.  Frost,  C.  B.  Divine  and  C.  W.  Reineking.   Journal  of  Infectious 
Diseases,  Supplement  I,  May,  1905,  page  298. 

It  is  generally  recognized  that  bacterium  pneumoniae  is  found  in  the 
saliva  of  a  considerable  proportion  of  healthy  individuals.  The  statement 
is  frequently  made  that  it  occurs  in  one  out  of  every  five  persons.  But  the 
experiments  upon  which  these  conclusions  were  based  were  made  by  differ- 
ent observers  at  various  times  of  the  year  and  under  a  variety  of  conditions ; 
so  much  so  that  it  seemed  worth  while  to  study  this  question  and  to  deter- 
mine independently  the  distribution  of  this  germ  in  the  saliva.  The 
salivas  of  some  fifty  individuals  were  examined,  and  in  some  cases  that  of 
the  same  individuals  at  different  times  of  the  year.  This  was  done  to 
determine  whether  or  not  there  was  any  variation  in  the  seasonal  distri- 
bution of  the  germ.  The  results  seem  to  show  that  there  is  marked  varia- 
tion in  the  distribution  of  this  germ  at  different  seasons  of  the  year.  Other 
examinations  have  been  made  upon  different  classes  of  individuals  at 
the  same  season  of  the  year  to  note  if  any  variation  occurred  which  could 
be  properly  assigned  to  difference  of  occupation.  Here  again  a  variation 
appeared,  especially  when  the  distribution  of  the  germ  in  the  saliva  of 
those  employed  "indoors"  was  compared  with  the  distribution  of  the  germ 
in  the  saliva  of  those  employed  "out  of  doors". 

The  authors  state  that  they  are  well  aware  that  the  conclusions  which 
might  be  drawn  from  these  experiments  are  not  conclusive,  but  they  believe 
that  the  results  obtained  are  of  sufficient  import  to  warrant  a  somewhat 
detailed  account  of  the  experiments  and  the  data  collected. 

The  presence  of  bacterium  pneumoniae  were  determined  exclusively  by 
the  inoculation  of  rabbits  with  two  cubic  centimeters  of  saliva  intraperi- 
toneal^, as  soon  as  possible  after  collection.  In  cases  where  the  animals 
died  the  autopsies  were  performed  without  delay.  Cover-slips  of  the  blood 
from  the  various  organs  were  stained  by  means  of  the  Welch  capsule  stain. 
Cultures  were  also  made  of  the  various  organs.  Those  cases  only  were 
counted  as  positive  in  which  there  developed  a  septicemia  and  in  which 


228 


CURRENT   MEDICAL  LITERATURE 


there  was  found  in  the  blood  of  the  rabbit,  or  milk  subcultures  therefrom, 
a  lancet  shaped  diplobacillus  about  which  a  definitely  stained  capsule  could 
be  demonstrated. 

There  were  eighty-five  inoculations.  Thirty-two  or  37.6  per  cent,  of  these 
gave  a  positive  result.  The  saliva  was  obtained  from  fifty  different  indi- 
viduals. Eighteen,  or  thirty-six  per  cent,  of  these  showed  the  presence  of 
the  germ.  The  percentage  of  positive  results  obtained  is  higher  than  that 
reported  by  previous  observers. 

Of  the  fifty  individuals  tested,  twenty-six  were  university  students,  two 
were  high  school  children,  six  were  ward  school  children,  five  were  team- 
sters, five  were  outside  laborers  (carpenters),  five  were  draughtsmen  and  one 
was  a  housewife.  All  were  well  at  the  time  the  saliva  was  collected  and  it 
is  not  known  that  any  of  them  fell  sick  for  some  time  afterward,  so  that 
they  may  fairly  be  considered  to  have  been  healthy  at  the  time  their  saliva 
was  examined. 

One  object  of  the  inoculations,  as  already  indicated,  was  to  determine 
whether  or  not  the  season  of  the  year  had  any  influence  on  the  prevalence 
of  the  germ  in  the  saliva.  The  results  obtained  show  that  of  the  thirty 
examinations  made  in  the  fall,  seven,  or  approximately  twenty-four  per 
cent,  were  positive ;  that  of  the  thirty-five  inoculations  made  in  the  winter, 
fifteen,  or  forty-three  per  cent,  were  positive,  and  that  of  the  twenty  inocula- 
tions in  the  spring,  ten,  or  fifty  per  cent,  were  positive. 

Another  question  of  considerable  importance  was  that  of  the  virulence 
of  the  organism  of  pneumonia  as  it  occurs  in  the  saliva.  This  was  judged 
entirely  by  the  period  elapsing  between  the  time  of  inoculation  and  the 
death  of  the  rabbits.  This  time  has  varied  from  twenty  to  one  hundred 
hours.  It  would  appear  that  the  virulence  of  the  pneumococcus  is  greater 
during  the  time  when  it  is  most  prevalent  and  lower  when  it  is  less  common. 
In  other  words  it  appears  that  ninety  per  cent,  of  the  rabbits  died  within 
twenty-four  hours  in  the  spring,  about  seventy-three  per  cent,  in  the  winter, 
and  only  forty-two  per  cent  in  the  fall  months. 

Still  another  point  of  some  interest  was  the  question  as  to  whether  or  not 
the  germ  persists  in  the  same  throat  for  some  time.  It  was  found  that  of 
the  seven  individuals  whose  saliva  contained  bacterium  pneumoniae  in  the 
fall,  only  four  contained  it  in  the  winter  months,  and  that  of  the  twelve 
individuals  who  harbored  it  in  the  winter,  eight  had  acquired  it  since  the 
previous  examination.  Again  only  four  out  of  the  fifteen  gave  the  same 
reaction  at  both  examinations. 

In  regard  to  the  influence  of  occupation  on  the  presence  of  this  organism 
in  saliva  three  classes  were  studied :  those  who  were  indoors  almost  entirely, 
those  in  and  out,  and  those  who  worked  outside  all  day.  For  convenience 
they  were  divided  into  groups.  One  group  consisting  of  five  draftsmen, 
working  in  a  machine  shop,  had  the  pneumococcus  present  in  the  saliva 
of  all  or  100  per  cent.  Two  groups  of  five  students  harbored  it  in  forty 
and  sixty  per  cent,  respectively,  as  also  did  two  of  five  teamsters.  In  five 
laborers  it  did  not  occur.  These  results  suggest  that  occupation  may  be 
a  factor  in  accounting  for  the  variation  of  the  distribution  of  this  germ  in 
the  saliva  of  healthy  individuals. 


Vol.  xxvii 


APRIL,  1906 


No  4. 


ALBANY 

MEDICAL  ANNALS 


Original  Communications 

SOME  POINTS  IN  THE  DIAGNOSIS  AND  TREATMENT 
OF  PULMONARY  TUBERCULOSIS. 

An  Address  Delivered  at  the  Centennial  Anniversary  of 
the  Medical  Society  of  the  County  of  Rensselaer, 
Held  at  Troy,  N.  Y.,  February  22,  1906. 

By  LAWRASON  BROWN,  M.  D., 

Resident  Physician,  Adirondack  Cottage  Sanatorium,  Saranac  Lake,  N.  Y. 

Mr.  President  and  Gentlemen: 

It  will  be  impossible  for  me  to  do  more  to-day  than  to  touch 
upon  a  few  of  the  most  important  points  in  the  diagnosis  of  pul- 
monary tuberculosis.  I  shall  not  attempt  to  give  you  a  true 
perspective  of  diagnosis  as  applied  to  this  disease  but  shall  draw 
largely  from  my  own  experience,  and  warn  you  of  my  mistakes 
and  errors. 

The  diagnosis  of  pulmonary  tuberculosis  often  demands  all 
of  our  critical  faculties.  In  the  first  place  many  of  us,  it  seems 
to  me,  are  not  entirely  unbiased  when  we  attempt  to  make  a  diag- 
nosis in  a  friend  or  an  old  patient.  Many  cases  of  pulmonary  tuber- 
culosis are  overlooked  simply  for  the  reason  that  the  examiner 
cannot  convince  himself  that  his  friend  or  his  patient  whom  he 
has  known  for  years  could  have  such  a  thing  as  tuberculosis.  I 
know  that  to  be  true  especially  in  physicians'  families  where  a 
number  of  sad  instances  have  come  under  my  observation.  The 
diagnosis  in  some  of  these  should  have  been  made  months  before 
it  was,  and  I  can  offer  no  explanation  but  the  foregoing. 

There  are  a  number  of  symptoms  which  suggest  tuberculosis 
even  to  the  patient.  Among  these  are  haemoptysis,  cough,  expec- 
toration, loss  of  weight  and  strength,  and  possibly  fever.  If 


230  DIAGNOSIS  AND  TREATMENT  OF   PULMONARY  TUBERCULOSIS 

any  scries  of  cases  is  gone  over  carefully,  I  think  it  will  be  found 
that  in  the  majority  of  cases  the  onset  was  not  with  one  of  these 
symptoms,  unless  it  be  cough  or  expectoration.  Haemoptysis  is, 
in  many  instances,  the  first  symptom  noticed  by  the  patient.  If 
heart  disease,  or  a  lesion  above  the  glottis  can  be  excluded, 
haemoptysis  of  any  quantity  can,  I  think,  in  nearly  every  case, 
when  it  occurs  in  a  person  enjoying  good  health,  be  said  to  be 
due  to  pulmonary  tuberculosis.  At  any  rate,  it  should  be  taken 
for  granted  that  such  is  the  case,  and  the  burden  of  proof  rests 
on  him  who  denies  it.  If  coupled  with  a  little  loss  of  weight 
and  strength,  and  possibly  slight  fever  in  the  afternoon,  even 
though  there  is  no  cough,  no  sputum,  and  no  physical  signs  in 
the  lungs,  the  diagnosis  of  pulmonary  tuberculosis  can  be  made 
almost  positively.  Slight  expectoration,  especially  in  the  morn- 
ing is,  as  you  all  know,  quite  common,  particularly  among  the 
dwellers  in  the  larger  cities.  It  is  surprising  how  often  a  golden 
rule  of  medical  practice  is  overlooked  ;  namely,  that  whenever 
a  patient  complains  of  any  pulmonary  or  otherwise  suspicious 
symptoms,  and  has  any  expectoration,  or  even  if  he  says  he  has 
none,  the  examiner  should  insist  upon  his  clearing  his  throat  in 
the  morning,  and  bringing  him  what  he  can.  In  more  than  one 
instance  I  have  been  able  in  this  way  to  obtain  sputum  contain- 
ing tubercle  bacilli.  One  examination  of  sputum  if  negative  Is 
good  for  very  little.  It  should  be  examined  on  five  or  six  suc- 
cessive days,  and  the  patient  told  how  to  collect  it. 

Loss  of  weight  and  strength  in  an  adult  without  other  ex- 
planation is  also  suggestive  and  should  put  us  on  our  guard. 
Slight  elevation  of  temperature  in  the  afternoon  is  the  first  symp- 
tom in  some  cases.  To  exclude  a  rise  of  temperature,  it  should 
be  taken  every  two  hours  for  several  days.  Repeated  attacks  of 
fever  with  slight  pulmonic  symptoms  are  important.  These  are 
only  a  few  of  the  many  ways  in  which  this  disease,  protean  in  its 
first  manifestations,  shows  its  presence. 

In  speaking  of  the  physical  signs  I  shall  quote  from  a  paper 
based  on  a  study  of  201  incipient  cases  at  the  Adirondack  Cottage 
Sanitarium. 

Absence  of  physical  signs  in  the  chest  is  no  better  proof  that 
a  patient  has  not  pulmonary  tuberculosis  than  the  absence  of 
tubercle  bacilli  in  the  sputum.  Tubercle  bacilli  occurred  in  the 
sputum  of  only  71  (35%)  of  201  incipient  cases.  Fifty-eight 
per  cent,  of  these  cases  did  not  apply  for  admission  to  the  sanitarium 


LAWKASON  BROWN 


within  the  first  six  months  of  illness.  Auscultation  is  by  far  the 
most  important  method  of  physical  exploration  in  incipient  pul- 
monary tuberculosis.  Inspection  (including  mensuration)  and 
percussion  seem  to  me  of  nearly  equal  importance.  Palpation  is 
of  less  value.  Auscultation  should  be  practiced  before  the  patient 
is  made  to  breathe  deeply,  as  otherwise  fine  crepitation  may  be 
overlooked.  In  many  incipient  cases  little  or  no  deformity  of  the 
chest  exists.  In  a  majority  of  the  cases  the  chest  is  well-developed, 
though  possibly  a  trifle  long,  with  a  slight  prominence  of  the 
clavicle  on  the  affected  side.  The  intercostal  spaces  and  angle, 
as  well  as  Louis'  angle  are  in  the  majority  of  cases  normal.  The 
movement  of  the  chest  as  noted  by  inspection  is  in  the  majority 
of  cases  restricted  on  the  affected  side.  Restriction  of  move- 
ment on  the  unaffected  side  is  by  no  means  uncommon.  Careful  in- 
spection showed  a  restriction  of  movement  in  ten  out  of  eighteen 
cases,  percussion  of  the  bases  revealed  it  in  thirteen,  radioscopy  in 
thirteen.  The  lower  part  of  the  affected  side  shows  in  some 
cases  an  exaggerated  movement  on  inspection,  which  may  be  of 
value  in  certain  cases.  The  vocal  fremitus  w*as  normal  in  two- 
thirds  of  the  cases  and  was  three  times  more  apt  to  be  increased 
on  the  affected  than  on  the  unaffected  side.  Direct  percussion 
upon  the  clavicle  has  not  proved  of  much  value  in  these  cases. 
Some  degree  of  dulness  may  occur  without  change  in  the  auscul- 
tatory signs.  Kronig's  method  of  percussion  is  of  value  in  the 
examination  of  incipient  cases.  Percussion  and  radioscopy  seem 
of  nearly  equal  value  in  determining  the  movement  of  the  base 
of  the  lung.  Radioscopy  has  a  distinct  advantage  in  deep- 
seated  lesions ;  percussion,  possibly  in  "  pleuritic  "  cases.  In 
fourteen  per  cent,  of  201  cases  percussion  was  negative,  while 
auscultation  revealed  some  pathological  signs.  Prolonged  ex- 
piration was  present  in  thirty-two  per  cent,  (in  four  per  cent, 
as  the  only  abnormal  auscultatory  sign).  Wavy  breathing  was 
present  at  the  site  of  the  lesion  in  eleven  per  cent.  "  Wavy 
breathing  "  at  the  left  base  may  be  a  cardiorespiratory  murmur. 
Weakened  breathing  at  the  site  of  the  lesions  was  present  in 
ten  per  cent,  (in  one  per  cent,  as  the  only  abnormal  auscultatory 
sign).  Puerile  breathing  was  present  in  twelve  per  cent.,  harsh 
breathing  with  loss  of  vesicular  murmur  in  eight  per  cent.  Some 
deficiency  in  the  vesicular  murmur  was  present  in  forty-one  per 
cent.  The  vocal  resonance  was  normal  in  sixty-two  per  cent., 
increased  at  the  site  of  the  lesion  in  thirty-eight  per  cent.  Rales 


23a  DIAGNOSIS  AND  TREATMENT  OF  PULMONARY  TUBERCULOSIS 

occurred  in  seventy  per  cent.  The  following  order  indicates  their 
relative  frequency:  fine,  medium,  rhonchi,  mixed.  Pleuritic 
friction  occurred  in  but  two  cases  (one  per  cent.).  In  these  201 
cases  the  site  of  the  primary  lesion  was  most  frequently  above  the 
clavicle,  then  in  the  suprascapular  area  and  subclavicular  fossa. 
Sixry-one  per  cent,  occurred  on  the  right  side. 

A  rule  of  practice  which  I  have  found  to  stand  me  in  good  stead 
is  that  physical  signs  at  one  apex  should  be  considered  as  due 
to  tuberculosis  until  the  contrary  is  proved ;  physical  signs  at 
one  base  should  be  considered  non-tuberculous  until  the  contrary 
is  proved. 

Tuberculin  carefully  administered  is  perfectly  safe  and  should 
be  used  in  all  doubtful  cases.  We  use  it  now  in  all  cases  with- 
out bacilli,  to  settle  once  for  all  the  question  of  diagnosis.  The 
agglutination  phenomenon  described  by  Arloing  and  Courmont 
with  a  homogeneous  culture  and  by  Koch  with  an  emulsion  of 
pulverized  tubercle  bacilli  and  Wright's  opsonic  method,  have 
not  yet  afforded  us  much  help  in  diagnosis. 

The  value  of  discovering  a  possible  source  of  infection  in  a 
suspicious  case  needs  only  to  be  mentioned.  The  differential 
diagnosis  of  pulmonary  tuberculosis  from  latent  exophthalmic 
goitre,  latent  suppuration  and  other  diseases  cannot  be  gone  into 
at  this  time. 

Since  the  time  of  Galen  dry  air  has  been  looked  upon  as  a  speci- 
fic in  consumption,  and  since  Benjamin  Rush,  in  the  early  part  of 
the  last  century  advocated  horse-back  riding  for  consumptives,  it 
has  been  widely  followed.  However,  the  first  logical  advocate 
of  the  fresh  air  treatment  was  Dr.  George  Bodington,  of  Sutton 
Coldfield,  England.  Like  many  other  discoverers,  he  failed,  as 
did  Dr.  MacCormac  after  him,  to  force  his  idea  on  the  world,  and 
it  remained  for  Dr.  Hermann  Brehmer  in  1859  to  demonstrate 
scientifically  at  Goerbersdorf  in  Silicia,  Germany,  the  practical 
value  of  fresh  air  in  the  treatment  of  pulmonary  tuberculosis. 
Among  his  patients  was  a  young  physician,  Dr.  Dettweiler,  who 
after  recovering  his  health,  founded  in  another  part  of  Germanv 
(Falkenstein  in  the  Taunus  Mountains)  a  second  sanatorium. 
He  too  advocated  fresh  air,  and  while  his  teacher  Brehmer  ad- 
vised systematic  exercise  for  the  small  heart  of  the  consumptive 
(a  point  now  not  fully  accepted),  he  laid  great  stress  upon  the 
rest  treatment,  especially  at  first.  Both  believed  in  a  liberal 
diet.    And  so,  gentlemen,  you  see  the  origin  of  the  therapeutic 


LAWRA80N  BROWN 


233 


triad  of  pulmonary  tuberculosis :  fresh  air,  rest  or  regulated  exer- 
cise, and  good  food. 

The  "  Sanatorium  treatment "  is,  I  take  it,  used  to  indicate  the 
treatment  of  patients  in  institutions  especially  adapted  to  meet  the 
requirements  of  this  therapeutic  triad.  To  describe  briefly  such  treat  - 
ment is  not  an  easy  task  and  possibly  the  best  idea  can  be  gained 
from  a  description  of  the  routine  life  of  a  patient.  This  varies 
slightly  according  to  the  plan  (cottage  or  pavilion)  of  the  institu- 
tion. On  admission  the  patient  has  his  history  taken,  is  examined 
(a  general  physical  examination  of  all  parts  of  the  body,  as 
well  as  of  the  lungs),  has  his  temperature  taken  for  a  varying 
length  of  time,  and  for  one  week  is  told  to  rest  his  body,  his 
stomach,  and  his  mind  if  possible. 

I  might  say  at  the  outset  that  the  best  results  are  obtained  only 
by  individualizing  the  patients.  Were  it  possible  the  physician  in 
charge  of  the  sanatorium  ought  to  take  the  patient's  history  him- 
self and  not  to  relegate  it  to  one  of  his  assistants.  This,  how- 
ever, is  impossible  for  him;  but  he  should  as  soon  as  possible 
come  to  know  the  mental  temperament  of  each  patient,  and  estab- 
lish a  bond  of  sympathy  between  the  patient  and  himself.  The 
patient  has  to  be  told  and  to  have  explained  to  him  each  detail  of 
the  treatment,  and  the  reason  for  it.  Patients  quickly  learn  one 
from  another  the  disastrous  results  of  breaking  rules.  The 
sputum  and  urine  are  carefully  examined  and  reexamined  re- 
peatedly if  -  necessary.  Everv  patient  should  be  kept  for  at  least 
a  week,  not  in  bed  necessarily,  but  at  rest  on  a  couch  or  in  a  good 
reclining  chair.  At  the  end  of  such  a  period  the  history  and  the 
results  of  all  examinations  are  carefully  gone  over,  and  the 
proper  amount  of  food,  exercise  and  rest  prescribed.  There  are. 
it  seems  to  me,  four  centra-indications  to  exercise:  elevated 
temperature,  rapid  pulse,  lose  of  weight,  and  blood  in  the  sputum. 
I  use  a  little  card  which  will  fit  in  the  waistcoat  pocket  and  be  at 
hand  for  readv  reference.    On  it  is  printed  the  following: 

Rules  for  Exercise. 

(Exercise  means  walking.     Special  permission  must  be  ob- 
tained before  indulging  in  other  forms  of  exercise.) 
None  for  one  week,  then  ask  about  it. 
None  if  feverish. 
None  if  blood  in  sputum. 
None  if  loss  of  weight 


234  DIAGNOSIS   AND  TREATMENT  OF  PULMONARY  TUBBRCULOSIS 


None  if  fast  pulse. 
Never  get  out  of  breath. 
Never  get  tired. 
Never  run. 

Never  lift  heavy  weights. 
No  mountain  climbing. 
GO  SLOW. 

Exercise  regularly  and  systematically  whether  rain  or  shine. 

Walk  uphill  at  the  start  so  as  to  come  down  hill  on  return. 

Remember  always  that  you  will  have  to  return. 

Rest  one-half  hour  before  and  after  meals. 

The  reverse  side  contains  only  the  patient's  name  and  is  left 
blank  below  for  special  directions.  I  have  found  that  I  have  ob 
tained  the  best  results  when  I  carefully  prescribed  the  time  to 
be  devoted  to  exercise  and  not  the  distance.  Some  patients  will, 
as  I  shall  point  out  later,  take  advantage  of  you  in  either  case. 
Ten  minutes  at  first  in  the  morning,  then  ten  minutes  both  morn 
ing  and  afternoon  which  should  be  carefully  increased  to  one-halt 
hour  morning  and  afternoon  is  sufficient  for  some  months.  Too 
little  exercise  when  the  disease  is  fully  arrested  and  especially 
when  the  patient  purposes  returning  to  work  is  a  mistake  often 
made  in  health  resorts.  To  plunge  into  the  "  strenuous  life  " 
from  one  of  ease  and  rest  is  disastrous  to  many  so-called  "  cures." 
No  hard  and  fast  rules  can  be  drawn  in  regard  to  what  exercise 
some  patients  can  stand.  It  is  unwise  to  predict  a  speedy  demise 
for  all  patients  who  indulge  in  over-exercise.  I  recall  well  a 
strapping  youth  of  twenty,  who  one  afternoon  occupied  the 
pitcher's  box  for  a  local  base-ball  team.  He  seemed  none  the 
worse  for  it.  but  after  a  little  "  heart  to  heart  "  talk  he  promised 
to  be  more  cautious.  I  have  heard  recently,  however,  that  his 
good  resolutions  waned  last  summer,  and  he  pitched  professional 
base-ball  and  enjoyed  good  health.  Such  cases  I  believe,  however, 
to  be  very  exceptional.  Lawn  tennis  is  in  most  sanatoriums  pro- 
hibited, as  well  as  bowling  and  all  sports  that  involve  active  use  of 
the  thoracic  muscles,  or  that  are  apt  to  raise  the  blood  pressure. 

I  have  dwelt  so  fully  upon  exercise  and  rest,  as  it  seems  to 
me  to  be  the  phase  of  the  modern  treatment  of  pulmonary  tubercu- 
losis that  is  least  understood. 

That  good  pure  air  is  requisite  every  minute  of  the  twenty- 
four  hours  is  now  well  established.  But  let  me  insist  upon  one 
point :  no  structure  that  needs  to  be  ventilated  is  as  good  as  an 


LAW  RA  SON  BROWN 


235 


open  verandah.  For  this  reason  all  rooms,  tents  and  shacks  are 
inferior  to  a  good  verandah  for  sitting  or  sleeping  out.  Sleeping 
out  of  doors  bids  fair  now  to  be  overdone  in  some  cases.  It  does 
not  agree  with  all  patients,  and  is  not  necessary  if  the  patient 
spends  eight  to  ten  hours  a  day  in  the  open,  and  sleeps  in  a 
well-ventilated  room.  I  feci,  however,  very  strongly  about  the 
question  of  sleeping  out  for  patients,  who  returning  home,  are 
forced  to  work  indoors  all  day.  For  these  I  believe  it  is  almost 
a  sine  qua  non  of  health,  and  should  be  followed  if  at  all  possible. 

The  third  important  factor  is  the  diet,  which  as  I  said  before 
should  be  liberal.  Many  state  institutions  will  run  aground  upon 
the  shoal  of  too  great  economy  in  the  kitchen.  A  sanatorium 
cannot  be  properly  maintained  at  the  cost  per  capita  of  a  hospital 
for  the  insane. 

I  shall  dismiss  this  subject  with  a  resume  of  the  diet  in  detail 
for  a  day : 

A  glass  of  milk  before  rising.  If  the  cough  is  severe  or  dis- 
tressing, a  teaspoonful  of  whiskey  in  a  glass  of  hot  milk  may  be 
substituted,  or  if  milk  cannot  be  taken,  a  cup  of  very  hot  water 
with  ten  to  twenty  drops  of  aromatic  spirit  of  ammonium  and  a 
pinch  of  table  salt  and  cooking  soda.  This  will  greatly  facilitate 
morning  expectoration.  For  breakfast  one  or  two  eggs,  chops 
or  steak  with  a  little  broiled  bacon,  bread  and  considerable 
butter,  one  or  two  glasses  of  milk  and  a  cup  of  coffee  or  tea. 

If  necessary  a  glass  of  milk  or  raw  egg  one  and  one-half  to 
two  hours  after  breakfast.  A  cup  of  hot  water  one  hour  before 
dinner  is  advisable  for  many  patients. 

Dinner  five  hours  after  breakfast:  soup,  thickened  (puree.) 
or  tasty  bouillon  or  broth ;  fish  or  oysters,  rare  roast  beef,  mut- 
ton, turkey,  chicken,  and  occasionally  if  preferred,  ham,  pork, 
duck,  or  a  little  goose;  fresh  vegetables  in  abundance  and 
variety ;  salads.  Sauces  should  be  prepared  with  much  butter. 
Puddings  (milk.  etc.).  jellies,  ice-cream,  simple  cake.  One  or 
two  glasses  of  milk  at  the  end  of  the  meal.  Demi-tasse  coffee. 
Bread  and  butter. 

If  necessary  a  glass  of  milk  with  or  without  a  raw  egg  one 
and  one-half  to  two  hours  after  meals.  A  cup  of  hot  water  one 
hour  before  supper. 

Supper  five  hours  after  dinner:  cold  roast  beef,  mutton, 
chicken,  occasionally  ham  :  one  course  of  hot  meat  with  vegeta- 
bles or  eggs  ;  bread,  butter,  tea.  cocoa,  milk  (one  or  two  glasses), 
jam  or  fruit  (fresh  or  preserved). 


236  DIAGNOSIS  AND  TREATMENT  OP  PULMONARY  TUBERCULOSIS 

A  glass  of  milk  or  an  egg  at  bed-time. 
A  glass  of  milk  or  an  egg  during  the  night  if  necessary. 
(Only  the  best  butter  should  be  used  for  cooking  as  well  as  at 
table.) 

In  other  words,  a  good  general  diet,  with  as  much  variety  as 
possible,  is  best. 

While  for  the  majority  of  patients  no  farther  treatment  is 
necessary,  some  will,  however,  tax  your  ingenuity  and  skill  to  the 
utmost.  How  long  a  febrile  case  should  be  kept  in  bed  out  of 
doors  if  his  temperature  shows  no  signs  of  lessening,  how  anti- 
pyretics should  be  used,  if  they  are  to  be  used  at  all,  how  to  treat 
the  various  complications  that  arise,  and  how  to  manage  neurotic 
cases,  are  only  a  few  of  the  many  problems  to  be  decided  every 
day.  I  have  often  been  tempted  to  change  the  old  adage,  "Mens 
sana  in  cor  pore  sano,"  to  "  Corpus  sanum  propter  mentem  sanam." 
For  this  reason  it  seems  to  me  most  important  to  afford  patients  who 
are  well  enough  some  light  work  or  amusement  in  the  open  air. 
We  have  tried  to  meet  this  need  at  the  Adirondack  Cottage  Sani- 
tarium by  establishing  one  year  ago  a  workshop  where,  under 
very  competent  and  inspiring  teachers,  patients  are  taught  book- 
binding, illuminating  in  the  manner  of  the  monks  of  old,  wood  carv- 
ing, and  photography.  We  hope  soon  to  add  stenography  and  tele- 
graphy, for  these  pursuits  can  often  be  followed  in  well  venti- 
lated rooms. 

Realizing  the  value  of  an  outdoor  hobby,  especially  for  those 
who  return  to  their  former  and  in  most  instances,  indoor  occupa- 
tions, a  bird  club  was  organized,  and  the  pleasure  it  has  given 
many  patients  has  well  repaid  us.  Its  chief  value  lies,  however, 
it  seems  to  me,  in  tempting  patients  after  they  leave  the  sana- 
torium into  the  woods  and  fields,  nature's  great  laboratory.  Botany 
is  of  equal  value. 

I  have  briefly  mentioned  how  one  patient  teaches  another,  but 
the  educational  advantages  of  the  sanitorium  are  great.  The 
patient  has  impressed  upon  him  the  importance  of  good  hygienic 
living,  and  before  he  leaves  it  should  have  become  a  habit.  I 
frequently  tell  patients  to  cultivate  an  outdoor  conscience,  a 
conscience  that  reproaches  them  as  soon  as  they  cross  the  thres- 
hold. In  fact  I  feel  so  strongly  upon  this  whole  subject,  that 
when  a  patient  asks  me  if  he  is  going  to  get  well  I  reply  that  it 
is  in  his  hands ;  which  we  are  willing  to  support  until  the  going 
down  of  the  sun  as  did  Aaron  and  Hur  for  Moses  while  Joshua 


LAWRASON  BROWN 


337 


was  struggling  for  another  sort  of  an  existence.  I  believe,  how- 
ever, that  patients  can  be  watched  and  guided  so  carefully  every 
minute  of  the  day  that  when  they  leave  the  sanatorium  they  are, 
in  some  instances  at  least,  ill-fitted  to  resist  the  temptations 
that  are  ever  present.  This  danger  should  be  pointed  out  to 
them,  and  they  should  be  encouraged,  as  I  said  before,  to  form 
ingrained  habits  of  hygienic  living.  A  reception  pavilion  or 
cottage  should  be  set  apart  where  new  patients  can  be  under  the 
constant  supervision  of  a  nurse  and  have  carefully  demonstrated 
to  them  all  the  necessary  details  for  a  certain  fixed  period  of 
time.  I  say  a  "  certain  fixed  period "  advisedly,  for  I  am 
thoroughly  convinced  that  talk  as  you  will,  in  season  and  out  of 
season,  indoors  and  out  of  doors,  you  cannot  inculcate  the  rules 
of  proper  living,  of  proper  care  into  some  patients,  you  cannot 
give  them  either  patience,  imagination  or  common  sense,  three 
essentials  to  recovery  from  pulmonary  tuberculosis.  When  this 
fact  has  been  demonstrated  sufficiently  often,  you  will  do  well  to 
concentrate  your  energies  elsewhere  and  allow  the  weakling  to 
choose  his  own  wavering  course.  The  care  of  the  mouth,  of  the 
teeth,  of  the  bowels,  the  use  of  cold  water,  sprays,  sponges,  or 
plunges  each  morning,  and  one  or  two  hot  baths  a  week,  should 
all  be  fully  explained  to  the  patients  in  a  series  of  informal  talks 
by  the  medical  staff.  Over  two  years  ago  I  ventured  a  little  oit 
the  beaten  track,  and  tried  the  experiment  of  a  little  monthly 
paper  which  would  replace  such  talks.  Some  of  you  have  no 
doubt  seen  our  little  journal  which  seems  to  have  met  with  con- 
siderable success. 

This  will,  I  trust,  give  vou  some  idea  of  the  treatment  of  pul- 
monary tuberculosis  as  it  is  carried  on  in  sanatoriums  today.  To 
discuss  intelligently  the  treatment  of  the  many  symptoms  and 
complications  that  may  arise  in  the  course  of  pulmonary  tubercu- 
losis would  lead  us  into  too  great  detail.  I  shall  not  attempt  it, 
but  would  like  to  draw  your  attention  for  a  few  moments  to  the 
consideration  of  the  treatment  of  pulmonary  haemorrhage.  The 
treatment  of  this  symptom  or  accident  is  at  present  most  unsatis- 
factory. It  is  indeed  fortunate  that  most  haemoptvses  cease  of 
themselves  and  this  too  in  spite  of  the  treatment  employed. 
Haemoptysis  may  be  controlled  by  increasing  the  coagulabilitv 
of  the  blood,  by  lessening  the  rapidity  of  its  flow,  by  reducing 
the  volume  of  blood  in  a  given  part,  by  lowering  the  blood 
pressure  or  by  constricting  the  affected  vessel,  which  may  act  in 


238  DIAGNOSIS   AND  TREATMENT  OF   PULMONARY  TUBERCULOSIS 

one  of  the  several  ways  heretofore  mentioned.  When  the 
pathology  of  the  pulmonary  lesion  is  considered  any  attempt 
to  change  the  calibre  of  the  ariected  vessel,  often  an 
aneurysmal  dilation  of  a  branch  of  the  pulmonary  artery, 
when  this  is  considered  it  seems  to  me,  its  futility  at  once 
becomes  apparent.  Attempts  to  decrease  the  coagulation  time 
have  not  met  with  marked  success.  Calcium  chloride,  so  warmly 
recommended  by  Wright,  has  not  given  me  any  very  satisfac- 
tory results  in  this  condition,  and  Dr.  Boggs  of  the  Johns  Hopkins, 
has  told  me  he  has  failed  to  verify  some  of  Wright's  experiments 
along  this  line.  Turpentine  has  been  extensively  employed  and 
some  praise  it  highly,  but  so  little  scientific  work  has  been  done 
with  it  in  haemoptyses  that  I  have  used  it  but  little.  To  lessen 
the  rapidity  of  the  flow  is  of  less  importance  than  to  equalize 
it  and  this  leads  me  to  consider  what  seems  to  me  the  most 
important  factor  in  the  treatment  of  haemoptysis,  i.  e.,  the  pul- 
monary blood  pressure.  Professor  Wm.  H.  Howell  (of  the 
Johns  Hopkins)  tells  me  that  the  estimation  of  the  pulmonary 
blood  pressure  presents  many  difficulties.  .Many  contradictory 
results  have  been  obtained  and  the  end  is  not  yet.  Vaso-motor 
nerves  in  these  vessels  have  yet  to  be  satisfactorily  demonstrated. 
As  far  as  we  can  see  today  the  estimation  of  the  pulmonary 
blood  pressure  depends  chiefly,  ceteris  paribus,  upon  the  amount 
of  blood  supplied  to  the  right  auricle,  that  is  it  is  concerned 
mainly  if  not  entirely  with  mechanical  factors.  To  regulate 
the  pulmonary  blood  pressure  it  is  then  necessary  to  control 
the  blood  supply  to  the  right  side  of  the  heart.  Venous  stasis 
or  dilatation  of  the  peripheral  capillaries  and  splanchnic  area  is 
the  quickest  way  to  accomplish  this. 

Haemoptysis  in  many  cases  seems  to  be  directly  connected 
with  a  sudden  increase  in  the  blood  pressure.  A  single  act  of 
over  exertion,  a  violent  paroxysm  of  coughing,  mental  excite- 
ment, violent  emotion,  all  are  direct  factors  in  the  etiology  of 
haemoptysis.  In  this  connection  the  frequent  recurrence  of 
haemoptysis  in  the  early  morning  hours  when  as  the  night  wanes 
consciousness  returns  wholly  or  in  part  is  suggestive.  Professor 
Howell  in  his  recent  published  work  on  physiology  has  expounded 
a  theory  of  .sleep  which  seems  to  me  to  explain  these  matutinal 
haemoptyses.  By  use  of  the  plethymograph  he  has  demon- 
strated a  peripheral  dilatation  of  the  vessels  during  sleep,  due 
he  thinks  to  the  fatigue  of  the  vaso-constrictor  centers  in  the 


LAWRASON  BROWN 


*39 


medulla  and  the  consequent  loss  of  tone  of  the  peripheral 
vessels,  thus  leading  to  cerebral  anaemia.  However  this  may 
be  the  fact  is  that  a  dilatation  of  these  vessels  occurs  during  sleep, 
more  pronounced  during  deep  slumber,  and  marked  by  many 
sudden  oscillations  as  consciousness  gradually  returns.  An 
even  pressure  in  the  pulmonary  vessels  although  high  seems  to 
me  to  be  of  less  danger  to  the  patient  than  any  sudden  increase. 
For  these  reasons  haemoptysis  is  often  apt  to  recur  in  the  early 
morning  hours ;  the  patient  awakes  spitting  blood. 

To  dwell  upon  the  need  for  absolute  rest  in  a  semi-recumbent 
position  is,  I  am  sure,  unnecessary.  For  the  reasons  mentioned 
the  utmost  calm  and  quiet  should  be  preserved.  No  whispering 
should  be  permitted  and  even  the  most  serious  haemoptysis  should 
be  treated  apparently  as  the  most  casual  occurrence.  I  will  not 
mention  the  long  list  of  remedies,  suspicious  in  itself,  that  have 
been  recommended,  nor  have  I  time  to  recount  even  all  the 
possible  complications  and  their  treatment,  but  I  will  outline 
for  you  what  seems  to  me  the  most  rational  procedure  in  the 
treatment  of  haemoptysis.  The  patient  having  been  gotten  to 
bed  and  quieted,  his  clothes  may  be  removed.  One  of  our  Ger- 
man confreres  has  related  an  instance  where  a  patient  put  to 
bed  for  haemoptysis  was  found  at  the  end  of  two  weeks  still 
to  have  his  shoes  on.  Possibly,  though  it  is  not  so  stated,  his 
attendants  wished  to  take  no  chances  about  his  dying  with  his 
boots  on.  -Slight  haemoptysis,  besides  rest  in  bed,  restriction 
of  the  diet  for  a  few  days  and  codeine  (gr.  ^4  4  h.),  needs 
little  treatment.  Severe  and  repeated  haemoptysis  calls  for  the 
greatest  care.  The  patient  should  be  in  the  semi-recumbent 
position.  The  windows  should  be  fully  opened  but  the  tempera- 
ture of  the  room  not  allowed  to  fall  too  low.  Small  doses  of 
salts  should  be  given  every  morning.  The  diet  should  include 
nothing  hot,  no  tea  or  coffee,  and  the  fluids  should  be  reduced 
to  a  minimum.  In  other  words,  the  patient  should  be  treated  for 
aneurysm.  The  blood  pressure  may  be  lowered  by  Esmarch 
bandages  about  the  limbs,  three  only  being  tied  off  at  one  time 
and  changed  every  twenty  minutes.  The  circulation  should  be 
equalized,  by  morphine  hypodermically  (gr.  ^  q.  4  h.),  but  the 
best  means  that  we  now  possess  for  controlling  the  blood  pres- 
sure lies  in  the  nitrites.  Amvl  nitrite  should  be  administered 
at  once  in  the  case  of  a  severe  haemoptysis,  a  second  pearl  of 
three  minims  be  given  in  two  or  three  minutes  if  necessary. 


240  DIAGN06I6   AND  TRBATMENT  OF  PULMONARY  TUBERCUL08I8 

This  can  be  frequently  repeated  and  it  can  be  put  in  the  hands 
of  the  patient  himself.  The  effect  of  this  drug,  strongly  recom- 
mended by  Hare  of  Australia,  is  very  evanescent  and  in  some 
cases  cannot  on  account  of  the  profuse  bleeding  be  inhaled.  For 
this  reason  nitroglycerin,  long  used  by  Flick,  is  under  such 
circumstances  to  be  preferred.  In  severe  haemoptyses,  however, 
it  is  always  advisable  to  administer  drugs  hypodermically.  Con- 
sequently nitroglycerin  tablets  hypodermically,  if  known  to  be 
reliable,  are  to  be  preferred  to  the  spiritus  glyceryhs  nitratis 
by  mouth.  Sodium  nitrite  is  much  more  stable,  less  likely  to  be 
followed  by  untoward  symptoms  and  while  slightly  less  power- 
ful is  a  trifle  more  prolonged  in  its  action  than  nitroglycerin. 
It  can  be  given  hypodermically  in  one  grain  doses  and  it  is  often 
wise  to  administer  it  with  the  morphine,  just  after  the  amyl 
nitrite.  The  danger  of  these  drugs,  however,  lies  in  the  fact 
that  the  blood  pressure  may  be  reduced  to  too  low  a  level  and 
it  needs  to  be  carefully  watched.  In  recent  cases  I  have  kept 
upon  the  patient's  arm  the  cuff  of  the  sphygmomanometer  and 
taken  frequent  readings.  An  intelligent  nurse  may  soon  be 
taught  to  take  careful  observations.  By  these  means  the  pres- 
sure may  be  kept  between  certain  levels  and  sodium  nitrite 
administered  only  when  the  upper  limit  is  exceeded.  The  cuff 
may  further  be  used  as  a  tourniquet,  if  necessary,  and  seems  to 
cause  the  patient  little  or  no  discomfort.  Since  I  have  used  this 
treatment  of  haemoptysis  I  have  had  but  few  opportunities  to 
test  its  value  and  no  treatment  of  haemoptysis  can  be  said  to  be 
of  value  until  it  has  been  tried  in  a  large  number  of  cases.  It 
has  but  one  recommendation,  it  seems  to  be  a  little  less  empirical 
than  many  methods  of  treatment  heretofore  advocated  and  fol- 
lowed. One  word  more  and  I  am  through  with  this  subject. 
To  prevent  the  matutinal  recurrences  of  haemoptysis,  I  have 
given  a  dose  of  morphine  and  sodium  nitrite  a  few  hours  before 
the  usual  recurrence  in  the  morning  and  it  has  seemed  of  benefit 
in  some  cases. 

I  should  like  to  speak  to  you  of  nightsweats,  and  their  treat- 
ment, of  pleurisy,  of  cough,  of  expectoration,  at  times  so  harass- 
ing and  distressing,  and  of  much  else.  But  I  must  hasten  to  say 
a  word  or  two  of  the  results  of  treatment  in  pulmonary  tubercu- 
losis and  I  shall  use  the  results  at  the  Adirondack  Cottage 
Sanatorium  as  my  text. 

At  the  last  meeting  of  the  National  Association  for  the  Study 


LAWRASON  BROWN 


241 


and  Prevention  of  Tuberculosis  various  definitions  were  adopted 
which  it  was  hoped  would  do  away  with  much  confusion.  An 
incipient  case  of  pulmonary  tuberculosis  was  defined  as  follows: 
**  Slight  initial  lesion  in  the  form  of  infiltration  limited  to  the 
apex  or  a  small  part  of  one  lobe.  No  tuberculous  complications. 
Slight  or  no  constitutional  symptoms  (particularly  including 
gastric  or  intestinal  disturbances  or  rapid  loss  of  weight).  Slight 
or  no  elevation  of  temperature  or  acceleration  of  the  puise  at 
any  time  during  the  twenty-four  hours  especially  after  rest. 
Expectoration  usually  small  in  amount  or  absent.  Tubercle 
bacilli  may  be  present  or  absent."  This  definition  as  is  readily 
seen  does  not  define  early  pulmonary  tuberculosis,  as  many 
patients  may  present  all  the  symptoms  mentioned,  and  if  the 
sputum  show  no  tubercle  bacilli  would  only  suggest  pulmonary 
tuberculosis.  But  if  a  diagnosis  of  pulmonary  tuberculosis  has 
been  made  then  the  definition  defines  the  early  or  first  stage. 
I  would  like  to  emphasize  the  importance  of  recognizing  the 
disease  in  this  early  or  latent  stage,  but  I  would  also  urge  care 
and  caution  in  the  diagnosis.  It  is  in  these  doubtful  cases  that 
tuberculin  is  of  especial  value  and  no  one  has  today  to  con- 
demn a  patient  to  the  "  cure  "  for  pulmonary  tuberculosis  without 
establishing  beyond  all  cavil  the  diagnosis.  I  say  this  advisedly, 
as  three  cases  have  been  admitted  to  the  sanitarium  in  the  last 
year  with  a  diagnosis  of  pulmonary  tuberculosis  who  later  were 
proved  to  be  free  from  it.  As  the  proper  treatment  of  pulmon- 
ary tuberculosis  consists  not  only  in  a  six  months  residence  at 
a  health  resort  or  sanatorium,  this  indeed  being  but  the  beginning, 
the  probation  of  the  patient,  but  to  be  effective  must  extend 
over  five  or  six  years,  the  first  six  to  twelve  months  of  which 
should  be  spent  at  a  sanatorium  if  possible  and  the  remainder 
of  the  time  in  a  most  carefully  regulated  life  at  home.  Work 
need  not  be  forbidden,  but  riotous  living  and  overwork  should 
be  shunned  if  our  patient  is  not  to  prove  once  more  that  pulmon- 
ary tuberculosis  is  a  disease  of  a  relapsing  nature.  This  I  am 
more  and  more  surely  convinced  is  the  weak  spot  of  the  present 
methods  of  combatting  pulmonary  tuberculosis.  The  care  of 
these  patients  and  getting  suitable  employment  for  them  is  the 
important  work  for  your  anti-tuberculosis  societies.  Take  care 
of  the  returning  patient  and  you  will  greatly  reduce  your  mor- 
tality from  pulmonary  tuberculosis. 

"Advanced  "  cases,  as  you  will  see  from  the  foregoing,  may  be 


242  DIAGNOSIS   AND  TREATMENT  OP  PULMONARY  TUBERCULOSIS 

cases  with  very  slight  pulmonic  and  constitutional  involvement, 
but  who  unfortunately  suffer  from  some  tuberculous  complica- 
tion, such  as  laryngitis,  adenitis,  or  otitis.  This  class  is  a  broad 
one  and  some  include  in  it  cases  in  whom,  without  constitutional 
disturbance,  the  disease  has  advanced  to  cavitation  of  a  limited 
extent.  Many  advanced  cases  do  remarkably  well,  and  compose 
the  larger  number  of  patients.  It  is  difficult  to  subdivide  them 
and  in  regard  to  the  results  obtained  by  treatment  these  cases 
should  be  called  "  questionable.'' 

"  Far  advanced  "  (or  unfavorable)  cases  are  those  with  severe 
constitutional  disturbances,  or  extensive  ulceration  or  fibrosis, 
or  as  usually  happens,  with  both. 

In  classifying  results  five  classes  are  usually  employed,  "  pro- 
gressive or  unimproved.''  "  improved,"  "  arrested,"  "  apparently 
cured,"  and  "  cured."  "  Progressive  or  improved  "  is  self- 
explanatory.  "  Improved  "  should  mean  more  than  the  gain  of 
a  few  pounds  in  weight  and  a  little  tan  on  the  cheek.  To  come 
under  this  class  the  patient  must  have  his  constitutional  symp- 
toms lessened  or  entirely  absent;  his  physical  signs  improved  or 
unchanged.  Cough  and  expectoration  with  bacilli  are  usually 
still  present. 

A  case  is  usually  said  to  be  "  arrested  "  when  all  constitu- 
tional symptoms  have  been  absent  for  two  months.  The  cough 
and  expectoration  with  or  without  bacilli  may  be  present,  and  the 
physical  signs  stationary  or  retrogressive. 

"Apparently  cured "  indicates  those  patients  who  for  three 
months  have  lost  all  constitutional  symptoms  and  bacilli  and  in 
whom  the  physical  signs,  if  present,  indicate  a  healed  lesion. 
When  this  condition  exists  for  a  period  of  two  years  under  the 
ordinary  conditions  of  life,  the  patient  is  said  to  be  "  cured." 

For  some  years  a  vast  literature  has  been  accumulating  in 
regard  to  the  curability  of  consumption  and  the  results  of  the 
sanatorium  treatment.  That  pulmonary  tuberculosis  can  be 
cured  is  an  established  fact,  but  he  who  thinks  he  can  always 
tell  what  case  is  going  to  recover  and  what  case  fail  can  be  sure 
of  but  one  thing,  that  is,  his  percentage  of  error  will  be  large. 
No  one  believes  more  fully  than  I  in  the  curability  of  pulmonary 
tuberculosis,  but  I  must  confess  that  I  can  not  take  the  roseate 
view  of  this  subject  that  some  profess.  One  of  the  leading 
physicians  in  New  York  City  said  to  me  some  time  ago:  "  What 
I  would  like  to  see  you  do  in  Saranac  Lake  is  to  cure  advanced 


LAWRASON  BROWN 


243 


cases.  Anybody  can  cure  an  incipient  case."  So  the  pendulum 
has  swung,  as  it  always  does,  too  far,  and  passed  the  golden 
mean.  It  is  an  easy  thing,  it  is  true,  to  get  many  patients  into 
a  condition  of  perfect  health  as  far  as  outward  conditions  reveal 
it.  But  it  is  another  task  to  get  them  into  such  condition  that 
they  can  maintain  good  health  when  they  return  to  their  old 
employment  as  many  do.  In  other  words,  the  statistics  on  dis- 
charge have  to  be  taken  in  connection  with  the  results  after  a 
few  years,  after  the  inexorable  test  of  time  has  been  applied. 
From  its  opening  in  1885  to  tne  en^  of  1901,  there  were  admitted 
to  the  Adirondack  Cottage  Sanatorium  1,542  patients,  765  males, 
and  777  females.  All  cases  in  which  the  diagnosis  was  doubtful, 
and  all  patients  whose  stay  in  the  sanatorium  was  less  than  a 
month,  have  been  omitted.  In  1902  an  attempt  was  made  to 
find  out  the  condition  at  that  time  of  all  those  who  had  been 
patients,  and  to  establish  a  system  of  following  up  old  patients 
once  a  year  in  future.  This  effort  wras  so  far  successful  that 
in  TQ03,  on  the  anniversary  of  their  respective  discharges. 
1. .157  of  the  1,542  were  traced,  only  385  being  unfound.  Oi 
the  traced  cases  590  (fifty-one  per  cent.)  were  found  to  be  alive 
two  to  eighteen  years  after  discharge.  To  determine  more 
exactly  what  these  figures  meant,  we  compared  according  to  age 
and  sex  the  number  of  patients  wTho  should  be  alive  with  those 
who  were  actually  alive  and  obtained  the  following  results : 

Of  those  discharged  apparently  cured,  ninety- three  per  cent, 
of  the  expected  living  are  alive ;  of  the  disease  arrested,  sixty-five 
per  cent. ;  of  the  cases  discharged  with  active  symptoms,  twenty- 
three  per  cent.  The  death  rate  among  the  apparently  cured 
patients  is  during  the  first  ten  years  about  three  times  the  ordi- 
nary death  rate.  The  death  rate  among  the  patients  discharged 
with  the  disease  arrested  increases  during  the  first  few  years  to 
many  times  (ten  to  fifteen)  times  the  normal  death  rate,  but 
afterwards  decreases.  Nearly  half  of  the  patients  discharged 
with  an  active  disease,  died  in  the  first  two  years.  Patients 
between  thirty  and  forty,  when  discharged  apparently  cured,  seem 
to  relapse  less  than  younger  patients.  This  tendency  is  little  if 
at  all  marked  among  the  patients  discharged  with  the  disease 
arrested.  Incipient  cases  seem  to  relapse  less  than  advanced, 
when  both  were  discharged  in  the  same  condition. 

In  conclusion  I  wish  to  thank  you  for  your  indulgence  and  to 
emphasize  and  to  leave  with  you  several  points :    ( 1 )  Think  no 


244 


MEDICAL  SOCIETY   OF  RENSSELAER  COUNTY 


one  immune  from  tuberculosis.  (2)  Bear  in  mind  that  symp- 
toms may  develop  before  physical  signs  and  physical  signs  before 
symptoms.  (3)  Establish  firmly  the  diagnosis,  but  do  it  in  as 
few  days  as  possible.  (4)  Tell  your  patient  what  is  wrong  with 
him.  (5)  Impress  sufficiently  often  the  dangers  of  over  exercise 
and  the  great  length  of  time  that  must  elapse  before  he  is  secure. 
If  you  will  do  this,  you  will  find,  I  am  sure,  that  in  one  disease 
at  least,  experience  will  be  less  fallacious  and  judgment  less 
difficult. 


HISTORY  OF  THE  MEDICAL  SOCIETY  OF  THE  COUNTY 
OF  RENSSELAER,  NEW  YORK. 

Abstract  of  the  Address  Delivered  at  the  Centennial  Anniversary  of  the 
Society,  at  Troy,  N.  Y.,  February  22,  igo6. 

By  REED  BROCKWAY  BONTECUE,  M.  D  . 

Historian  of  the  Society. 

The  Medical  Society  of  the  County  of  Rensselaer  was  organ- 
ized July  first,  1806,  approximately  three  months  after  the 
enactment  of  an  act  by  the  State  Legislature  "to  incorporate 
medical  societies  for  the  purpose  of  regulating  the  Practice  of 
Physic  and  Surgery  in  this  State,"  passed  on  April  4th,  1806. 

The  records  state  that  "Physicians  and  surgeons  to  the  num- 
ber of  twenty  convened  at  the  Court  House  at  Troy  and  pro- 
ceeded by  ballot  to  elect  their  officers,  who  were  as  follows: 
president,  Benjamin  Woodward;  vice-president,  John  Loudon; 
treasurer,  Samuel  Gale;  secretary,  I.  M.  Wells."  Committees 
were  at  once  formed  to  draft  by-laws,  and  so  briefly  the  society 
came  into  existence. 

The  early  records  Of  the  society  were  completely  destroyed  by 
fire  in  1820,  so  that  nothing  is  known  of  its  proceedings  up  to 
that  time.  The  society  remained  active,  however,  and  mani- 
fested considerable  interest  in  regulating  the  practice  of  medi 
cine.  Thus  in  1825  a  committee  was  formed  to  urge  the  legis- 
lature to  correct  the  present  method  of  granting  degrees  and 
licenses,  and  recommended  that  no  member  of  the  society  should 
recognize  or  hold  intercourse  with  those  not  complying  with 
the  law.  It  decided  that  an  honorary  degree  should  not  entitle 
any  man  to  practice  medicine. 


REED   BROCKWAY  BONTECUE 


In  1839  the  society  resolved  that  the  present  term  of  study 
for  medical  students,  established  by  statute,  was  too  short,  and 
urged  that  it  be  lengthened  one  year.  A  petition  to  legalize 
public  dissection  for  the  teaching  and  study  of  anatomy  was 
circulated  through  the  state  and  was  received  in  Rensselaer 
county  in  1844.  The  petition  received  the  endorsement  of  the 
County  society  and  was  forwarded  to  the  legislature. 

In  1850  the  question  of  preliminary  education  came  up  at 
the  meeting  of  the  State  society,  which  recommended  that  a 
knowledge  of  Latin  and  Greek  should  be  included  in  the  require- 
ments. Subsequently  a  committee  was  formed  in  Rensselaer 
county  to  examine  all  those  commencing  the  study  of  medicine. 

The  code  of  ethics  recommended  by  the  American  Medical 
Association  was  adopted  in  1853  "it  having  been  reported 
that  some  of  the  members  had  been  in  the  habit  of  con- 
sulting with  homeopaths  and  other  quacks  and  calling  them  in 
consultation." 

The  society  in  1874  sent  members  to  confer  with  the  members 
of  the  legislature  from  this  county  and  to  urge  them  to  prevent 
the  repeal  of  the  law  permitting  experiments  on  living  animals 
as  "vivisection  is  indispensable  for  scientific  investigations." 

In  the  early  records  of  the  society  one  reads  numerous  refer- 
ences to  the  Thompsonians  and  homeopaths.  The  practice  of 
the  former  is  termed  in  the  records  "a  form  of  quackery  started 
in  England  by  one  Dr.  Thompson  and  his  followers.  Their 
popularity  was  built  on  the  fact  that  many  people  had  been 
injured  by  mercurial  and  other  metallic  and  mineral  poisons, 
and  they  claimed  to  use  only  remedies  of  a  vegetable  nature, 
such  as  roots  and  herbs."  Dr.  Bontecue  describes  one  of  these 
Thompsonians  who  practiced  in  Troy,  named  Dr.  Coffin,  a  very 
tall,  slim  man  with  a  very  pale  face  and  pale,  high-crowned 
hat  like  that  worn  by  the  cartoons  of  Uncle  Jonathan.  He 
carried  a  huge  cane  with  an  ivory  knob  on  it  and  a  carpet  bag 
for  his  remedies  and  a  big  pewter  syringe.  "I  was  very  ill  at 
the  time  with  scarlet  fever  and  a  big  swelling  in  my  neck,  and 
this  Dr.  Coffin  doctored  me  two  or  three  times  a  day  for  several 
days,  using  each  time  his  big  pewter  syringe  with  hot  butternut 
tea  in  my  bowels.  This  gave  me  such  a  severe  colic  that  my 
parents  became  alarmed  and  changed  for  Dr.  Skilton,  who  came 
and  soon  relieved  me  by  cutting  my  throat." 

Dr  Blatchford,  president  of  the  society  in  1842,  was  a  very 


246  MEDICAL  SOCIETY   OF   RENSSELAER  COUNTY 

aggressive  opponent  of  the  homeopathists,  and  in  his  annual 
address  he  chose  for  his  subject  homeopathy  of  the  present  day. 
He  received  the  thanks  of  the  society  for  this,  and  five  hundred 
copies  were  ordered  printed  for  distribution.  Shortly  after- 
ward he  delivered  a  public  address  at  the  county  court  house 
exposing  the  "absurdities  of  homeopathy." 

In  1850  the  advent  of  cholera  was  discussed  at  a  meeting  of 
the  society,  and  Dr.  Cook  and  Dr.  Bryan  declared  it  could  only 
be  learned  by  a  faithful  study  of  homeopathy,  and  declared 
themselves  firm  believers  in  the  doctrine.  "These  two  mem- 
bers had  been  suspected  of  disloyalty  to  the  regular  profession, 
but  this  public  declaration  was  like  an  explosion  which  startled 
its  members." 

At  the  following  meeting  a  memorial  resolution  in  relation  to 
the  homeopathic  members  was  passed.  The  papers  and  ad- 
dresses delivered  at  the  meetings  were  generally  confined  to  the 
report  of  rare  or  unusual  cases,  or  to  questions  relating  to  pub- 
lic health.  Among  the  unusual  cases  reported  are  a  few  that 
are  very  interesting  and  worthy  of  mention. 

Dr.  Hubbard  cites  a  case  of  an  insane  woman  in  187 1  who 
v.ut  out  two  feet  of  her  transverse  colon  and  lived  for  three 
years  after.  The  intestines  not  having  been  repaired,  the  sinus 
formed  between  the  divided  ends  carried  on  the  function  of  the 
lost  intestine. 

Dr.  Bontecue  describes  an  accident  that  happened  to  Dr. 
Amatus  Robbins  in  which  the  doctor  was  thrown  from  his  sleigh 
and  struck  his  head  against  a  hitching  post  in  such  a  way  that 
"the  entire  scalp  was  torn  clean  from  the  cranium  from  occipital 
to  frontal  bone."  Dr.  B.  writes:  "I  put  him  in  my  sleigh  and 
carried  him  to  his  house  and  replaced  the  scalp  by  a  continu- 
ous suture  reaching  from  ear  to  ear.  He  was  unconscious  dur- 
ing the  operation,  but  soon  revived,  and  recovered  without  any 
suppuration,  the  wound  healing  by  first  intention." 

Dr.  McClellan  reported  and  published  in  the  Medical  and 
Physical  Journal,  Vol.  II,  a  remarkable  case  of  self-performed 
Caesarean  section.  The  case  is  so  unique  that  his  report  is 
given  in  full: 

"In  the  afternoon  of  January  29,  1822,  I  was  called  in  consultation 
with  Dr.  Bassett  of  Nassau  in  the  case  of  a  servant  girl.  I  immediately 
repaired  to  the  house  where  she  was  employed,  and  found  the  patient 
to  be  a  girl  14  years  old,  one  fourth  black;  she  had  a  firm  pulse  and  little 


REED   BROCKWAY  BONTECUE 


247 


or  no  pain.  Dr.  Bassett  told  me  she  had  a  wound  of  the  abdomen  from 
which  he  had  extracted  a  full  grown  foetus  that  was  in  part  protruded 
together  with  a  considerable  portion  of  the  intestines.  The  placenta, 
having  two  umbilical  cords,  he  had  removed  from  the  same  wound,  and 
he  had  introduced  his  hand  to  the  uterus  per  vaginam.  On  examination 
I  found  an  irregular  incision  about  four  inches  in  length,  about  two  inches 
above  the  umbilicus,  and  another  incision  about  two  inches  in  length  at 
nearly  right  angles  to  the  former  towards  the  sternum.  The  lower  part 
of  the  abdomen  was  considerably  distended  with  blood,  and  our  attempts 
were  in  the  first  place  directed  to  the  evacuation  of  the  blood,  which  was 
partly  effected  by  a  change  of  posture  and  slight  compression.  We  then 
brought  the  edges  of  the  wound  together  by  interrupted  sutures,  dressed 
it  with  lint  spread  with  emollient  ointment,  and  secured  the  whole  with 
a  broad  bandage,  and  after  administering  an  anodyne,  left  her  for  the 
night.  I  did  not  see  her  again,  but  the  Doctor  informed  me  that  she 
never  had  any  violent  symptoms.  The  second  day  he  bled  her  and  gave 
a  cathartic  and  pursued  the  antiphlogistic  regimen  a  few  days  when  the 
febrile  excitement  subsided.  An  ordinary  use  of  tonics  was  then  resorted 
to,  and  in  a  few  weeks  the  patient  was  perfectly  recovered. 

"The  circumstances  attendant  on  the  infliction  of  this  wound  were 
these:  While  the  family  were  at  dinner  the  girl  went  about  fifty  rods 
from  the  house,  placed  herself  on  a  snow  drift  near  a  fence,  where  she 
was  first  discovered  by  her  master  in  the  act  of  covering  something  with 
snow,  which  afterward  proved  to  be  a  naked  child.  As  soon  as  she 
perceived  that  she  was  observed,  she  immediately  ran  to  the  house  with 
the  second  child  hanging  out  of  the  wound  together  with  a  considerable 
portion  of  her  intestines.  Lying  beside  her  was  a  razor  and  a  large 
needle,  which  were  the  instruments  she  had  previously  prepared  for  the 
operation.  I  should  judge  from  the  appearance  on  the  snow,  there 
being  several  places  where  she  had  stopped,  that  the  incision  was  made 
immediately  preceding  the  rupture  of  the  membranes,  and  that  the  first 
child  was  delivered  per.vias  naturales,  the  third  pain  after  rupture." 

In  1865  the  society  called  a  special  meeting  to  hear  an  address 
delivered  by  Dr.  Morton,  the  discoverer  of  ether  anaesthesia. 
He  gave  an  interesting  narrative  of  its  first  use  and  the  trouble 
he  had  had  in  introducing  its  use  into  hospitals.  The  Govern- 
ment had  failed  to  grant  him  any  compensation  for  his  work, 
and  the  society  appointed  a  committee  to  arrange  a  plan  for 
assisting  the  Morton  fund. 

Among  the  four  hundred  physicians  who  have  been  members 
of  the  society  are  many  who  acquired  considerable  distinction  in 
the  profession,  and  a  short  biographical  sketch  of  each  one  is 
found  in  the  complete  history  of  the  society.  It  will  be  only 
possible  to  mention  here  a  few  of  those  most  prominent : 

Dr.  Moses  Hals,  one  of  the  earlier  practitioners,  was  better  known 
in  Troy  and  vicinity  than  any  other  physician  of  his  time.    Born  in  1780, 


248  MEDICAL  SOCIETY   OF   RENSSELAER  COUNTY 


he  began  practice  in  1804,  and  did  all  the  surgical  work  in  Troy  up  to 
the  time  of  his  death  in  1837.  He  was  one  of  the  incorporators  of  the 
Troy  Lyceum  of  Natural  History,  the  first  of  its  kind  in  this  country. 
He  also  helped  to  establish  the  Rensselaer  School,  now  the  Rensselaer 
Polytechnic  Institute,  and  was  its  secretary  at  the  time  of  his  death. 

Dr.  Thomas  W.  Blatchford  was  born  in  1794,  and  received  his  medi- 
cal education  at  Guy's  and  St.  Thomas's  Hospitals  in  London.and  at  the 
College  of  Physicians  and  Surgeons  in  New  York.  He  began  his  prac- 
tice in  1828,  and  soon  acquired  a  large  practice.  He  had  the  respect 
and  confidence  of  the  community,  and  held  many  positions  of  trust, 
serving  as  President  of  the  Board  of  Education,  Trustee  of  the  Rensselaer 
Polytechnic  Institute  and  Troy  Female  Seminary.  He  was  elected  and 
held  the  office  of  President  of  the  State  Medical  Society.  He  possessed 
considerable  literary  ability,  and  wrote  several  excellent  essays,  some  of 
which  are  still  in  print.    He  died  in  1866. 

Dr.  Thomas  C.  Brinsmade,  the  son  of  a  prominent  physician  in  Litch- 
field county,  Connecticut,  attended  lectures  at  the  Yale  Medical  School, 
and  was  licensed  to  practice  in  1823.  An  honorary  decree  of  M.  D.  was 
conferred  on  him  by  Yale  College  in  1857.  He  began  his  practice  in 
1832,  and  continued  with  a  success  never  excelled  for  thirty-five  years. 
He  was  elected  President  of  the  State  society  in  1848  and  1849,  anfl  was 
Health  Officer  of  Troy  for  some  years  Later  he  became  President  of 
the  Rensselaer  Polytechnic  Institute,  and  while  addressing  an  audience 
in  behalf  of  the  Institute  in  Athaneum  Hall,  suddenly  died  at  the  age 
of  66.  He  is  described  as  having  a  presence  at  once  pleasing  and  assur- 
ing, and  was  generous  to  a  fault,  giving  for  benevolent  purposes  more 
money  during  his  life  than  he  left  at  his  death. 

Dr.  William  P.  Seymour,  born  at  Troy  in  1825,  received  his  pre- 
liminary training  at  Williams  College  and  his  professional  education  at 
the  University  of  Pennsylvania.  He  began  practice  in  Troy  in  1849. 
When  the  cholera  prevailed  in  New  York  city  he  went  with  Dr.  Bontecue 
to  study  the  disease  in  the  hospitals  and  the  methods  of  treatment  in 
use  there.  He  is  spoken  of  as  a  close  student,  becoming  the  best  read 
and  most  learned  of  the  profession.  He  held  the  Professorship  of  Materia 
Medica  and  Therapeutics  in  Castleton  Medical  College  and  in  the  Berkshire 
Medical  College,  and  was  Professor  of  Gynecology  in  the  Albany  Medical 
College  from  1873  to  1875.  Besides  being  a  member  of  the  State  society 
and  association,  he  was  a  member  of  the  Association  for  the  Advance- 
ment of  Science.  In  many  of  his  views  he  is  said  to  have  been  in  advance 
of  his  profession  by  a  generation.  In  1857,  during  an  attack  of  typhlitis, 
now  known  as  appendicitis,  he  charged  his  physician  to  open  his  abdo- 
men and  remove  the  appendix  should  it  recur.  He  ever  afterward  advo- 
cated this  procedure  in  his  lectures.  He  died  in  1893,  conscious  to  the 
last,  and  when  about  to  take  his  last  breath,  drew  with  his  own  hands 
the  sheet  over  his  head  and  expired  serenely. 

[Dr.  Reed  Brockway  Bontecue,  who  has  so  carefully  prepared  the 
history  of  the  society,  from  which  this  sketch  has  been  drawn,  is  still  an 
active  and  enthusiastic  member  of  the  society  and  its  treasurer  at  the 
present  time.    He  began  the  study  of  medicine  in  1842  under  Dr.  A.  G. 


REED   BROCKWAY  BONTECUE 


249 


Skilton,  Dr.  Thomas  C.  Brinsmade  and  Dr.  John  Wright  in  Troy,  and 
later  attended  lectures  at  the  Medical  Department  of  the  University  of 
the  City  of  New  York  and  at  the  Castleton  Medical  College  in  Vermont, 
receiving  from  this  institution  his  M.  D.  degree  in  1847.  He  made  a 
voyage  up  the  Amazon  river  in  1846  with  Dr.  Brinsmade,  and  explored 
this  region  in  the  interests  of  science  for  more  than  a  year.  He  served 
as  surgeon  during  the  civil  war,  being  present  at  the  fight  between  the 
Monitor  and  Merrimac,  the  capture  of  Yorktown  and  the  ironclad  attack 
on  Fort  Sumter.  He  had  charge  of  the  Hygeia  United  States  General 
Hospital  at  Fortress  Munroe  and  the  Harewood  United  States  General 
Hospital  at  Washington.  At  the  close  of  the  war  he  was  brevetted 
lieutenant -colonel  of  volunteers,  March  13,  1865,  for  faithful  and  meri- 
torious services  during  the  war. 

Dr.  Bontecue  then  returned  to  Troy  and  resumed  his  private  practice. 
He  has  been  a  member  of  this  society  since  1849,  anc*  was  its  President 
in  1 89 1  and  1892.  In  addition  to  being  a  member  of  the  State  medical 
bodies  he  is  a  member  of  the  American  Medical  Association  and  the 
American  Surgical  Association.  In  his  early  practice  his  work  was 
m  ostly  in  general  medicine,  but  later  he  devoted  his  time  more  to  surgery, 
and  for  many  years  was  the  foremost  surgeon  in  Troy.  He  has  contrib- 
uted extensively  to  the  improvement  and  advancement  of  his  pro- 
fession. He  originated  and  practiced  the  application  of  photography 
to  military  surgery,  and  devised  a  provisional  wound  dressing  for  mili- 
tary service  to  be  carried  in  the  soldier's  pocket.  He  was  also  one  of  the 
largest  contributors  to  the  Surgical  History  of  the  War  and  to  the  Army 
Medical  Museum.  In  a  resume  of  the  operations  on  the  larger  joints  in 
the  Transactions  of  the  American  Medical  Association  of  1876,  Dr.  Bonte- 
cue's  work  is  frequently  referred  to.  He  performed  what  is  believed  to 
be  the  first  operation  in  this  country  for  the  repair  of  the  intestine  for 
perforation  in  typhoid  fever.  Dr.  Bontecue  is  still  in  active  practice  in 
Troy,  much  respected  and  revered  by  his  colleagues,  who  recently  ten- 
dered him  a  banquet  in  honor  of  his  fifty-sixth  year  as  a  member  of  the 
county  society.  H.  W.  Carey  ] 

In  looking  back  over  the  lives  of  the  physicians  who  have 
been  prominent  in  the  profession  in  Rensselaer  county,  one  is 
struck  with  the  large  number  of  them  that  were  interested  in 
Natural  History.  Perhaps  the  greater  number  were  interested  in 
Botany  and  Geology.  Dr.  John  Wright  was  Professor  of  Natural 
History  at  the  Rensselaer  Polytechnic  Institute,  Dr.  Skilton  was 
an  enthusiastic  botanist,  and  Dr.  Camp  is  said  to  have  been  as 
familiar  with  the  fauna  of  this  country  as  any  man  of  his  day. 
Many  others  were  botanists,  and  in  seeking  some  explanation 
for  the  popularity  of  this  branch  of  natural  science  it  seems 
probable  that  the  study  of  materia  medica  in  the  early  days 
required  more  intimate  knowledge  of  plants  and  herbs  than  now. 


250         FLAT-FOOT   SERIES   OF  DISABILITIES   OF  THE  FOOT 


Among  the  physicians  who  received  political  distinction  are 
Dr.  James  Thorn  and  Dr.  Alfred  Wotkyns.  Both  were  elected 
and  served  as  Mayor  of  Troy  during  their  period  of  active  prac- 
tice, a  precedent  which  shows  that  in  those  days  the  physician 
was  neither  too  busy  nor  too  indifferent  to  interest  himself  in 
the  government  of  his  community. 


THE  FLAT-FOOT  SERIES  OF  DISABILITIES  AND 
DEFORMITIES  OF  THE  FOOT. 

Read  at  the  January,  1906,  meeting  of  The  Medical  Association  of  Troy 

and  Vicinity. 

By  J.  M.  BERRY,  M.  D.. 
Troy,  N.  Y. 

The  term  "  flat-foot  "  is  often  used  ambiguously,  but  when 
properly  applied  it  signifies  but  one  phase  of  a  progressive  dis- 
ability and  deformity.  At  present  there  is  no  one  term  that  can 
be  employed  to  designate  the  flat-foot  series.  The  various  phases 
are  distinct  and  yet  they  bear  such  a  close  relation,  the  one  to 
the  other,  that  for  a  clear  understanding  they  should  be  studied 
collectively.  Clinically  at  one  end  of  the  series  is  the  disability 
known  as  pronated  foot,  while  at  the  other  end  of  the  series  is 
the  deformity  of  rigid  flat-foot. 

Varieties. 

Numerous  conditions  of  disability  and  deformity  associated 
with  flat-foot  have  been  described  and  considerable  confusion 
has  resulted  from  the  fact  that  different  terms  have  been  em- 
ployed in  describing  the  same  condition.  Following  is  an  incom- 
plete list  of  the  terms  used  to  designate  the  various  phases  of  the 
flat-foot  series.  There  are :  Weak  foot,  splay  foot,  abducted  foot, 
weak  ankle,  knock  ankle,  pes  valgus,  pes  planus,  medio-tarsal 
valgus,  flat-foot,  rigid  flat-foot,  etc.  No  attempt  will  be  made 
to  describe  all  these  varying  conditions  or  to  tell  wherein  they 
differ. 

The  condition  of  true  flat-foot  is  a  deformity.  In  other  words, 
a  condition  of  flat-foot  is  not  reached  until  the  foot  is  actually 
deformed.  There  are  two  main  divisions  of  flat-foot;  the  con- 
genital and  the  acquired.   Congenital  flat-foot  is  in  reality  a  form 


J.   M.  BERRY 


of  club-foot.  Paralytic  flat-foot  and  traumatic  flat-foot  are  in 
classes  by  themselves  and  will  not  be  considered  in  this  paper. 

Preceding  deformity  of  the  foot  there  is  a  weakening  at  the 
ankle  joint  and  the  instep  culminating  in  a  lowering  of  the  arches. 
The  old  term  of  weak  ankles,  used  to  designate  this  condition, 
has  given  place  to  that  of  pronated  foot. 

Following  flat-foot  and  developing  out  of  it  is  a  deformity 
known  as  rigid  flat-foot. 

A  typical  case  may  go  through  a  regular  sequence  of  pronated 
foot,  weakened  arch,  flat-foot  and  rigid  flat-foot.  Mention  should 
be  made  of  the  intimate  association  which  exists  between  Hallux 
valgus,  Monton's  toe  and  flat-foot. 

Consideration  of  the  Foot. 

The  anatomy  of  the  foot  in  its  relation  to  flat-foot  and  the 
study  of  the  various  joints  and  arches  and  their  muscular  and 
ligamentous  supports  is  too  complicated  a  subject  to  be  treated 
in  this  paper.  The  foot  serves  as  a  passive  support  to  the  body 
and  as  an  active  lever  to  raise  and  propel  it:  as  a  consequence 
its  structure  is  such  as  to  adapt  it  for  weight  bearing  and  at  the 
same  time  allow  of  considerable  motion.  Normally  there  is  an 
appreciable  degree  of  voluntary  muscular  control  present  in  the 
foot.  The  effect  of  training  is  shown  in  the  performances  of 
"  armless  wonders."  Bradford  has  written  an  interesting  article 
on  "  The  .  Arboreal  Trails  of  the  Human  Foot,"  in  which  he  dis- 
cusses various  movements  present  and  states  that  in  new  bom 
infants  there  is  a  slight  grasping  action.  As  the  child  grows 
and  the  effect  of  modern  foot  wear  becomes  manifest,  many  of 
the  movements  of  the  foot  are  lost.  Whitman  calls  attention 
to  the  fact  that  changes  of  contour  occur  under  weight  and  use 
and  that  this  is  the  effect  of  normal  motion  in  the  joints  and  not 
overstretching  of  ligaments  and  fascia. 

For  purposes  of  illustration,  the  foot  can  be  considered  as  a 
mechanism :  part  of  the  mechanism  of  the  body,  which  under 
certain  conditions  is  best  adapted  for  work  and  when  these  con- 
ditions are  not  present  or  are  altered  the  mechanism  suffers  and 
its  work  is  interfered  with. 

Etiology. 

The  conditions  of  pronated  foot  and  flat-foot  are  two  of  the 
most  common  afflictions  of  modern  times.    The  sale  of  flat-foot 


252         FLAT-FOOT   SERIBS   OF  DISABILITIES   OF  THE  FOOT 

braces  in  all  drug  stores,  shoe  stores,  leather  stores,  etc.,  is  an 
excellent  index  of  the  prevalence  of  this  trouble.  All  ages  are 
affected,  but  it  is  more  common  at  puberty  and  in  later  life  when 
all  the  bodily  activities  are  on  the  decline.  The  female  sex  is 
more  affected  than  the  male.  Lovett  in  an  observation  of  500 
nurses  found  that  sixty-four  per  cent,  of  flat-foot  cases  appeared 
in  the  months  of  February,  March,  April  and  May. 

As  has  been  stated  the  foot  can  be  considered  as  a  mechanism 
and  therefore  anything  that  will  impair  the  working  of  the 
machine  is  detrimental.  The  mechanical  factors  acting  on  the 
foot  in  the  production  of  flat  foot  can  be  described  as  follows: 

1.  A  disproportion  between  the  strength  of  the  machine  and 
the  work  it  is  called  upon  to  do. 

2.  Weakness  in  the  machine. 

3.  Defective  support  to  the  machine  disarranging  its  adjust- 
ment and  so  interfering  with  its  work. 

A  disproportion  between  the  strength  of  the  machine  and  the 
work  it  is  called  upon  to  do  is  equivalent  to  increase  in  weight 
in  the  individual  or  excessive  use  of  the  feet.  Weakness  in  the 
machine  is  equivalent  to  rheumatism,  gout,  rachitis,  wasting  dis- 
ease and  general  muscular  weakness  to  which  may  be  added 
trauma.  Defective  support  to  the  machine  is  equivalent  to  im- 
proper shoes. 

In  many  ways  the  last  factor,  that  of  improper  shoes,  is  the 
most  important.  Improper  shoes  alone  are  responsible  for  large 
numbers  of  flat-foot  cases  and  in  those  cases  where  an  excessive 
amount  of  work  is  demanded  of  the  foot  as  well  as  in  the  cases 
where  the  foot  becomes  weakened  by  rheumatism,  gout,  etc.,  the 
added  factor  of  improper  shoes  turns  the  scale  and  flat-foot 
trouble  begins.  An  improper  shoe  by  supporting  the  foot  in  a 
faulty  attitude  makes  impossible  its  best  use  and  causes  the  foot 
to  be  acting  always  under  a  strain. 

In  order  that  the  least  amount  of  strain  and  the  greatest  amount 
of  strength  may  be  present  in  the  foot  there  are  certain  normal 
positions  for  rest  and  activity.  Whitman  calls  attention  to  the 
passive  attitude  of  the  foot,  the  chief  characteristic  of  which  is  an 
outward  rotation.  "  This  attitude  enlarges  the  base,  locks  the 
joints  and  throws  the  strain  upon  ligaments  to  relieve  muscles. 
The  attitude,  normal  when  the  foot  is  used  as  a  passive  support, 
is  abnormal  when  it  is  in  active  use  in  that  the  strain  falls  upon 
the  inner  border  of  the  foot  or  to  the  inner  side  of  the  fulcrum 


J.  M.  BERRY 


253 


and  makes  the  proper  exercise  of  muscular  power  and  alteration 
of  posture  impossible." 

There  is  a  tendency  among  orthopaedic  surgeons  to  advise 
against  the  passive  attitude  even  during  rest.  Taylor,  in  dis- 
cussing foot  postures,  states  that  structurally  man  was  made  to 
go  and  he  stands  still  only  at  his  peril.  Movements  are  pre- 
ponderantly antero-posterior  and  the  joints  and  muscles  work 
best  in  or  near  the  anterior-posterior  plane.  "  The  child,  the 
youth  and  the  soldier  should  be  plainly  told  that  straight  foot 
standing  and  walking  are  strong,  natural  and  correct,  the  everted 
foot,  weak,  inefficient  and  degenerate."  It  is  interesting  to  note 
that  the  best  sculptors  both  ancient  and  modern  depict  the  active 
or  working  foot  in  the  strong  position. 

Quoting  from  Whitman :  "When  the  foot  is  used  as  a  lever 
it  should  be  held  in  such  relation  to  the  leg  that  the  line  of  weight, 
passing  downward  through  the  center  of  the  knee  and  ankle  joint 
is  continued  over  the  second  toe  or  practically  the  center  of  the 
foot."  The  calf  muscles  are  the  power,  the  foot  is  the  lever  and 
the  distal  end  of  the  metatarsals  is  the  fulcrum  over  which  the 
body  weight  is  lifted.  "  As  the  body  is  lifted  over  the  fulcrum 
the  leg  is  turned  outward  in  its  relation  to  the  fore  foot  because 
the  inner  side  of  the  fulcrum  formed  by  the  first  metatarsal  bone 
is  longer  than  its  outer  side,  thus  the  strain  is  directed  toward 
the  outer  and  stronger  side  of  the  foot." 

In  walking,  the  weight  of  the  body  is  thrown  forward  at  each 
step  and  the  position  of  greatest  strength  is  secured  when  the  feet 
are  held  in  a  line  with  the  direction  of  body  weight  and  progres- 
sion, i.  e.,  straight  ahead  and  parallel.  If  the  feet  are  so  held  then 
when  the  body  is  lifted  up  on  the  toes  and  let  fall  the  rising  and 
falling  are  in  the  line  that  the  body  wants  to  go  and  the  line  of 
body  weight  falls  over  the  center  of  the  foot.  If,  however,  the 
feet  are  turned  out  in  walking,  then  the  line  of  body  weight  falls 
inside  the  foot,  more  weight  is  thrown  on  the  heel,  the  spring  is 
lost  from  the  step  and  what  is  known  as  the  "  pedistal  walk  "  re- 
sults. 

Bradford  describes  the  normal  walk  as  follows :  "  In  the 
normal  step  the  foot  is  brought  forward  striking  the  ground  at 
the  heel,  weight  is  then  thrown  normally  upon  the  outer  edge  of 
the  foot  and  is  later  brought  upon  the  ball  of  the  foot  from  the 
outer  to  the  inner  portion,  when  the  head  of  the  first  metatarsal 
and  great  toe  are  brought  to  the  ground.   The  body  is  then  poised 


354         FLAT-POOT   SERIES   OF   DISABILITIES   OF  THE  FOOT 

with  the  weight  upon  the  ground  the  toes  being  brought  to  the 
ground.  The  other  foot  is  then  brought  forward  and  as  weight 
is  brought  upon  that  the  push  comes  from  the  rear  foot,  the  heel 
being  raised  and  the  front  of  the  foot  and  the  toes  exerting  pres- 
sure to  propel  the  body  forward.  If  the  moving  foot  is  brought 
forward  in  the  line  of  motion,  the  strain  at  the  medio-tarsal 
articulation  will  be  small.  If,  however,  the  foot  when  brought 
forward  is  turned  out  greater  strain  will  be  brought  on  the  inner 
portion  when  the  foot  is  placed  upon  the  ground." 

The  effect  of  abduction  of  the  foot  has  been  well  demonstrated 
by  Sampson.  He  has  shown  that  abduction  tends  to  lower  and 
weaken  the  inner  longitudinal  arch,  while  adduction  raises  and 
strengthens  it.  The  effect  of  abduction  on  standing  and  walking 
can  be  shown  by  a  model.    (See  figure  I  and  2.) 

The  practical  application  of  the  above  mentioned  foot  postures 
is  found  in  the  use  of  shoes.  The  usual  modern  or  improper  shoe 
tends  to  make  the  foot  during  use  assume  what  Whitman  has 
called  the  passive  attitude.  It  does  not  allow  of  the  normal  walk 
as  described  by  Bradford,  and  it  holds  the  foot  in  an  abducted 
position  as  demonstrated  by  Sampson.  The  result  is  that  the  foot 
is  continually  working  under  a  disadvantage  and  a  strain,  and 
sooner  or  later  shows  a  weakening  and  breaking  down. 

Pathology. 

It  is  not  until  the  later  stages  of  trouble  that  structural  changes 
take  place.  At  first  there  are  simply  changes  in  contour  of  the 
foot  and  changes  in  the  relation  of  the  bones.  Lovett  and  Cotton 
define  pronated  foot  as  "  That  vicious  attitude  of  the  foot  in 
which  in  habitual  standing  position  it  rolls  over  inward,  the 
inner  malleolus  projects  and  abduction  of  the  front  part  of  the 
foot  occurs."  (An  exaggerated  or  faulty  use  of  the  "  Passive 
Attitude.") 

The  Astragulus  is  the  keystone  of  the  inner  arch  of  the  foot. 
In  flat-foot  it  is  dislocated  forward,  downward  and  inward.  The 
scaphoid  is  popped  outward  and  the  foot  is  abducted  and  everted. 
The  middle  cuneiform  slips  downward,  the  internal  cuneiform 
inward  and  pressure  on  the  plantar  vessels  and  nerves  causes 
oedema  and  pain. 

The  structural  changes  which  occur  include:  weak  and  dis- 
tended ligaments,  denudation  of  cartilage  from  exposed  articular 
surfaces,  formation  of  new  articular  facets,  thickened  periostem 


J.   M.  BERRY 


255 


and  the  formation  of  osteophytes;  the  internal  structure  ©f  the 
bones  becomes  changed  in  the  later  stages  and  there  may  be 
marked  muscular  atrophy. 


A.  K 


Fig.  i  Fig.  2 

Fig.  i.  Model  of  the  foot  made  from  spring  brass.  The  model  is  made  up  of  four  piece* 
designated  A.  B.  C.  and  D. 

A.  represents  the  os  calcis, 

B.  represents  the  astragalus, 

C.  represents  the  cuboid  and  4th  and  5th  metatarsal  bones. 

D.  represents  the  navicular,  cuneiforms  and  1st,  .2nd  and  3rd  metatarsal  bones. 
Adduction  and  abduction  of  the  foot  take  place  at  the  articulations  between  the  os  calcis 

and  cuboid  and  between  the  astragalus  and  navicular,  the  part  of  the  foot  in  front  of  these 
joints  moving  as  a  whole.  In  the  model  the  astragalus  (B)  is  firmly  fastened  to  the  os 
calcis  (A).  The  articulations  between  the  os  calcis  and  cuboid  and  between  the  astragalus 
and  navicular  are  made  by  means  of  the  rivets  E.  and  F. 

The  front  part  of  the  foot  is  made  to!move  as  a  whole  by  fastening  C.  and  D.  together 
at  H.  The  line  L.  M.  represents  the  line  of  body  weight  in  the  normal  foot.  Note  that  it 
falls  over  the  2nd  metatarsal.    Note  the  height  of  the  inner  longitudinal  arch. 

Fig .  2.  Same  as  Fig.  1  only  abducted.  Note  that  the  line  of  body  weight  now  fall6  to 
the  inner  side  of  the  foot  and  note  the  lowering  of  the  inner  longitudinal  arch.  The  raising 
of  the  inner  longitudinal  arch  by  adducting  the  foot  can  be  readily  shown  on  the  same  model. 


256      flat-foot  series  of  disabilities  of  the  foot 

Symptoms. 

The  numerous  symptoms  which  may  appear  during  the  various 
phases  of  the  flat-foot  series  have  facetiously  been  compared  in 
number  and  variety  to  those  produced  by  the  "  Boston  eye  strain." 
All  sorts  of  symptoms  are  described,  varying  from  a  simple  feel- 
ing of  discomfort  in  the  feet  to  herpes  progenitalia  and  pain  in 
the  pubic  region  described  by  Ehrmann. 

The  symptoms  vary,  depending  upon  the  degree  of  advance- 
ment of  the  trouble,  but  there  is  no  certain  relation  between  the 
degree  of  deformity  and  the  severity  of  the  symptoms. 

As  a  rule  in  the  earliest  stages  there  is  a  loss  of  elasticity  in 
the  walk;  there  is  no  longer  any  pleasure  in  walking.  Not  only 
do  the  feet  feel  tired,  but  there  is  a  general  tired  feeling  and  loss 
of  ambition.  Irritability  of  temper  is  a  marked  characteristic  in 
cases  of  well  developed  weak  feet.  As  the  trouble  advances  pain 
is  present  in  varying  degrees  of  severity.  Wet  weather  seems  to 
aggrevate  the  condition  and  there  may  be  periods  of  relief  or  the 
trouble  may  shift  from  one  foot  to  the  other.  Every  step  is  now 
painful.  The  patient  walks  with  a  limp  and  a  rough  or  uneven 
pavement  so  aggrevates  the  trouble  as  to  make  walking  almost 
impossible.  Pain  may  be  referred  to  the  calf  of  the  leg,  to  the 
knee,  thigh  or  back.  The  patient  frequently  runs  the  rounds  of 
treatment  for  rheumatism,  gout,  arthritis,  etc.,  and  even  neuras- 
thenia. Thompson  gives  a  graphic  description  of  a  characteristic 
case.  The  patient  has  gone  through  a  course  of  antirheumatic 
remedies,  liniments,  lotions,  baths,  electricity,  etc.,  possible,  he  has 
had  rheumatism  and  it  has  all  gone  except  in  the  feet.  The 
patient  rises  in  the  morning  and  it  takes  five  or  ten  minutes  to 
get  used  to  standing  on  the  feet ;  he  works  all  day  in  discomfort, 
and  rushes  home  at  night  to  get  his  shoes  off.  In  bed  the  patient 
frequently  cannot  get  to  sleep  on  account  of  pain  and  discomfort. 
I  have  seen  patients  that  said  they  could  not  bear  the  weight  of 
the  bed  clothes  on  the  feet. 

As  the  flat-foot  condition  advances  muscle  spasm  appears ; 
the  foot  may  be  reddened,  swollen  and  oedematous  and  the  diag- 
nosis of  tuberculosis  is  quite  frequently  made.  Structural  changes 
occur  and  the  conditions  may  pass  on  into  that  of  rigid  flat-foot. 

Examination. 

For  a  thorough  examination  the  shoes  and  stockings  should  of 
course  be  removed.   One  of  the  first  things  to  be  observed  is  the 


J.  If.  BERRY 


257 


walk.  The  characteristic  walks  are  the  outward  rotation  of  the 
feet  and  rolling  in  of  the  ankle  in  pronated  foot ;  the  painful  limp 
of  weakened  arch  and  flat-foot  and  the  stilt-like  walk  of  rigid 
flat-foot. 

The  appearance  of  the  foot  varies  from  that  condition  seen  in 
congenital  flat-foot  where  figuratively  speaking  "  the  hollow  of 
the  foot  makes  a  hole  in  the  ground,"  to  a  condition  where,  on 
inspection,  the  foot  is  apparently  normal  and  the  diagnosis  is 
made  from  the  history  alone. 

Imprints  of  the  foot  on  smoked  paper,  etc.,  are  worthless  in 
determining  the  degree  of  trouble.  (See  Plate  I.)  Pronation  of 
the  foot  is  a  most  important  symptom  to  be  observed.  Whitman 
describes  it  as  a  shifting  downward  and  inward  of  the  bones  of 
the  leg  from  off  the  os  calcis,  together  with  a  turning  outward  of 
the  foot.  The  foot  should  be  carefully  tested  for  limitation  of 
motion  and  for  muscle  spasm. 

Diagnosis. 

Diagnosis  is  usually  easy,  especially  if  a  careful  examination 
of  the  foot  is  made.  The  idea  that  the  weakened  and  painful  foot 
must  be  associated  with  obliteration  of  the  arches  is,  of  course, 
erroneous. 

A  differential  diagnosis  has  to  be  made  from  rheumatism, 
gout,  arthritis,  ostitis,  metatarsalgia,  periostitis,  etc.  The  most 
common  error  in  diagnosis  is  that  of  mistaking  the  weakened  foot 
for  rheumatism.  The  shifting  of  the  trouble  from  one  foot  to 
the  other  and  the  exacerbations  during  the  wet  weather  tend  to 
confirm  the  diagnosis  of  rheumatism.  Oftentimes  a  well-fitting 
felt  pad  applied  under  the  arch  will  clear  up  the  diagnosis  at  once. 

Treatment. 

The  treatment  varies  with  the  conditions  of  advancement  of 
the  trouble  and  with  the  severity  of  the  symptoms.  In  some 
cases  the  foot  may  be  rescued  by  simply  directing  its  proper  use; 
instructing  the  patient  to  use  the  heel-toe  walk,  holding  the  feet 
parallel.  Other  cases  may  require  simply  a  pad  under  the  arch 
or  a  raising  of  the  inner  side  of  the  sole  of  the  shoe.  Still  other 
cases  may  require  a  special  shoe,  while  the  most  advanced  cases 
may  require  severe  operative  interference. 

The  thing  to  be  aimed  at  is  a  rational  treatment.  For  prac- 
tical purposes  flat-foot  can  be  considered  as  a  dislocation  of  slow 


258    6    FLAT-FOOT  SERIES  OF  DISABILITIES   OF  THE  FOOT 

development.  We  are  taught  to  reduce  dislocations  along  the 
same  lines  that  they  are  produced  and  the  same  rule  can  be  ap- 
plied in  the  treatment  of  flat  or  weakened  feet. 

Consider  for  example  that  we  are  dealing  with  a  case  of 
genuine  flat-foot.  The  first  thing  to  be  done  is  to  reduce  the  dis- 
location and  restore  the  foot  to  its  normal  contour.  Thompson 
gives  the  following  method  of  reduction,  which  sometimes  has 
to  be  done  under  an  anaesthetic : 

1.  Extend  sharply  on  tarsus  (increasing  the  space  between 
internal  cuneiform  and  astragulus). 

2.  Forcibly  invert  and  adduct,  and  flex  again  to  900,  main- 
taining the  adducted  and  inverted  positions.  (This  will  bring 
the  scaphoid  back  into  place.) 

Following  the  reduction,  the  foot  is  held  in  proper  position  by 
means  of  adhesive  strapping,  or  in  the  severe  cases  by  a  plaster 
of  paris  dressing.  I  cannot  speak  too  highly  of  the  adhesive 
strapping  combined  with  a  felt  pad  in  the  instep  for  the  ordinary 
cases  of  painful  weakened  foot.  A  patient  that  has  suffered  for 
months  may  be  almost  completely  relieved  from  pain  in  as  many 
hours. 

The  effect  of  the  adhesive  strapping  or  plaster  paris  dressing 
is  to  relieve  the  muscle  spasm,  and  to  stop  at  this  point  is  use- 
less if  a  cure  is  desired.  The  poor  circulation  of  the  foot  must 
be  restored  by  alternate  hot  and  cold  douching.  The  weakened 
and  overstretched  muscles  and  ligaments  must  be  strengthened 
by  massage  and  carefully  regulated  gymnastics.  An  excellent 
gymnastic  exercise  to  correct  the  tendency  to  pronation  is  to 
have  the  patient  walk  along  two  boards  set  up  at  an  angle  of 
i6o°-i65°. 

The  treatment  of  flat-foot  is  popularly  associated  with  the  use 
of  a  support  or  brace.  The  supports  and  braces  in  use  vary  from 
a  simple  pad  of  felt  placed  beneath  the  arch  to  a  complicated  con- 
structed apparatus  surrounding  the  foot  and  extending  up  the 
leg.  Townsend  has  written  an  excellent  article  on  "  The  Abuse 
of  Fiat-Foot  Supports."  He  calls  attention  to  the  fact  that  when 
flat-foot  does  exist  it  does  not  necessarily  follow  that  a  brace 
should  be  used.  Slight  degrees  of  trouble  may  not  need  a  sup- 
port, while  severe  degrees  may  require  operative  interference. 
Extreme  spasm,  deformity  or  an  inflammatory  condition  are  con- 
traindications for  the  use  of  a  brace.  One  would  as  soon  think 
of  treating  a  case  of  rigid  flat-foot  with  a  brace  as  of  putting  a 


To  Illustrate  Dr.  Berry's  Article  on  "The  Flat- Foot  Series  on  Disabilities  and 
Deformities  of  the  Foot." 

Albany  Medical  Annals,  April,  igo6 


Plate  I 

Foot  imprints  of  six  cases  are  shown  illustrating  three  types  of  feet.  The  first  two  im- 
prints A.  and  B.  are  "island"  imprints. 
Imprint  A.  is  from  a  foot  without  pain. 
Imprint  B.  is  from  a  very  painful  foot. 
Imprints  C.  and  D.  represent  a  second  type  of  foot. 
Imprint  C.  is  from  a  foot  without  pain. 

Imprint  D.  is  from  a  painful  foot.   

Imprints  E.  and  F.  represent  a  third  type  of  foot  in  which  there  is  almoBt  complete 
obliteration  of  the  longitudinal  arches  under  weight  bearing. 
Imprint  E.  is  from  a  foot  without  pain. 
Imprint  F.  is  from  a  painful  foot. 


J.   M.  BERRY 


259 


dislocated  shoulder  in  splints  without  first  reducing  the  dis- 
location.   Different  cases  require  different  treatment. 

Quoting  from  Townsend's  article :  "  The  valgus  or  abduc- 
tion must  be  overcome,  the  weakened  structures  must  be  strength- 
ened, the  free  and  normal  motion  of  the  foot  must  be  restored, 
the  deformity  overcome,  the  patient  made  to  walk  as  patients 
with  normal  feet  should  walk,  and  the  application  of  a  support 
simply  intended  to  push  up  a  weakened  arch  can  never  accom- 
plish this.  Temporary  relief  may  be  obtained,  but  not  a  cure, 
when  a  true  and  severe  case  of  flat-foot  exists.  Perfect  reduc- 
tion of  a  deformity  may  be  gained  by  the  use  of  a  support,  and 
by  not  strengthening  the  muscles  and  cultivating  normal  move- 


Fig.  3.  A.  represents  the  supporting  part  or  brace  proper  which  is  moulded  to  fit  the  arch 
of  the  foot. 

B.    is  the  base  piece  supporting  the  brace  and  holding  it  in  the  shoe. 
The  head  C.  fits  into  the  slot  D. 
Fig.  4.    The  brace  ready  for  use. 


ments  the  foot  may  be  still  farther  weakened  rather  than  im- 
proved. By  the  use  of  an  improper  brace  what  is  not  a  flat-foot 
may  be  made  one.  It  follows,  therefore,  that  the  routine  practice 
of  patients  treating  themselves  or  being  treated  by  ready-made 
supports  should  be  discouraged." 

The  use  of  plates  is  to  apply  corrective  force  with  the  body 
weight  acting  as  a  counterforce.  The  brace  or  plate  should 
interfere  as  little  as  possible  with  the  normal  motion  of  the  foot. 
The  fault  with  a  great  many  braces  is  that  they  splint  the  foot. 
Athletes  training  for  a  boat  race  do  not  put  their  arms  in  splints 


360        PLAT-FOOT  SERIES  OF  DISABILITIES  OF  THE  FOOT 


and  stay  in  bed.  (Figures  3  and  4  are  sketches  of  a  brace  whick 
I  have  found  very  useful  in  the  treatment  of  weakened  feet.) 

In  the  treatment  of  flat  or  weakened  foot  a  proper  support  may 
be  applied  and  all  benefit  lost  by  an  improper  shoe.  As  a  prophy- 
lactic measure  and  as  an  aid  to  cure  the  most  important  thera- 
peutic agent  is  a  proper  shoe.  No  sane  physician  would  think  of 
treating  a  patient  for  the  effects  of  tight  lacing  and  allow  the 
tight  lacing  to  continue ;  and  yet  time  and  again  when  a  weakened 
condition  of  the  foot  is  caused  or  is  kept  up  by  improper  shoes  no 
attempt  is  made  to  correct  them.  I  wish  to  mention  a  last  devised 
by  Dr.  Sampson.  In  a  later  article  I  hope  to  give  an  explanation 
of  the  improved  features  of  this  last  over  that  of  the  ordinary 
commercial  last.  Suffice  it  to  say  that  it  is  a  last  for  the  in- 
dividual foot  and  that  it  allows  the  foot  to  adduct  sufficiently  to 
bring  all  parts  into  their  proper  relations  when  the  foot  is  called 
upon  to  perform  its  function. 

A  brief  summary  of  treatment  is  as  follows :  Reduction  of  the 
dislocation.  Retentive  splinting  to  relieve  the  pain  and  muscle 
spasm.  Hot  and  cold  douching  to  restore  the  vascular  and 
nervous  tone.  Massage  and  gymnastics  to  strengthen  the  weak- 
ened muscles  and  ligaments.  Instruction  in  the  proper  use  of  the 
feet.  The  use  of  a  proper  brace  which  will  act  as  a  support  but 
yet  allow  of  freedom  of  movement  and  so  not  splint  the  foot. 
And  then  in  order  that  all  of  these  measures  may  have  their  full 
benefit,  that  the  foot  may  act  in  a  normal  way  such  that  every 
step  instead  of  being  a  strain  is  a  stimulus  to  strengthen  the  last 
and  most  important  treatment  is  a  proper  shoe. 


BIBLIOGRAPHY. 


Bradford.  Journal  of  Medical  Research,  May,  1902. 

American  Journal  of  Orthopaedic  Surgery,  April,  1905. 

Ehrmann.  Wiener  klin.  Woch.  No.  34. 

Lovktt.  American  Journal  of  Orthopaedic  Surgery,  Aug.,  1903. 

Taylor.  American  Journal  of  Orthopaedic  Surgery,  July,  1905. 

Townsbnd.  American  Journal  of  Orthopaedic  Surgery,  Aug.,  1903. 

Thompson.  New  York  Medical  Journal,  Jan.  17,  1903. 

Whitman.  Orthopaedic  Surgery,  (Text  Book) 

Sampson.  American  Medicine,  Jan.  18,  1909. 

Lovitt  and  Cotton.    Transactions  American  Orthopaedic  Association,  Vol.  xi. 


EDITORIAL 


26l 


EMtortal 

It  is  perfectly  certain  that  all  diseases  without 
ixception  are  preventable;  or,  if  not  so,  that  they 
can  be  so  weakened  as  to  do  no  harm.  It  is  per- 
fectly certain  that  all  accidents  are  preventable;  there 
is  not  one  that  does  not  arise  from  folly  or  negligence. 
All  accidents  are  crimes.  It  is  perfectly  certain  that 
all  human  beings  are  capable  of  physical  happiness. 
It  is  absolutely  incontrovertible  that  the  ideal  shape 
of  the  human  being  is  attainable  to  the  exclusion 
of  deformities.  It  is  incontrovertible  that  there  is 
no  necessity  for  any  man  to  die  but  of  old  age;  and 
that  if  death  cannot  be  prevented,  life  can  be  pro- 
longed far  beyond  the  farthest  now  known. 
The  Story  of  My  Heart.  Richard  Jefferies. 


On  February  twenty-second  last,  the  physicians 
of  Rensselaer  county  celebrated  the  centennial  an- 
T*C  ^nte^nial  niversary  of  the  organization  of  their  society.  In 
at  Troy  tne  afternoon  addresses  were  given  in  the  hall  of  the 
Young  Men's  Christian  Association,  as  follows: 

"The  Early  Diagnosis  and  Treatment  of  Pulmonary  Tuber- 
culosis," by  Dr.  Lawrason  Brown,  Saranac  Lake  Cottage  Sana- 
tarium,  Saranac  Lake,  N.  Y. ; 

"The  Pathogenic  Protozoa,"  with  Lantern  Slide  Exhibition, 
by  Dr.  Richard  M.  Pearce,  Director  of  the  Bender  Hygienic 
Laboratory,  Albany,  N.  Y. ; 

u  A  Discussion  of  Some  of  the  Immediate  and  Some,  of  the  Late 
Consequences  of  Cranial  Injuries  and  their  Treatment,"  by  Dr. 
Harvey  Cushing,  Associate  Professor  of  Surgeiy,  Johns  Hopkins- 
Medical  School,  Baltimore,  Md. 

In  the  evening  the  centennial  banquet  was  held  at  the  Troy- 
Club.  Remarks  weie  made  by  prominent  citizens  of  Troy,  by 
Dr.  William  M.  Polk,  of  New  York,  and  a  history  of  the  medical 
profession  of  Rensselaer  county  was  presented  by  the  modern 
Hector,  Dr.  Bontecue,  who,  like  the  hero  of  the  ancient  city,  may 
be  said  to  be  "not  only  the  bravest  and  most  powerful,  but  also 
the  most  amiable,  of  his  countrymen." 

It  has  been  the  purpose  and  the  desire  of  the  Annals  to 
present  a  memorial  number  of  this  celebration,  that  the  achieve- 
ment and  progress  of  which  it  was  the  token  might  have  perma- 


262 


EDITORIAL 


nent  record.  Unfortunately,  the  addresses  are  not  all  available 
for  publication.  Dr.  Brown's  paper  only  was  written  ready  for 
reproduction.  Dr.  Pearce's  lantern  slide  exhibition  cannot  be 
placed  in  type,  and  Dr.  Cushing's  address  was  not  delivered 
from  manuscript.  The  Annals,  however,  takes  the  opportunity 
to  demonstrate  its  respect  for  the  colleagues  of  the  sister  citv. 
Fortunately,  there  is  at  hand  a  paper  which  may  be  taken 
to  represent  the  profession  of  that  city,  and  in  this  issue  are 
published  the  contribution  by  Dr.  Berry,  a  member  of  the  Medical 
Society  of  the  County  of  Rensselaer,  and  also  an  abstract  of  the 
historical  sketch  prepared  by  Dr.  Bontecue. 

It  is  with  great  satisfaction,  then,  that  the  Annals  dedicates 
this  issue  to  the  physicians,  past,  present  and  future,  of  Troy. 

+        •£  + 

It  has  been  the  pleasure  of  the  Annals  each 
The  Albany   vear  to  announce  the  work  and  the  growth  of  this 
Guild       remarkable  charity,  and  the  Annual  Report,  just 
issued,  justifies  again  reference  to  the  progress 
and  to  the  record  of  achievement.    Faith  in  a  local  institution 
is  now  justified  by  a  reputation  which  bids  fair  to  be  national. 
In  the  Spring  of  1905  the  chairman  of  the  National  Committee 
of  Visiting  Nursing  sent  blanks  for  information  to  all  associa- 
tions and  corporations  in  the  United  States  doing  district 
nursing,  and,  in  due  time,  informed  the  Guild  that  its  work  was 
found  to  be  "the  broadest  and  most  unique  in  the  whole  country." 
As  a  result  the  Guild  was  invited  to  representation  in  the  National 
Conference  of  Charities  and  Corrections,  and  the  head  nurse, 
sent  as  delegate  to  Portland  last  Summer,  adds  an  interesting 
report  to  those  of  which  this  volume  is  made. 

The  activity  of  the  Guild  is  revealed  in  the  great  number  of 
facts  of  the  Annual  Report,  which  requires  seventy-eight  pages, 
whereas  in  1897  fifteen  pages  were  sufficient.  Each  additional 
page  is  the  record  of  some  good  to  humanity.  From  a  small  group 
of  ladies,  well  intentioned  and  energetic,  who  personally  carried 
delicacies  to  the  sick  poor,  the  Guild  has  developed  into  a  strong 
organization  to  provide  nursing  and  care  for  the  poor  when  sick, 
to  teach  them  how  to  avoid  sickness  when  well,  and,  under  its 
later  regulations,  to  extend  its  help  to  those  in  better  circum- 
stances to  whom  sickness  comes  as  a  calamity  and  whose  re- 
sources are  thus  jeopardized. 


EDITORIAL 


263 


The  organization  of  the  Guild  comprises  a  Board  of  Managers, 
with  Standing  Committees,  an  Advisory  Board,  upon  which  are 
always  two  physicians,  a  Dental  Department,  a  Special  Obstetri- 
cal Department,  a  Diet  Kitchen  Department  and  a  Lecture 
Course  for  Nurses  in  the  employ  of  the  Guild.  Five  graduate 
nurses  are  employed  by  the  Guild.  These  nurses  answer  all  calls 
for  their  services.  There  are  also  six  assistant  nurses,  who  are 
in  training,  and  at  the  end  of  a  two  and  a  half  year  course  receive 
a  certificate  from  the  Guild  which  places  them  at  once  in  good 
standing  in  the  communtiy.  The  lecture  course  is  a  necessary- 
aid  to  this  training,  but  takes  quite  a  subordinate  place,  and  the 
certificate  of  these  nurses  is  recognized  as  representing  experience 
and  work.  As  in  all  of  the  affairs  of  the  Guild  reputation  has 
been  based  upon  acts  rather  than  words. 

The  Special  Obstetrical  Department  continues  in  active  work. 
Fifty-seven  cases  were  attended  during  the  year,  and  thirty -three 
medical  students  were  given  the  opportunity  for  practical  train- 
ing.   Obstetrical  clinics  have  also  been  held  at  the  Guild  House. 

For  the  many  other  instructive  details  readers  of  the  Annals 
are  referred  to  the  report.  The  Annals  only  wishes  physicians 
and  the  community  to  know  what  an  exceptional  and  vigorous 
aid  they  have  at  hand  with  which  to  meet  and  combat  the 
emergencies  and  the  distresses  of  life. 

4*  4*  4* 
On  Monday  afternoon,  March  twelfth,  the  new 
The  Contagious  Pavilion  G  of  the  Albany  Hospital  was  opened  to 
Hospital  the  public  for  inspection,  prior  to  the  reception  of 
patients.  On  the  following  day  the  first  patient,  a 
child  with  scarlet  fever,  was  admitted,  and  the  work  of  this  new 
department  thus  inaugurated.  For  several  years  the  need  of  an 
institution  for  the  care  of  contagious  diseases  has  been  agitated, 
and  after  the  city  authorities  decided  to  add  this  department  to 
the  Albany  Hospital,  considerable  delay  occurred  before  its  final 
assumption  of  work.  It  is  now  believed  that  many  of  the  hard- 
ships incident  upon  the  presence  of  contagious  diseases  in  the 
household  may  be  obviated,  that  quarantine  regulations  may  be 
carried  out,  and  that  the  spread  of  epidemics  prevented,  or  at 
least  in  some  measure  controlled.  Dr.  Arthur  Sautter,  deputy 
health  officer  of  the  city,  has  been  appointed  attending  specialist 
in  contagious  diseases  to  the  Hospital,  and  will  have  care  of  the 
new  pavilion. 


264  LITTLE  BIOGRAPHIES 

The  structure  is  two-story  and  basement,  but  only  the  base- 
ment and  first  story  are  completed.  The  upper  floor  is  so  arranged 
that  it  may  be  turned  into  wards  within  a  very  short  time.  It 
is  intended  to  use  this  floor  as  an  emergency  plant. 

The  basement  contains  the  caretakers'  quarters,  the  nurses' 
apartments,  orderlies'  rooms,  kitchen,  laundry,  sterilizing  room, 
morgue,  etc.  The  main  floor  is  arranged  for  the  physician's 
office,  bath  rooms,  parlors,  four  wards,  private  rooms,  sterilizing 
and  warming  equipments,  etc.  Each  ward  is  provided  with  food- 
warming  apparatus,  sterilizer,  bath  rooms,  medicine  cases  and 
every  convenience,  so  that  it  is  complete -in  itself,  and  all  wards 
are  isolated  and  independent.  There  are  bath  rooms  for  con- 
Talescent  patients,  and  lockers  for  sterilized  apparel  in  readiness 
for  use  on  discharge.  The  building  is  heated  by  the  same  system 
as  the  main  hospital,  and  everything  is  constructed  with  a  view 
to  its  sanitary  and  hygienic  needs. 

Patients  with  contagious  diseases  are  admitted  to  the  hospital 
either  upon  order  of  the  health  officer  or  a  reputable  physician. 
Public  or  charity  cases  are  committed  by  the  health  officer  and 
private  cases  by  the  patient's  physician.  The  discharges  are 
upon  order  of  the  health  officer  after  the  usual  quarantine. 

This  addition  adds  to  the  perfection  of  the  Albany  Hospital. 
In  fact,  there  are  few  hospitals  in  the  country  with  so  generous 
provision  for  all  classes  of  disease.  The  work  of  the  new  pavilion 
will  be  watched  with  interest,  and  much  may  be  expected  from 
the  perfection  of  its  construction  and  the  ideal  plan  of  organiza- 
tion and  administration. 

Xittle  Blograpbies 

IV.  VALSALVA. 

ANTONIO  MARIA  VALSALVA  was  born  of  noble 
parentage  at  Imola,  Italy,  February  15,  1666.  His 
early  education  was  obtained  under  the  tutelage  of 
the  Jesuits,  and  from  the  first  he  showed  an  extreme 
aptitude  for  anatomy.  The  major  part  of  his  education  was 
carried  on  at  that  early  center  for  anatomical  and  medical 
research,  the  University  of  Bologna,  where  he  first  devoted 
himself  to  mathematics,  philosophy  and  botany,  and  later  took 
up  the  study  of  medicine,  paying  especial  attention  to  anat- 


LITTLE  BIOGRAPHIES 


a65 


omy.  He  was  a  student  of  the  famous  Malpighi,  but  as  the 
latter  was  not  able  to  give  him  all  the  instruction  he  wanted, 
he  worked  also  under  other  scholars  at  the  University.  He 
obtained  his  Doctor's  degree  in  1687,  Dut  continued  to  prose- 
cute his  anatomical  studies  with  great  diligence,  remaining 
in  Bologna  for  the  purpose.  His  work  was  done  upon  both 
cadavers,  and  living  animals  in  disease  and  health,  and  in  the 
year  of  his  graduation  he  successfully  removed  a  kidney  from 
a  dog  without  causing  the  subsequent  death  or  ill-health  of  the 
animal.  It  is  also  related  of  him,  as  showing  his  enthusiasm 
for  his  work,  that  he  caused  the  body  of  a  person  who  died 
of  some  unusual  malady  to  be  disinterred  in  midsummer,  that 
he  might  investigate  for  himself  the  conditions  present.  Such 
studies  affected  his  none-too-robust  health  (he  is  said  to  have 
had  phthisis),  and  though  his  friends  were  much  concerned 
about  him  he  paid  little  attention  to  their  solicitations ;  in 
this  he  was  apparently  justified  by  later  events,  as  his  death 
did  not  occur  until  February  2,  1723,  when  he  died  of  apoplexy 
at  the  age  of  fifty-seven. 

At  the  age  of  thirty-one  he  was  appointed  Professor  of 
Anatomy  in  his  Alma  Mater,  the  worthy  successor  of  Mun- 
dinus,  Arantius,  Varoli  and  his  master,  Malpighi.  He  prac- 
tised medicine,  however,  during  his  occupancy  of  this  chair, 
and  at  about  the  same  time  was  made  Surgeon  to  the  Hos- 
pital for  Incurables,  a  position  he  held  for  a  period  of  twenty- 
five  years,  or  until  his  death. 

During  his  services  at  this  hospital-  he  introduced  into  gen- 
eral usage  the  practice  of  ligaturing  severed  vessels,  and 
abolished  the  previous  haemostatic  use  of  the  actual  cautery. 
He  was  not  the  originator  of  the  use  of  ligatures,  a  practice 
first  devised  by  Ambrose  Pare  in  France  about  the  middle  of 
the  sixteenth  century,  and  later  highly  recommended  in  Italy 
by  other  surgeons,  but  he  it  was  who  revived  the  neglected 
and  almost  forgotten  method.  Valsalva  also  simplified  and 
improved  the  surgical  instruments  then  in  current  use.  How- 
ever, it  is  as  an  anatomist,  not  as  a  surgeon,  that  his  name  has 
come  down  to  us  as  one  of  the  foremost  men  of  his  time.  The 
chair  of  anatomy  at  Bologna  was  reserved  under  the  terms 
of  its  foundation  for  natives  of  the  city,  though  this  rule 
might  be  excepted  in  the  case  of  a  foreigner  whose  singular 
talents  merited  the  appointment.    That  the  governors  of  the 


266 


LITTLE  BIOGRAPHIES 


university  judged  rightly  in  considering  that  in  his  case  an 
exception  to  this  rule  should  be  made  was  amply  proven  by 
later  events. 

Valsalva's  main  work  was  upon  the  human  ear.  Upon  this, 
which  may  be  truly  said  to  have  been  his  life  work,  he  devoted 
himself  for  sixteen  years,  during  which  time  he  dissected 
more  than  one  thousand  heads.  The  results  of  this  work 
was  first  published  in  Bologna  in  1704  under  the  title  "  De 
aure  humana  tractatus  in  quo  integra  ejusdem  auris  fabrica, 
multis  novis  inventis  et  iconismis  illustrata,  describitur ;  omni- 
umque  ejus  partium  usus  indagatur,"  etc.  A  second  edition 
was  published  in  Utrecht  in  1707  and  a  third  in  Geneva  in 
1716.  A  collected  edition  of  all  his  works  was  published  in 
Venice  in  1740,  under  the  supervision  of  his  pupil,  Morgagni, 
to  which  was  added  a  life  of  Valsalva  by  Morgagni  and  three 
dissertations  which  the  former  had  presented  to  the  Academy 
of  Medicine  of  Bologna.  The  first  of  these  dissertations  was 
upon  the  colon,  the  aorta,  the  accessory  nerves  (of  the  eighth 
pair)  and  the  eyes ;  the  second  also  concerned  the  eyes,  and 
the  third  and  last  the  excretory  ducts  of  the  adrenals. 

The  main  part  of  the  work  was  in  two  subdivisions ;  the 
first  dealt  principally  with  the  anatomy  of  the  ear,  and  the  sec- 
ond with  the  physiology  of  its  component  parts,  together  with 
a  brief  account  of  the  chief  diseases  which  affect  this  organ. 
There  is  not  space  here  to  speak  in  detail  of  the  various  dis- 
coveries made  by  this  great  anatomst,  and  the  principal  ones 
only  will  be  mentioned.  He  demonstrated  the  anterior  and 
superior  auricular,  the  tragicus  and  antitragicus  muscles,  as 
well  as  several  muscles  of  the  pharynx.  He  described  several 
previously  unknown  features  of  the  middle  ear,  the  ossicles, 
the  cochlea  and  Eustachian  tube.  He  showed  the  true  loca- 
tion of  the  tensor  tympani  muscle  and  demonstrated  that 
deafness  might  be  caused  by  a  blocking  of  the  Eustachian  tube 
or  by  impaction  of  cerumen  in  the  external  auditory  canal. 
Several  cases  of  deafness  from  the  latter  cause  he  cured,  with 
much  consequent  renown  to  himself.  He  clearly  showed  the 
relationship  between  hemiplegia  and  lesions  of  the  cerebral 
cortex. 

In  his  dissertations  he  described  the  so-called  ligaments 
of  the  colon,  and  the  sinuses  of  the  aorta  which  bear  his  name. 
He  also  described  a  fourth  sinus  at  the  level  of  the  transverse 


SCIENTIFIC  REVIEW 


267 


aorta  near  the  origin  of  the  left  subclavian  artery,  a  point 
frequently  the  site  of  aneurysms.  He  clearly  understood  the 
cause  of  cataracts,  but  that  all  of  his  observations  were  not 
correct  may  be  seen  from  his  statement  that  the  intrinsic 
muscles  of  the  eye  had  tfyeir  origin  upon  the  dura  mater  and 
that  it  was  his  belief  that  in  glaucoma  the  crystalline  lens 
was  yellow.  He  considered  that  the  adrenals  had  an  import- 
ant part  in  the  generation  of  species  and  described  excretory 
ducts  passing  from  them  and  ending  in  the  ovary  in  the  female 
and  in  the  testis  in  the  male.  Portal  states  that  Valsalva  dis- 
sected the  cadaver  of  a  man  who  had  but  one  kidney  and  a 
dog  who  had  no  spleen,  but  adds,  "  nevertheless  these  obser- 
vations ought  to  be  confirmed  before  being  accepted." 

Not  the  least  of  Valsalva's  work  was  his  power  and  influ- 
ence as  a  teacher.  His  most  famous  pupil  was  Morgagni, 
afterward  Professor  of  Anatomy  at  Padua.  It  is  said  that  his 
influence  as  a  teacher  was  so  great  that  many  individuals  who 
came  to  him  in  the  capacity  of  servants  later  became  his  students 

Charles  K.  Winne.  Jr. 

REFERENCES. 

M.  Portal.  Histoire  de  L'Anatoniie  et  de  la  Chirurgie,  Paris,  1-70,  Toine  w, 

p.  322. 

Benj.  Hutchinson.    Biographica  Medica,  London,  1799,  Vol.  ii,  p.  466. 
(MlCHAUD).  Biographie  Universelle,  Paris,  1842-1865,  Tome,  xlii,  p.  533. 

HlRST-GURLT.  Biographisches  Lexicon  d,  hervorragenden  Aerzte.    Wien  u. 

Leipzig,  1888,  Bd.  vi,  s.  63. 


Scientific  1Rev>iew 

SOME  RECENT  REPORTS  UPON  THE  TOXAEMIAS  OF 

PREGNANCY. 

I.    The  Pathological  Anatomy  and  Pathogenesis  of  the 
Toxaemia  of  Pregnancy. 

James  Ewing.  The  American  Journal  of  Obstetrics.  1905,  LI, 
pp.  145-155. 

In  this  communication,  read  before  the  New  York  Obstet- 
rical Society  (date  not  given),  the  author  described  the  hepatic 
lesions  of  the  three  clinical  manifestations  of  the  toxaemia  of 


268 


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pregnancy,  viz.,  eclampsia,  acute  yellow  atrophy  and  pernicious 
vomiting,  in  connection  with  a  short  clinical  description  of  cases 
and  followed  by  remarks  on  the  pathogenesis  of  these  lesions. 

In  three  cases,  clinically  diagnosed  as  eclampsia,  and  dying 
from  this  condition  the  following  changes  were  found  in  the 
liver:  (i)  the  hemorrhagic  hepatitis  so  frequently  found  in 
these  cases;  (2)  acute  yellow  atrophy;  (3)  a  liver  without  strik- 
ing gross  changes,  but  only  microscopic  lesions,  which,  however, 
prove  to  be  those  of  the  very  significant  process  of  autolysis  of 
the  liver  cells. 

Three  cases,  selected  from  other  clinically  diagnosed  as 
vomiting  of  pregnancy,  showed  that  this  disease,  when  fatal, 
may  be  associated  (1)  with  acute  yellow  atrophy  of  the  liver  or 
(2)  with  the  same  necrotic  process  in  a  liver  which  is  not 
reduced  in  size  or  (3)  with  less  marked  degenerative  changes 
in  the  liver  which  might  be  overlooked  or  ignored,  but  which 
really  indicate  extensive  autolysis  and  profound  disturbance 
of  the  function  of  the  organ. 

The  hepatic  lesions,  in  the  three  fatal  cases  of  pernicious 
vomiting,  were  identical  with  those  found  in  the  last  two  cases 
of  eclampsia  and  in  one  of  the  cases  of  pernicious  vomiting,  a 
distinctly  atrophic  liver  was  found. 

As  a  result  of  these  studies  the  writer  states  "  that  the  mor- 
bid process  in  eclampsia,  acute  yellow  atrophy,  and  pernicious 
romiting  is  one  and  the  same.  This  conclusion  is,  of  course, 
not  new,  but  merely  a  verification  as  regards  eclampsia  and 
acute  yellow  atrophy,  of  the  statement  of  Klebs,  made  in  1888, 
and  of  the  recent  statement  of  Stone  (American  Gynecology, 
Vol.  II,  ipoj),  regarding  the  identity  of  all  three  manifesta- 
tions of  the  toxaemia  of  pregnancy." 

The  writer  reports  a  case  of  post-gestational  acute  yellow 
atrophy  and  also  the  autopsy  findings  in  two  cases  of  acute 
myelocytic  leukaemia  following  pregnancy,  in  both  of  which 
changes  in  the  liver  were  found,  in  the  first  those  of  acute 
yellow  atrophy  and  in  the  second  a  diffuse  granular,  hydropic 
and  fatty  degeneration. 

In  considering  the  relation  between  the  mild  and  severe 
cases  of  vomit? ng  of  pregnancy,  the  writer  says:  "  No  one 
doubts  that  the  mild  and  the  fatal  cases  of  eclampsia  are 
identical  in  nature,  but  there  persists  a  definite  impression 
in  some  quarters  that  acute  yellow  atrophy  never  occurs  in 


SCIBNTIFIC  RBVIBW 


269 


mild  form,  but  is  always  fatal,  while  it  is  still  generally  taught 
that  the  mild  vomiting  of  pregnancy  is  '  physiological '  and 
that  the  severe  vomiting  is  an  exaggerated  form  of  the  other, 
but  without  definite  pathological  basis.  Impressed  by  the 
supposed  rarity  and  unfavorable  prognosis  of  acute  yellow 
atrophy,  clinicians  seldom  attempt  the  diagnosis  of  this  dis- 
ease, hence  only  the  fatal  cases  are  commonly  recognized. 
But  recent  study  of  the  toxaemia  of  pregnancy  and  of  many 
other  clinical  conditions  furnishes  abundant  evidence  that  the 
morbid  process  in  acute  yellow  atrophy  is  of  very  frequent 
occurrence  and  is  often  followed  by  recovery." 

"  On  both  clinical  and  pathological  grounds  there  is  just  as 
little  reason  for  separating  the  mild  and  fatal  cases  of  vomit- 
ing of  pregnancy  as  for  denying  the  identity  of  mild  and 
severe  cases  of  diabetes.  Vomiting  is  seldom  the  only  symp- 
tom present  in  early  cases  of  vomiting  of  pregnancy,  but 
observation  usually  shows  also  striking  mental  symptoms, 
headache,  hysterical  tendencies,  pruritus,  constipation,  lassi- 
tude, etc.,  all  of  which  doubtless  result  from  the  mild  auto- 
intoxication which  is  the  cause  of  the  vomiting.  No  one  may 
claim  that  whenever  a  pregnant  woman  vomits  she  is  suffer- 
ing from  auto-intoxication ;  there  are  many  causes  of  vomit- 
ing, and  the  pregnant  woman  may  be  alcoholic  or  have  a 
brain  tumor,  but  the  characteristic  vomiting  of  pregnancy  is  a 
perfectly  definite  clinical  entity,  which  progresses  from  mild 
to  severe  stages  and  types,  and  after  death  there  is  a  very 
definite  lesion  in  the  liver.  This  lesion  is  attended  with  a 
disturbance  of  nitrogenous  metabolism  and  the  failure  of 
urea  formation,  and  is  marked  by  the  appearance  in  the  urine 
of  many  unoxidized  proteid  derivatives.  This  same  disturb- 
ance of  nitrogenous  metabolism  is  present  in  cases  of  vomit- 
ing of  pregnancy  which  are  not  fatal,  and  the  unoxidized 
proteid  derivatives  appear  in  the  urine  of  many  of  such  cases/' 

Ewing  classifies  the  toxaemia  of  pregnancy  as  "  a  func- 
tional disturbance  of  the  liver,  usually  but  not  necessarily 
attended  by  severe  anatomical  lesions  of  this  organ,  and  sec- 
ondarily with  functional  disturbance  and  anatomical  lesions 
of  the  kidneys  and  other  organs.  The  ground  for  regarding 
this  disease  as  primary  in  the  liver  is  the  fact  that  the  syn- 
thesis or  urea  is  exclusively  a  function  of  the  liver."  The 
interference  with  this  function  is  indicated  by  the  toxaemia 


270 


SCIENTIFIC  REVIEW 


resulting  from  the  presence  in  the  blood  of  those  proteid 
derivatives  in  a  poisonous  form,  which  are  normally  combined 
by  the  liver  into  urea  and  are  to  some  extent  excreted  in  the 
urine,  as  shown  by  the  presence  of  leucin  and  tyrosin  in  many 
of  the  cases.  "  Disturbance  of  the  kidney  doubtless  exists 
from  the  first,  but  only  becomes  pronounced  when  the  poisons 
resulting  from  the  failure  of  oxidation  in  the  liver  causes 
degeneration,  congestion  and  exudative  inflammation  of  these 
organs.  Therefore,  the  disease  may  be  far  advanced  before 
albuminuria  appears." 

The  functional  disturbance  of  the  liver  precedes  the  anatomical 
lesions,  hence  it  is  that  the  intensity  of  the  disease  does  not  vary 
with  the  severity  of  the  anatomical  lesions,  for  fatal  cases  may- 
occur  with  minimal  lesions  of  the  liver. 

The  writer  considers  that  many  factors  may  be  concerned 
in  the  disturbance  nitrogenous  metabolism  and  that  "  it  is 
not  necessary  to  fully  explain  the  ultimate  origin  of  the  toxaemia 
before  recognizing  its  existence  and  practical  importance." 

II.    Pernicious  Vomiting  of  Pregnancy. 

J.  W.  Williams.    Surgery,  Gynecology  and  Obstetrics,  1905,  I, 
41-45;  Zentralblatt  fur  Gynakologie,  1905  XXIX,  949-955. 

In  May.  1903,  the  writer  lost  a  patient  at  the  third  month  of 
pregnancy,  "  four  days  after  the  induction  of  abortion,  which 
was  undertaken  with  a  pulse  of  eighty  and  appeared  to  give 
every  promise  of  a  satisfactory  outcome.  Immediately  after 
the  operation  the  vomiting  ceased  and  the  patient  was  per- 
fectly comfortable  for  eighteen  hours,  after  which  she  began 
to  vomit  again  and  soon  was  almost  incessantly  expelling 
small  quantities  of  a  brownish  coffee  ground  like  material 
without  apparent  effort.  She  rapidly  passed  into  a  torpid 
condition  and  was  absolutely  unconscious  for  the  last  twelve 
hours  of  life." 

At  autopsy  there  were  found  in  the  liver  and  kidneys  the 
lesions  characteristic  of  acute  yellow  atrophy  of  the  liver. 

During  the  following  year  the  writer  saw  five  other  cases 
of  pernicious  vomiting,  in  all  of  which  the  pregnancy  was 
terminated.  Two  of  these  five  cases  died  with  the  jaundice 
and  diminution  in  the  size  of  the  liver  characteristic  of  acute 


SCIENTIFIC  REVIEW 


271 


yellow  atrophy,  thus  giving  a  mortality  of  fifty  per  cent  for  the 
six  cases. 

The  writer  has  carefully  studied  a  number  of  other  cases  and 
as  a  result  of  his  studies  on  the  subject  arrives  at  the  follow- 
ing general  conclusions : 

Excluding  all  cases  in  which  the  vomiting  results  from 
lesions  outside  of  the  generative  tract,  and  having  no  essen- 
tial connection  with  pregnancy,  and  which  should  be  regarded 
merely  as  accidental  complications,  he  considers  that  the 
evidence  at  present  available  justifies  one  in  dividing  the  cases 
of  serious  vomiting  of  pregnancy  into  the  following  groups : 

(I)  Reflex. 

(II)  Neurotic. 

(III)  Toxaemia. 

(I)  Reflex  vomiting  of  pregnancy.  This  variety  of  vomiting 
may  be  due  to  the  presence  of  abnormalities  of  the  generative 
tract  or  ovum,  which  existed  prior  to  the  onset  of  pregnancy, 
or  are  coincident  with  it.  Among  such  conditons  may  be 
mentioned : 

(a)  displacements  of  the  uterus,  particularly  retro- 
flexions, 

(b)  ovarian  tumors, 

(c)  certain  cases  of  endometritis, 

(d)  abnormalities  of  the  ovum,  such  as  hydatiform  mole, 
hydramnios  and  certain  cases  of  twin-pregnancy. 

(II)  Neurotic  vomiting.  This  group  of  cases  can  only  be 
explained  by  the  fact  that  cases  are  cured  by  suggestion,  rest 
and  by  employment  of  absolutely  worthless  remedies. 

(III)  Toxaemic  vomiting.  All  sorts  of  theories  have  been 
advanced  concerning  the  origin  and  nature  of  the  toxic  material 
giving  rise  to  this  condition,  among  which  may  be  mentioned : 

(a)  secretion  of  corpus  luteum. 

(b)  secretion  of  ovary, 

(c)  absorption  from  intestines, 

(d)  hepato-toxaemia  (Pinard  and  BoufYe  de  St.  Blaise), 

(e)  invasion  of  maternal  organism  by  fcetal  elements,  the 
syncyto-toxin  theory  of  Veit,  Behm  and  others, 

(f)  its  identity  with  eclampsia  on  the  one  hand  and  acute 
yellow  atrophy  on  the  other  (Champetier  de  Ribes  and 
BoufTe  de  St.  Blaise,  Stone,  Ewing  and  Edgar). 

The  writer  concludes  that  "  in  some  cases  of  pernicious 


272 


SCIENTIFIC  REVIEW 


vomiting  we  have  to  deal  with  a  toxaemia  which  gives  rise 
to  serious  lesions  in  the  liver  and  later  in  the  kidneys,  and 
that  the  latter  are  secondary  in  character,  as  is  indicated  by 
the  fact  that  the  urine  does  not  contain  albumin  until  shortly 
before  death."  Associated  with  these  lesions  is  a  striking 
change  in  metabolism,  which  is  manifested  by  a  marked  in- 
crease in  the  percentage  of  nitrogen  put  out  as  ammonia 
compared  with  the  total  nitrogen  of  the  urine,  so  that  the 
former,  instead  of  being  three  to  five  per  cent,  as  normal, 
may  rise  to  sixteen,  thirty-two  or  even  forty-six  per  cent,  as 
occurred  in  several  of  his  cases.  "  Whether  this  increased 
ammonia  coefficient  is  due  to  the  fact  that  the  marked  destruc- 
tion of  liver  tissue  interferes  with  the  normal  oxidation  of 
nitrogenous  material,  so  that  large  amounts  escape  conver- 
sion into  urea,  and  are  therefore  excreted  in  a  less  highly 
oxidized  form,  as  ammonia,  or  whether  it  merely  represents 
an  attempt  to  neutralize  an  excessive  production  of  acid — a 
so-called  acid  intoxication — is  as  yet  undecided."  Williams' 
experience  has  taught  him  that  a  marked  increase  in  the 
ammonia  coefficient  (*.  e.,  ten  per  cent  or  over)  in  a  woman 
suffering  from  pernicious  vomiting  indicates  the  existence  of 
a  serious  toxaemia,  which,  if  allowed  to  continue,  will  be 
found  to  be  accompanied  by  lesions  of  the  liver  and  other 
organs,  inconsistent  with  life.  Accordingly,  under  such  cir- 
cumstances, abortion  should  be  induced  as  soon  as  the  con- 
dition is  detected. 

"  On  the  other  hand,  in  the  reflex  and  neurotic  forms  of 
vomiting  the  ammonia  output  remains  normal  and  accord-^ 
ingly  the  determination  of  the  ammonia  coefficient  affords  not 
only  a  means  of  diagnosis  between  the  neurotic  and  toxaemic 
varieties  of  vomiting,  but  is  a  most  valuable  guide  as  to  treat- 
ment." 

Williams  agrees  with  Stone  and  Ewing  as  to  the  anatomical 
lesions  found  in  certain  cases  of  vomiting  of  pregnancy,  but 
does  not  support  them  in  the  view  that  the  toxaemic  vomiting, 
acute  yellow  atrophy  and  eclampsia  are  manifestations  of  one 
and  the  same  toxaemia.  He  thinks  that  there  are  at  least  two 
toxaemias  of  pregnancy,  and  probably  more,  one  giving  rise 
to  the  vomiting  of  pregnancy  and  acute  yellow  atrophy,  and 
the  other  to  eclampsia. 

In  support  of  the  above  he  gives  the  following  arguments : 


SCIENTIFIC  REVIEW 


'73 


(I)  That  while  neurotic  lesions  in  the  liver  occur  in  both 
conditions,  they  differ  from  each  other. 

(II)  In  most  cases  of  eclampsia  and  pre-eclamptic  toxaemia 
there  are  marked  signs  of  involvement  of  the  kidneys  and 
general  circulation,  as  manifested  by  scanty  urine  in  propor- 
tion to  the  intake  of  fluid,  the  early  appearance  of  pronounced 
albuminuria  and  the  presence  of  casts  and  oedema.  In  vomit- 
ing, on  the  other  hand,  the  urinary  output  is  diminished  only 
as  the  intake  of  fluids  is  interfered  with,  and  albumin  and 
casts  are  present  only  in  the  last  days  or  hours  of  life,  while 
oedema  is  absent. 

(III)  Chemical  analysis  of  the  urine  shows  that  the  total 
amount  of  nitrogen  is  greatly  diminished  in  eclampsia,  while 
the  ammonia  coefficient  remains  practically  normal.  In  vomit- 
ing, on  the  contrary,  in  spite  of  the  scanty  amount  of  urine, 
the  amount  of  total  nitrogen  remains  approximately  normal, 
while  the  ammonia  coefficient  is  wonderfully  elevated.  "  Gen- 
erally speaking,  it  may  be  said  that  a  high  ammonia  output  is 
a  favorable  prognostic  sign  in  eclampsia,  and  a  very  ominous 
one  in  vomiting." 

III.  Toxaemia  of  Pregnancy  with  Vomiting;  its  Toxic 
Manifestations,  its  Relation  to  Eclamptic  Toxaemia, 
Acute  Yellow  Atrophy  and  Experimental  Necrosis  of 
the  Liver. 

Ellice  McDonald.  The  American  Journal  of  Obstetrics,  1905, 
LII,  pp.  321-339. 

The  writer  reviews  the  literature  on  this  subject  in  order  to 
show  "(1)  the  identity  of  the  liver  lesions  of  toxaemia  of 
pregnancy  with  vomiting  and  eclamptic  toxaemia,  and  for  the 
comparison  of  these  lesions  with  those  of  experimental  liver 
necrosis ;  (2)  the  frequency  with  which  acute  yellow  atrophy 
occurs,  and  (3)  the  presence  of  more  marked  toxic  symptoms." 

In  addition  he  reports  a  case  with  the  following  diagnosis — 
"  Toxaemia  of  pregnancy  with  vomiting.  Acute  yellow  atrophy 
of  the  liver.  Mild  bronchitis.  Puerperal  neuritis.  Retained 
secundines."  The  patient  was  a  primipara,  36  years  old.  Vom- 
iting began  when  two  months  pregnant  and  persisted  for  the 
following  month,  but  a  physician  was  not  consulted  until  the 
fourth  month.    He  treated  the  patient  with  rectal  feeding, 


274 


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cocaine  by  the  mouth  and  after  several  days  curetted  her  and 
supposed  that  he  had  emptied  the  uterus.  Eight  days  after  the 
curettage  the  writer  took  charge  of  the  case,  owing  to  the  de- 
parture of  the  physician  from  town.  At  that  time  the  vomiting 
was  persistent.  There  was  slight  jaundice,  temperature  was  990 
and  pulse  140.  Heart  showed  the  signs  of  mitral  stenosis. 
Urine  contained  albumen,  granular  and  hyaline  casts,  and 
leucin  and  tryosin.  The  uterus  was  soft,  the  size  of  a  two 
months'  pregnancy  and  retroverted.  The  jaundice  disap- 
peared at  the  end  of  the  third  week,  and  while  the  vomiting 
was  much  less  it  still  continued  in  a  mild  form  until  after  the 
removal  of  the  placenta,  six  and  a  half  weeks  after  the  first 
curettage.  Neuritis  developed  in  the  sixth  week  and  at  the 
end  of  that  week  the  patient's  temperature  rose  to  1040.  On 
vaginal  examination,  placental  masses  were  felt  within  the  cervix. 
Under  ether  anaesthesia  the  cervix  was  dilated,  the  placental 
tissue  removed,  and  the  uterus  curetted.  Convalescence  was 
slow  and  twelve  months  afterward  the  patient  had  not  entirely 
recovered  complete  power  in  her  legs.  The  chief  interest  in 
the  case  lies  in  the  similarity  of  its  clinical  history  with  other 
cases  review  by  the  writer,  in  which  the  post-mortem  reports 
showed  acute  yellow  atrophy  and  also  in  the  fact  that  the  vomit- 
ing persisted  more  or  less  until  the  removal  of  the  placenta,  six 
and  one-half  weeks  after  the  escape  of  the  foetus. 

After  reviewing  the  literature  of  experimental  liver  necroses 
and  comparing  the  liver  lesions  thus  formed  with  those  found 
in  the  livers  removed  at  autopsy  from  patients  dying  from  the 
toxaemias  of  pregnancy,  the  writer  concludes  that  "  there  is 
evidence,  therefore,  that,  in  the  toxaemia  of  pregnancy,  an 
agglutinative  substance  occurs  in  the  blood  and  that  this,  by 
causing  the  clumping  of  red  cells,  leads  to  the  occurrence  of 
liver  necrosis.  It  is  possible  that  there  may  be,  in  addition, 
haemolytic  and  other  toxic  substances."  Dienst's  experiments 
have  added  additional  argument  to  the  above  hypothesis  by  ob- 
taining the  haemagglutinin  reaction  in  vitro,  from  the  blood  of 
eclamptics.  Dienst  obtained  blood  from  the  umbilical  stump  and 
from  the  placental  end  of  the  cord  at  the  time  of  labor  and  deter- 
mined the  action  of  these.  The  permeability  of  the  expelled 
placenta  was  tested  by  the  injection  of  milk  and  that  of  the 
placenta  in  situ  by  injecting  methylene  blue.  He  concludes  that 
eclamptic  toxaemia  is  due  to  agglutination  and  haemolysis  and 


SCIENTIFIC  REVIEW 


that  this  can  only  occur  when  there  is  a  free  communication 
between  mother  and  child.  Dienst's  supposition  that  the  haem- 
agglutinin  is  formed  in  the  foetus  is  weakened  by  Hitschmann's 
case  of  eclamptic  toxaemia,  occurring  in  connection  with  a  four 
and  one-half  months'  hydatiform  mole  and  by  Benin's  case  and 
the  one  reported  by  the  writer,  in  both  of  which  symptoms  of 
toxaemia  persisted  after  the  expulsion  of  the  foetus  and  until 
the  removal  of  the  placental  remains. 

IV.    Hyperemesis  Gravidarum. 

(A  Reply  to  a  Similar  Aricle  by  J.  W.  Willams  in  the  Zentral- 
blatt  fur  Gynaekologie,  XXIX,  949-955.) 

Dirmoser.    Zentralblatt  fiir  Gynakologie,  1905,  XXIX,  1256- 
1260. 

Dirmoser  calls  attention  to  the  fact  that  in  recent  years  the 
number  of  the  authors  who  look  upon  the  pernicious  vomiting 
of  pregnancy  as  an  auto-intoxication  has  increased.  He  reviews 
the  development  of  the  auto-intoxication  theory  both  along  patho- 
logical and  clinical  lines.  He  refers  to  one  of  his  own  cases  in 
which  eclampsia  occurred  as  a  complication  of  pernicious  vomit- 
ing at  the  end  of  the  third  month,  a  complication  which  has  also 
recently  been  brought  forward  by  the  French  writers.  In  this 
case  acetone  was  found  in  large  quantities. 

Dirmoser  does  not  think  that  the  source  of  the  intoxication  is 
in  the  ovum  but  rather  in  the  intestines,  and  that  these  are  re- 
flexly  affected  by  the  ovum  so  that  poisonous  substances  are 
absorbed,  which  are  responsible  for  the  toxic  manifestations  of 
the  disease. 

He  criticises  the  importance  placed  by  Williams  on  the  in- 
creased amount  of  ammonia  excreted  in  the  urine,  as  an  aid  in 
the  diagnosis  of  pernicious  vomiting  and  also  for  prognostic 
purposes,  for  it  may  also  be  found  increased  in  eclampsia.  In 
both  eclampsia  and  vomiting  it  is  indicative  of  disturbed  liver 
function. 

He  also  takes  exception  to  the  statement  of  Williams  that  in 
the  cases  of  toxaemic  vomiting  the  urine  does  not  contain  albu- 
men until  shortly  before  death,  for  albumen  may  be  absent  in 
eclampsia  and  present  in  cases  of  pernicious  vomiting. 


6 


276 


SCIENTIFIC  REVIEW 


Remarks. 

A  review  of  the  above  articles  and  also  of  similar  ones  on  the 
disturbances  associated  with  and  caused  by  pregnancy,  impresses 
one  with  the  fact  that  these  disturbances  may  be  of  a  very  serious 
nature,  and  that  it  may  be  necessary  to  terminate  the  pregnancy 
in  order  to  save  the  mother,  and  that  even  after  this  has  been 
done,  the  patient  may  be  unable  to  recover  from  the  pathological 
changes  which  have  been  caused  by  the  pregnant  condition. 

The  diversity  of  opinion  of  the  different  writers  in  regard  to 
the  different  phases  of  this  subject  shows  that  many  of  its 
important  problems  have  not  yet  been  solved,  as — 

(1.)  Is  the  pernicious  vomiting  of  pregnancy,  eclampsia  and 
acute  yellow  atrophy  of  the  liver  different  manifestations  of  one 
and  the  same  toxaemia,  or  have  we  several  toxaemias  with  which 
to  deal? 

(2.)  Are  the  so-called  physiological  disturbances  of  pregnancy 
also  manifestations  of  a  toxaemia  which  differs  only  in  severity 
from  one  giving  rise  to  one  of  the  other  more  serious  condi- 
tions ;  just  as  we  may  have  "  mild  and  severe  cases  of  diabetes," 
or  any  other  disease? 

(3.)  What  is  the  source  of  the  toxaemia;  does  it  come  directly 
from  the  ovum  or  does  the  ovum  reflexly  affect  some  other  organ 
of  the  body,  as  the  liver  or  intestines  ? 

(4)  What  is  the  significance  of  such  bodies  as  leucin,  tyrosin, 
aceton  and  diacetic  acid  and  also  the  increased  amount  of 
nitrogen  excreted  as  ammonia  as  compared  with  the  total  nitro- 
gen in  the  urine  and  their  importance  as  a  means  of  diagnosis 
and  prognosis  and  also  as  an  indication  of  the  treatment  to  be 
followed  ? 

I  think  that  we  must  agree  with  Ewing  that  many  factors  may 
be  concerned  in  the  disturbance  of  nitrogenous  metabolism,  and 
that  "  it  is  not  necessary  to  fully  explain  the  ultimate  origin  of 
the  toxaemia  before  recognizing  its  existence  and  practical  im- 
portance." It  is  evident  that,  at  least,  the  severe  cases  should 
receive  energetic  treatment  upon  the  rational  basis  that  the  dis- 
ease is  an  auto-intoxication,  bearing  in  mind  that  even  some  of 
the  cases  with  liver  lesions  may  recover.  Fluids  by  mouth  and 
saline  irrigations  are  indicated  as  an  aid  in  the  elimination  of 
the  toxic  substances,  and  where  fluids  are  not  well  taken  saline 
infusions  may  be  used.    If  it  seems  necessary  to  terminate  the 


PUBLIC  HEALTH 


277 


pregnancy,  the  physician  must  make  certain  that  he  has  removed 
the  entire  ovum,  otherwise  the  symptoms  may  persist  as  long 
as  the  secundines  are  retained,  and  if  the  termination  of  the  preg- 
nancy has  been  delayed  too  long,  even  this  procedure  may  not 
save  the  life  of  the  patient. 

We  hope  that  soon  the  significance  of  the  various  substances 
found  in  the  urine  in  these  cases,  will  be  more  clearly  under- 
stood and  also  their  true  value  as  a  source  of  diagnosis,  prognosis 
and  as  a  means  of  determining  whether  or  not  the  pregnancy 
should  be  terminated. 

John  A.  Sampson. 


public  Dealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 


Department 

of  Health — City 

of  Albany, 

N.  Y. 

Abstract  of 

Vital  Statistics. 

February,  i 

906. 

Deaths. 

1902 

1903 

1904 

i9°5 

1906 

Consumption  

  i7 

30 

14 

22 

14 

Typhoid  Fever  

  2 

1 

1 

1 

2 

2 

0 

0 

0 

0 

0 

0 

0 

Whooping-cough  

4 

0 

1 

0 

Diphtheria  a'hd  croup . . . 

  3 

0 

1 

0 

1 

  0 

3 

2 

3 

3 

Diarrhoeal  diseases  

  4 

0 

3 

3 

2 

  9 

10 

16 

21 

i5 

  3 

6 

3 

5 

4 

Bright 's  Disease  

  14 

10 

i5 

19 

17 

5 

9 

14 

8 

8 

8 

9 

*3 

Accidents  and  violence. . 

  6 

4 

3 

8 

3 

Deaths  over  70  years. . .  . 

  3i 

29 

32 

41 

28 

Deaths  under  one  vear. . 

  10 

21 

20 

16 

i5 

  141 

153 

135 

181 

i45 

Death  rate  

  i6.59  1 

8.01 

15.89 

21 .30 

17  .06 

Death    rate    less  non-resi- 
dents  17.18     15.18    1483    20.01  i5-77 


378  PUBLIC  HEALTH 

Deaths  in  Institutions. 


1902 

10 

D3 

1904 

1906 

1906 

iion- 

Non- 

Non- 

IN  on- 

Noa- 

Resi- 

Resi- 

Resi- 

resi- 

Resi- 

resi- 

Resi- 

resi- 

Resi- 

resi- 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

de» 

Albany  Hospital  

12 

5 

IO 

3 

i5 

4 

19 

1 1 

7 

9 

Albany  Orphan  Asylum  . .  . 

I 

o 

o 

o 

i 

o 

1 

O 

4 

0 

4 

2 

3 

i 

3 

I 

5 

O 

5 

2 

Home  for  Aged  

o 

0 

i 

o 

4 

o 

2 

0 

O 

0 

Homeopathic  Hospital  

4 

2 

i 

o 

1 

o 

3 

0 

0 

Hospital  for  Incurables. . .  . 

I 

O 

o 

o 

I 

o 

0 

0 

0 

1 

House  of  Good  Shepherd. . . 

2 

O 

o 

o 

0 

o 

1 

0 

O 

0 

Little  Sisters  of  the  Poor.  . 

I 

o 

I 

o 

0 

o 

1 

0 

0 

0 

Penitentiary  

O 

o 

o 

o 

0 

0 

0 

0 

0 

1 

Public  Places  

2 

o 

o 

o 

0 

o 

4 

2 

0 

0 

St.  Margaret's  House  

3 

o 

o 

o 

4 

5 

4 

I 

0 

St.  Peter's  Hospital  

6 

o 

2 

I 

5 

I 

5 

1 

3 

0 

St.  Vincent's  Female  Or- 
phan Asylum                       o      o      o      o      o      o      1      o      o  o 

Births  at  term   74 

Marriages   26 

Still  and  premature  births   9 

Total   109 

Bureau  of  Contagious  Diseases. 

1902  1903  1904  1905  1906 

Typhoid  Fever  

Scarlet  Fever  

Diphtheria  and  Croup, 

Chickenpox  

Measles  

Consumption  


Totals . 


3 

IO 

5 

4 

1 

9 

IO 

12 

6 

22 

27 

14 

16 

4 

7 

6 

49 

5 

8 

8 

8 

3 

7 

66 

2 

0 

0 

0 

0 

0 

S3 

92 

43 

38 

40 

Contagious  Diseases  in  Relation  to  Public  Schools. 

Reported  Deaths 
D.     S.  F.         D     S.  F. 


Public  School  No.  1  

Public  School  No.  3  

Public  School  No.  4  

Public  School  No.  7  

Public  School  No.  12  

Public  School  No.  20  

Albany  Boy's  Academy  

St.  Joseph's  Academy  

Number  of  days  quarantine  for  diphtheria : 

Longest   30  Shortest  

Number  of  days  quarantine  for  scarlet  fever : 

Longest   65    Shortest   13    Average   34$ 

Fumigations : 

Houses   24    Rooms   48 


SOCIETY  PROCEEDINGS  279 

Antitoxin. 

Cases  of  diphtheria  reported   7 

Cases  of  diphtheria  in  which  antitoxin  was  used   7 

Cases  of  diphtheria  in  which  antitoxin  was  not  used   o 

Deaths  after  use  of  antitoxin   o 


Plumbing  Inspections. 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  one 
hundred  and  fifty  inspections,  of  which  eighty-five  were  of  old  buildings 
and  sixty-five  of  new  buildings.  There  were  twenty-two  iron  drains  laid, 
six  connections  with  street  sewers,  nine  tile  drains,  fifteen  cesspools, 
twenty-nine  wash  basins,  thirty-nine  sinks,  twenty-nine  bath  tubs,  thirty- 
one  wash  trays,  one  butler's  pantry  sink,  one  trap  hopper  in  yard,  and 
sixty-two  tank  closets.  There  were  fifty-three  permits  issued,  of  which 
forty-four  were  for  plumbing  and  nine  for  building  purposes.  There 
were  five  plans  submitted,  of  which  one  was  of  an  old  building  and  four 
for  new  buildings.  Six  houses  tested  with  peppermint  and  nine  water 
tests.  There  were  thirty-nine  houses  examined  on  complaint  and  fifty- 
ieven  re-examined.  Twenty-seven  complaints  were  found  to  be  valid 
and  twelve  without  cause. 


Society  iProceetonas 

Medical  Society  of  the  County  of  Albany. 

A  regular  meeting  of  the  Medical  Society  of  the  County  of  Albany  was 
held  in  the  Albany  Medical  College  January  10,  1906,  at  8.15  p.  m. 

The  meeting  was  called  to  order  by  the  president.  There  were  present 
Drs.  Baldauf,  Bedell,  Blair,  Beilby,  Cook,  George,  Gutmann,  Hinman, 
Holding,  Lempe,  Laird,  Moore,  C.  H.,  MacFarlane,  Papen,  Rooney, 
Sampson,  Winne,  C.  K.  jr.,  Vander  Veer,  and  Wiltse. 

The  secretary  read  several  communications  from  the  State  Society, 
which  were  referred  to  the  proper  committees. 

Dr.  Pease  then  read  a  paper  on  "Some  Interesting  Features  and  Results 
of  the  Treatment  and  Prevention  of  Diphtheria  by  the  Use  of  Antitoxin.' * 

Dr.  Beilby,  in  opening  the  discussion,  said  that  he  had  observed  a  few 
of  the  cases  of  rash  following  antitoxin,  one  case  in  which,  after  about 
ten  to  twelve  hours  from  the  injection,  there  was  a  very  severe  urticaria. 
This  was  very  extensive,  involving  not  only  the  extremities,  but  also  the 
entire  front.  Some  of  these  cases  presented  slight  rise  in  temperature. 
In  one  case  observed  an  urticaria  followed  by  joint  pains  occurred  about 
one  month  after  the  injection  of  antitoxin.  The  symptoms  observed 
after  the  administration  of  antitoxin  were  not  observed  after  the  injec- 
tion of  normal  horse-serum.  The  only  symptom  observed  after  the  in- 
jection of  normal  horse-serum  was  a  slight  rise  of  temperature.  The 
local  skin  lesions  existed  from  an  hour  to  eight  to  ten  days.    There  were 


SOCIETY  PROCEEDINGS 


no  skin  disturbances  on  the  abdomen.  He  had  frequently  observed  at 
the  same  time  headache,  excessive  sweating  and  weakness. 

Dr.  Sampson  then  read  a  paper  on  "Uterine  Myomata  Simulating 
Pregnancy,  with  Especial  Reference  to  the  Submucous  Variety." 

Dr.  Lempe  said  that  a  case  had  come  under  his  observation  in  which 
a  woman  had  a  large  uterine  myoma  and  was  at  the  same  time  pregnant 
four  months.  He  also  asked  Dr.  Sampson  what  course  of  procedure 
should  be  taken  in  an  event  of  this  sort . 

Dr.  Sampson  replied  that  each  case  must  be  decided  for  itself.  In  the 
majority  of  these  cases  of  simultaneous  pregnancy  with  the  presence  of 
large  myomata  it  was  possible  to  allow  the  pregnancy  to  reach  term, 
when  a  Caesarean  section  might  be  done.  He  also  said  that  there  was 
no  place  in  which  more  myomata  occurred  than  in  Baltimore.  Perhaps 
there  was  one  exception  to  this,  which  might  be  New  Orleans.  On  the 
other  hand,  in  Baltimore,  with  surgeons  having  a  very  large  experience 
as  far  as  gynecology  was  concerned,  the  complication  of  pregnancy  and 
uterine  myoma  was  very  infrequent.  He  had  seen,  however,  several 
such  cases  in  which  myomata  and  pregnancy  were  co-existent.  He  had 
seen  several  instances  where  it  was  necessary  to  interfere  at  the  time  of 
labor  and  do  a  Caesarean  section.  He  had  never  seen  a  case  in  which  it 
was  necessary  to  remove  a  pregnant  uterus  which  was  also  myomatous. 
In  some  of  the  specimens  shown  the  tumor  would  not  have  interfered 
with  the  pregnancy,  nor  would  it  have  impeded  labor  to  a  great  degree. 
In  some  of  the  others  pregnancy  would  have  been  impossible.  It  was  a 
matter  of  opinion  and  judgment  whether  a  myoma  discovered  during 
pregnancy  would  demand  removal  of  the  pregnant  uterus,  or  whether  we 
should  preferably  wait  until  a  viable  child  might  be  born.  This,  as  he 
said  before,  was  a  question  which  must  be  decided  in  each  individual 
case.  The  size  of  the  myoma,  its  location,  its  possible  removal,  with- 
out interfering  with  pregnancy,  were  the  facts  which  must  determine 
the  question  of  the  time  of  interference. 

Dr.  Lempe  said  that  he  had  witnessed  an  operation  for  a  myoma  of  the 
cervix  in  which  a  caesarean  section  in  which  both  mother  and  child  sur- 
vived the  operation. 

Motion  to  adjourn  was  carried. 

James  F.  Rooney,  Secretary. 

A  regular  meeting  of  the  Medical  Society  of  the  County  of  Albany  was 
held  in  the  Albany  Medical  College,  February  14,  1906. 

The  meeting  was  called  to  order  by  the  President  at  8:40  p.  m. 

There  were  present  Drs.  Appleby,  Baldauf ,  Bedell,  Beilby,  Berry,  Cook, 
Craig,  Curtis,  Gutmann,  Hacker,  Happel,  Holding,  Hun,  Jenkins,  Laird, 
Lomax,  Macdonald,  MacFarlane,  Mereness,  Moore,  C.  H.,  Moston,  Neuman, 
O'Leary,  jr.,  Papen,  Sampson,  Stevenson,  Trego,  Vander  Veer,  A.,  Vander 
Veer,  E.  A.,  Wiltse. 

The  Secretary  read  a  communication  from  the  Corning  Medical  Society, 
asking  that  this  society  adopt  resolutions  in  consonance  with  the  resolu- 
tions presented  by  them  and  opposing  the  bill  to  legalize  Osteopathy- 


SOCIETY  PROCEEDINGS 


281 


Upon  a  motion  of  Dr.  Vander  Veer,  resolutions  the  same  as  those  pre- 
sented by  the  Corning  Society  were  adopted.  Dr.  Vander  Veer  also 
moved  that  the  legislative  committee  of  this  society  be  instructed  to 
appear  at  the  hearings  of  this  bill,  and  voice  the  opposition  of  this  society 
thereto.    Seconded  and  carried. 

Dr.  Neuman  moved  that  a  committee  to  revise  the  tentative  by-laws 
submitted  to  the  County  Society  by  the  State  Society  be  appointed. 
Seconded  and  carried. 

The  President  appointed  as  this  committee  Drs.  Curtis,  Neuman,  and 
Sampson.  The  Secretary  read  a  communication  from  the  society  for  the 
enactment  of  legislation  concerning  the  sale  of  medicines  containing 
alcohol,  powerful  drugs,  or  narcotics,  asking  that  the  society  take  action 
in  favor  of  the  bill  to  be  introduced  by  this  society  providing  for  the 
labeling  of  each  bottle  containing  alcohol  and  other  powerful  drugs. 
Upon  motion  of  Dr.  Holding  a  committee  was  to  be  appointed  to  draw 
up  resolutions,  and  to  favor  this  bill  before  the  committee  to  which  it 
should  be  referred.  Seconded  and  carried.  The  President  appointed 
Drs.  MacFarlane,  Holding  and  C.  K.  Winne,  jr. 

The  Secretary  moved  that  he  be  directed  to  send  notice  to  each  of  the 
members  of  the  society  asking  them  to  write  a  personal  letter  to  his  repre- 
sentative in  the  Legislature  voicing  his  opposition  to  the  Osteopathy  and 
Optometry  bills.    Seconded  and  carried. 

Dr.  Beilby  then  read  a  paper  on  diseases  of  the  thryoid  gland,  which 
will  be  published  in  the  Annals. 

Dr.  Vander  Veer  said  that  he  was  extremely  interested  in  the  very 
excellent  paper  of  Dr.  Beilby 's,  which  showed  thorough  study  and  much 
labor.  It  also  demonstrated  the  great  work  to  the  medical  profession 
of  Albany  arising  from  the  endowment  of  the  Bender  Laboratory  by  the 
late  Matthew  Bender.  It  seemed  to  him  that  a  paper  of  the  scope  of 
Dr.  Beilby 's  would  have  been  impossible  under  the  conditions  existing 
in  this  city  before  the  establishment  of  that  institution.  Beside  that, 
most  of  the  cases  drawn  from  the  literature  were  owing  to  the  facilities 
for  reference  given  by  the  State  Medical  Library.  It  had  been  of  very 
great  interest  to  men  like  himself  to  have  heard  this  paper,  men  who 
have  followed  this  line  of  work  during  its  development  through  a  long 
period  of  years.  Twenty-eight  years  ago  it  was  an  operation  which 
offered  very  great  and  many  difficulties  to  the  young  surgeon  who 
was  called  upon  to  remove  a  thyroid  gland.  He  thought  that  the  first  man 
in  this  country  to  attempt,  and  advise  the  removal  of  this  gland  was  Dr. 
Greene,  who  was  the  professor  of  surgery  at  Portland,  Maine.  He  re- 
ported some  cases  in  which  he  had  been  able  to  remove  the  thyroid.  He 
could  call  to  mind  the  fact  that  Alden  March  had  also  had  some  cases. 
He  remembered  very  well  the  first  case  in  which  he  himself  had  per- 
formed the  operation  of  the  removal  of  the  thyroid.  The  operation  was 
a  severe  one  and  complicated  by  much  hemorrhage,  which  was  the  chief 
danger  at  this  time.  This  patient,  however,  made  a  good  recovery. 
Shortly  after  this  the  use  of  artery  forceps  greatly  simplified  the  operation 
by  minimizing  the  hemorrhage.    Another  of  the  large  dangers  was  the 


SOCIETY  PROCEEDINGS 


general  anesthetic.  Now  it  is  possible  in  many  cases  to  operate  under 
cocaine.  We  are  much  indebted  for  the  knowledge  of  the  feasibility  of 
local  anesthesia  in  these  cases  to  Kocher.  Under  these  circumstances 
the  opportunity  for  recovery  is  greatly  increased. 

Drs.  Macdonald  and  Holding  presented  a  case  of  broken  neck  with 
permanent  distortion,  but  complete  recovery,  functionally,  to  the  society. 

On  motion  the  society  adjourned. 

James  F.  Rooney, 

Secretary. 


Medical  Society  of  the  County  of  Albany. 

A  special  meeting  of  the  Medical  Society  of  the  County  of  Albany  to 
take  action  upon  the  death  of  Dr.  Samuel  H.  Freeman,  was  held  in  the 
College  Library,  Tuesday  afternoon,  March  20,  1906.  The  meeting  was 
called  to  order  by  the  President  at  5:40. 

The  Secretary  read  the  following  letter: 

March  20,  1906. 

Dr.  James  W.  Wiltse,  President, 

Albany  County  Medical  Society, 
Albany,  N.  Y. 

My  Dear  Doctor: — I  had  intended  to  be  present  at  the  meeting  of  the 
County  Society  this  afternoon  to  take  action  on  the  death  of  Dr.  Freeman; 
but  circumstances  render  it  impossible  for  me  to  do  so. 

Dr.  Freeman  retired  from  active  practice  so  long  ago  that  to  many  of 
the  younger  members  of  the  Society  he  was  scarcely  known  at  all;  but, 
when  I  came  to  Albany,  and  for  many  years  afterwards,  he  was  doing  a 
large  professional  business,  and  was  universally  trusted  and  beloved  by 
his  patients.  He  was  a  man  of  sterling  Christian  character,  most  amiable 
qualities,  and  for  many  years  stood  in  the  front  rank  of  his  profession. 
After  serving  for  many  years  as  attending  physician  at  the  Albany 
Hospital,  he  was  placed  upon  the  consulting  staff,  and  was  its  President. 
In  the  faithful  discharge  of  all  his  duties,  in  his  adherence  to  principles, 
and  in  his  courteous  treatment  of  all  with  whom  he  came  in  contact,  he 
set  us  all  an  excellent  example. 

I  heartily  regret  that  circumstances  make  it  impossible  to  be  with  you 
this  afternoon.  Very  truly  yours, 

Samuel  B.  Ward. 

The  Secretary  moved  that  the  President  appoint  a  committee  of  three 
to  draw  resolutions  upon  the  death  of  Dr.  Freeman.    Seconded.  Carried. 

The  President  appointed  Drs.  Curtis,  Cook  and  Tucker. 

Dr.  Tucker  said  that  in  Dr.  Freeman,  death  had  removed  one  of  the 
oldest  members  of  the  Society.  Dr.  Freeman  had  graduated  from  the  Albany 
Medical  College  in  1846  and  since  then  had  spent  most  of  his  time  in  the 
practice  of  medicine  in  the  city.  He  said  that  he  remembered  Dr.  Free- 
man from  the  time  of  his  (Dr.  Tucker's)  association  with  medicine.  Dr. 


SOCIETY  PROCEEDINGS 


Tucker  was  a  student  in  the  office  of  Dr.  Armsby,  who  had  married  a 
daughter  of  Mr.  Gideon  Hawley,  while  Dr.  Freeman  had  married  another 
daughter  of  the  same  gentleman,  so  that  the  connection  between  Dr. 
Armsby  and  Dr.  Freeman  was  especially  intimate.  Dr.  Freeman  was  an 
old  and  valued  member  of  the  Fourth  Presbyterian  Church,  and  was 
sincere  and  indefatigable  in  the  pursuance  of  his  duties.  While  at  no 
time  an  officer  of  the  Faculty  of  the  College  he  served  faithfully  and  well 
in  an  onerous  office  which  was  indirectly  a  part  of  the  institution,  that 
of  one  of  the  Board  of  Curators.  He  held  this  office  from  1867  to  1890, 
when  the  Board  became  non-existent.  Many  of  those  present  here  today 
have  passed  before  him  before  their  graduation  from  the  College.  He 
was  one  of  the  earliest  members  of  the  Alumni  Association  of  the  College. 
He  was  also  a  member  of  the  Committee  who  had  charge  in  the  erection 
of  the  memorial  to  Dr.  Armsby  in  Washington  Park.  In  his  death  the 
profession  loses  one  whose  life  has  been  a  faithful  example  of  all  that  a 
physician  should  be. 

Dr.  Curtis  read  a  sketch  of  the  life  of  Dr.  Freeman  which  will  appear 
in  the  Annals. 

Dr.  Curtis  on  behalf  of  the  committee  offered  the  testimonial  they  had 
prepared  as  follows : 

The  Albany  County  Medical  Society  desires  to  place  on  the  records  of 
the  Society  a  memorial  of  the  life  of  Dr.  Samuel  H.  Freeman  with  an 
expression  of  its  satisfaction  in  the  busy  life  well  spent  in  our  membership 
and  his  association  with  us,  as  a  man  of  wide  education  and  courteous 
and  attractive  character,  always  helpful  and  grateful  in  his  memory. 
We  also  give  form  to  our  regret  at  his  departure  from  us  and  would  direct 
that  this  expression  of  our  sentiments  be  spread  upon  the  minutes  of  the 
Society. 

F.  C.  Curtis, 
D.  H.  Cook, 
W.  G.  Tucker. 

Dr.  Mosher  moved  that  the  expressions  be  adopted  and  spread  on  the 
minutes  and  that  a  copy  be  sent  the  family  of  our  late  member.  Seconded. 
Carried. 

Dr.  Mosher  moved  that  the  Society  defray  the  expense  of  procuring  a 
cut  to  be  made  from  the  photograph  of  Dr.  Freeman  to  appear  in  the 
Annals  with  the  sketch  of  his  career.    Seconded.  Carried. 

Upon  motion  the  Society  adjourned. 

James  F.  Rooney,  Secretary, 

No.  123  Grand  St. 


284 


MEDICAL  NEWS 


Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick. — Statistics  for 
February,  1906. — Number  of  new  cases  96,  classified  as  follows;  district 
cases  reported  by  the  health  physicians,  15  ;  charity  cases  reported  by 
other  physicians,  81;  patients  of  limited  means,  46;  total  number  of 
patients  under  nursing  care  during  the  month,  159. 

Classification  of  diseases  (new  cases),  medical,  25  ;  surgical,  4;  gynaeco- 
logical, 4;  obstetrical  work  of  the  Guild,  29  mothers  and  28  infants; 
under  professional  care:  dental,  4;  skin,  2;  throat  and  nose,  2;  removed 
to  hospitals,  3;   deaths,  6. 

Special  Obstetrical  Department:  Number  of  obstetricians,  1 ;  medical 
students  in  attendance,  2  ;  Guild  nurses,  2;  cases,  1;  number  of  visits  by 
attending  obstetricians,  1;  by  the  Guild  nurses,  16;  total  number  of 
Tisits  in  this  department,  28. 

Visits  of  Guild  nurses — (all  departments).  Number  of  visits  with  nursing 
treatment,  878;  for  professional  supervision  of  convalescents,  173;  total 
number  of  visits,  1,051 ;  five  graduate  nurses  and  six  assistant  nurses  were 
on  duty.  Cases  were  reported  to  the  Guild  by  4  of  the  health  physicians, 
and  by  32  other  physicians  and  by  3  dentists. 

Official  Organ  of  the  National  Association  for  the  Study  and 
Prevention  of  Tuberculosis. — The  Journal  of  the  Outdoor  Life  which 
is  published  at  the  Adirondack  Cottage  Sanitarium,  Trudeau,  N.  Y. 
(Saranac  Lake),  which  has  just  entered  on  its  third  year,  has  been  made 
the  official  organ  of  the  National  Association  for  the  Study  and  Preven- 
tion of  Tuberculosis.  The  Journal  of  the  Outdoor  Life  deals  with  the 
outdoor  treatment  of  tuberculosis  in  an  intelligent  and  scientific  manner. 
It  does  not  advocate  self-treatment  by  the  laity,  or  attempt  to  supplant 
personal  medical  advice.  It  aims  to  point  out  the  more  common  pit- 
falls that  beset  the  unwary  health  seeker,  and  to  awaken  in  its  readers  a 
healthful  interest  in  an  outdoor  life.  It  advocates  competent  medical 
supervision,  fresh  air,  nourishing  food  and  carefully  regulated  exercise. 

The  Newberry  Library. — The  John  Crerar  Library. — Arrange- 
ments have  been  completed  for  the  transfer  of  the  Medical  Department 
of  the  Newberry  Library,  including,  with  the  permission  of  Dr.  Senn,  the 
Senn  Collection  of  Medical  History,  to  the  ownership  and  management  of 
the  John  Crerar  Library.  This  has  been  done  partly  because  the  natural 
relations  of  these  books  to  the  chosen  field  of  The  John  Crerar  Library 
and  the  lack  of  such  relations  to  that  of  the  Newberry  Library  make  the 
transfer  in  many  ways  mutually  advantageous,  and  partly  because  the 
medical  profession  o*  the  city  has  urged  strongly  the  desirability  of  a 
more  central  location.  Unfortunately,  however,  the  collection  cannot 
be  accommodated  in  the  temporary  quarters  of  The  John  Crerar  Library, 
so  that  it  will  remain  in  its  present  location  until  the  permanent  building 
is  completed. 


MEDICAL  NEWS 


Back  numbers  of  the  Annals  are  wanted  by  Dr  George  Blumer,  of 
San  Francisco: — 

1897 —  February,  September,  October. 

1898 —  November,  December. 

1901 —  January. 

1902 —  March,  April. 

Those  having  duplicates  please  inform  the  Annals. 

The  Germantown  Homeopathic  Medical  Society  of  Philadelphia. 
— At  its  last  meeting  the  Germantown  Homeopathic  Medical  Society  of 
Philadelphia  resolved  to  place  itself  on  record  as  opposed  to  the  manu- 
facture and  sale  of  all  patent  medicines  or  nostrums  of  whatsoever  sort, 
and  requests  all  members  of  the  medical  fraternity  to  abstain  from  pub- 
lishing their  articles  in  any  medical  journal  advertising  patent  medicines 
or  nostrums. 

This  society  commends  all  medical  journals  and  all  newspapers  which 
abstain  from  advertising  patent  medicines  and  nostrums  for  their  cam- 
paign against  the  patent  medicines  and  nostrum  business. 

The  Pure-food  Commissioner  of  the  State  is  commended  for  the  work 
he  is  accomplishing  in  this  direction,  and  this  society  pledges  him  its 
support  in  all  future  efforts  of  the  same  kind. 

The  public  is  cautioned  against  the  use  of  patent  medicines  and  nos- 
trums as  unscientific  and  dangerous  to  the  general  health  and  welfare. 

New  York  Skin  and  Cancer  Hospital. — (Second  Avenue,  corner  19th 
street.)  The  Governors  of  the  New  York  Skin  and  Cancer  Hospital 
announce  that  Dr.  L.  Duncan  Bulkley  will  give  four  special  lectures  on 
"The  Principles  and  Application  of  Local  Treatment  of  Diseases  of  the 
Skin,"  on  Wednesday  afternoons,  March  21st  and  28th;  and  that  Dr. 
William  Seaman  Bainbridge  will  give  a  clinical  lecture  on  "Malignant  and 
Non-Malignant  Growths,"  on  Wednesday,  April  18th,  in  the  Out-Patient 
Hall  of  the  Hospital  at  4.15  p.m. 

The  lectures  will  be  free  to  the  medical  profession. 

Epilepsy. — The  transactions  of  the  National  Association  for  the  Study 
of  Epilepsy  aud  the  Care  and  Treatment  of  Epileptics  are  being  printed, 
and  should  be  ready  for  delivery  May  1st.  They  cover  four  years,  1902 
and  1903  being  in  one  volume  and  1904  and  1905  being  in  the  other 
volume.  They  will  be  well  bound  in  very  heavy,  smoke-grey  paper, 
stamped  in  gold,  and  will  contain  numerous  illustrations.  They  are  de- 
signed for  library  shelves.  Three  hundred  copies  only  will  be  printed. 
The  price,  including  the  cost  of  carriage,  will  be  S2.75  for  the  two  volumes. 
They  will  not  be  sold  separately.  Among  the  contributors  to  these  vol- 
umes are  the  following: 

presidential  addresses. 

1902 —  Frederick  Peterson,  M.  D.,  New  York  City. 

1903 —  Wharton  Sinkler,  M.  D.,  Philadelphia,  Pa. 

1904 —  William  N.  Bullard,  M.  D.,  Boston,  Mass. 

1905 —  William  P.  Spratling,  M.  D.,  Sonyea,  N.  Y. 

Dr.  W.  P.  Spratling,  of  Sonyea,  N.  Y.,  who  is  editing  the  work,  will 
be  glad  to  receive  subscriptions. 


286 


MEDICAL  NEWS 


American  Gastro-Enterological  Association. — The  preliminary 
program  of  the  ninth  annual  meeting,  to  be  held  at  Boston, Mass.,  June  4 

and  5,  1906,  has  been  issued: 

1.  President's  Address:  The  Mutual  Obligations  of  the  Surgeons  and 
Internists  in  the  Proper  Development  of  Gastric  Surgery.  H.  W.  Bett- 
raann,  Cincinnati. 

2.  Remarks  on  Banti's  Disease.    Max  Einhorn,  New  York. 

3.  Demonstration  of  Gastric  and  Intestinal  Movements.  W.  B.  Can- 
non, Boston. 

4.  The  Kidney  in  Gastro-Enterology.    A.  L.  Benedict,  Buffalo. 

5.  Paper.    Franklin  W.  White,  Boston. 

6.  A  Further  Consideration  of  the  Gastro-Intestinal  Disturbances 
Associated  with  Migraine.    J.  A.  Lichty,  Pittsburg. 

7.  Hypersecretion,  Associated  with  Cirrhosis  of  the  Liver.  H.  F. 
Hewes,  Boston. 

8.  On  the  Influence  of  Rest,  Exercise  and  Sleep  on  Gastric  Digestion. 
Julius  Friedenwald,  Baltimore. 

9.  A  Case  of  Hyperplastic  Colitis:  Extirpation  of  the  Entire  Colon, 
the  Upper  Portion  of  the  Sigmoid  Flexure  and  Four  Inches  of  the 
Ileum.    Morris  Manges,  New  York. 

10.  A  Case  of  Pyloric  Stenosis  in  a  Child  of  Five  Years.  S.  W.  Lam- 
bert, New  York. 

11.  Recent  Studies  in  the  Diagnosis  of  Gastric  Ulcer.  J.  C.  Hemmeter, 
Baltimore. 

12.  Gastric  Ulcer  in  Childhood.    Harry  Adler,  New  York. 

13.  Further  Remarks  on  the  Treatment  of  Chronic  Round  Ulcer  of  the 
Stomach.    F.  H.  Murdoch,  Pittsburg. 

14.  Spontaneous  Rupture  of  the  Colon  from  Violent  Peristalsis,  with 
Report  of  Fatal  Case.    G.  W.  McCaskey,  Ft.  Wayne. 

15.  Habitual  Constipation  Viewed  from  the  Standpoint  of  Modern 
Evolution  of  Dietetics  as  a  Physiologic.  Phenomena.  C.  D.  Spivak,  Den- 
ver. 

Personal. — Dr.  Albert  Vander  Veer  sailed  for  Europe  on  March  3rd. 
He  will  read  a  paper  at  the  International  Medical  Congress  held  at  Lisbon 
in  April. 

— Dr.  Wilfred  S.  Hale  (A.  M.  C.  1894)  is  in  the  Holy  Land  for  the 
winter. 

— Dr/Fred  M.  Barney  (A.  M.  C.  1888)  has  removed  from  Dolgeville, 
N/Y.,  to"  Fisherman's  Point,  Caiman  era,  Cuba. 

— Dr.  Arthur  Will  (A.  M.  C.  1900)  has  sold  his  practice  at  North 
Creek,  N.  Y.,  and  is  doing  post  graduate  work  in  Albany. 

— Dr.  Joseph  A.  Cox  (A.  M.  C.  1901)  after  doing  eight  months  post 
graduate  work  in  Baltimore  and  Boston,  has  taken  up  practice  in  Albany 
at  332  State  street. 


MBDICAL  NEWS 


287 


— Dr.  George  C.  Merriman  (A.  M.  C.  1902)  has  removed  to  512  North 
Washington  avenue,  Scranton,  Pa. 

— Dr.  Frank  Wheeler  (A.  M.  C.  1902)  has  started  practice  at  North 
Creek,  N.  Y.,  having  purchased  Dr.  Will's  practice. 

— Dr.  Frank  G.  Schaible  (A.  M.  C.  1905)  has  been  appointed  resident 
pathologist  to  the  Albany  Hospital. 

— Dr.  Herbert  B.  Reece  (A.  M.  C.  1905)  has  completed  his  service  at 
Lying-in  Hospital,  New  York  City,  and  has  opened  offices  at  282  9th 
street,  Brooklyn,  N.  Y. 

— Dr.  Kenn  R.  Coffin  (A.  M.  C.  1905)  is  practicing  at  Olmsteadville , 
Essex  County,  N.  Y. 

— Dr.  H.  A.  Bushnell  (A.  M.  C.  1905)  is  practicing  in  North  Adams, 
Mass. 

— Dr.  A.  B.  Chapelle  (A.  M.  C.  1905)  is  practicing  at  Pattikill,  N.  Y. 

— Dr.  Donald  Boyd  (A.  M.  C.  1902)  has  removed  to  Brooklyn,  N.  Y. 

Married. — Will-Littlejohn. — November  9,  1905,  at  Upper  Montclair 
N.  J.,  Arthur  Will  (A.  M.  C.  1900)  of  North  Creek,  N.  Y.,  and  Hilda 
Littlejohn,  of  Montclair,  N.  J. 

 BUSHNELL-BOYNTON.  Dr.    H.    A.    BUSHNELL    (A.  M.  C.  1905),  of 

North  Adams,  Mass.,  and  Caroline  Boynton,  of  Schenectady,  N.  Y., 
recently,  at  Schenectady,  N.  Y. 


Deaths. — Dr.  Adelbert  D.  Head  (A.  M.  C.  1866),  aged  63,  died  at 
Syracuse,  N.  Y.,  January  21st,  1906,  after  having  had  diabetes  for  nearly 
a  year.  Dr.  Head  was  widely  known;  a  member  of  the  American  Medi- 
eal  Association;  New  York  State  Medical  Society;  Syracuse  Academy  of 
Medicine. 

— Dr.  George  Archie  Stockwell  (A.  M.  C.  1866)  died  at  Houston, 
Texas,  January  29,  1906,  aged  59  years. 

— Dr.  Fordyce  H.  Benedict  (A.  M,  C.  1868)  died  at  Weedsport,  N. 
Y.,  of  pneumonia,  March  8,  1906,  aged  61  years. 

— Dr.  John  U.  Haynes  (A.  M.  C.  1872)  died  recently  from  cerebral 
hemorrhage,  at  his  home  in  Cohoes,  N.  Y. 


288 


IN  MEMORIAM 

« 


f  n  /I&emortam 

Samubl  Huntington  Freeman,  M.  D. 
A  Biographical  Sketch. 
By  Frederic  C.  Curtis,  M.  D. 

Dr.  Samuel  Huntington  Freeman  died  at  his  home  in  Albany,  March  15, 
1906,  at  the  ripe  age  of  86.  His  contemporaries  have  long  since  passed 
away.  Considerably  earlier  on  the  stage  of  life,  but  long  workers  side 
by  side  with  him,  were  March,  the  two  McNaughtons,  the  elder  Hun  and 
Boyd,  the  brothers  Staats;  Armsby,  his  senior  by  ten  years,  and  related 
to  him  by  marriage,  was  long  his  associate  in  business;  and  of  men  of 
his  own  age  were  Vander  Poel,  Babcock,  U.  G.  Bigelow  and  Joseph 
Lewi,  all  of  whom  many  of  us  have  personally  known,  but  who  dropped 
out  of  our  life  here  years  ago.  Of  the  members  of  our  County  Medical 
Society  there  is  not  one  living  who  joined  the  Society  within  twenty 
years  of  Dr.  Freeman;  the  palm  of  seniority  so  thoroughly  established 
has  passed  to  others  by  a  long  step  from  1846  to  1866. 

Dr.  Freeman  was  of  New  England  lineage,  born  at  Hanover,  N.  H., 
in  1820.  In  a  sketch  of  the  life  of  his  uncle,  Dr.-  Samuel  Freeman,  once 
a  practitioner  here,  which  he  wrote  for  a  collection  of  biographies  pre- 
pared for  the  third  volume  of  our  County  Medical  Society  Transactions, 
he  says  of  his  father,  Hon.  Jonathan  Whitehouse  Freeman  (grandfather 
of  our  Dr.  Freeman)  that  he  was  a  member  of  the  first  Continental  Con- 
gress, a  member  of  the  Committee  of  Public  Safety,  and  for  many  years  a 
trustee  and  treasurer*  of  Dartmouth  College.  It  is  further  said  that  he 
was  a  personal  friend  of  George  Washington,  and  a  frequent  visitor  at 
Mount  Vernon.  He  was  a  lineal  descendant  of  Edward  Freeman,  who 
came  from  England  in  1635  to  the  Plymouth  colony;  one  of  the  first 
settlers  of  the  township  of  Hanover,  N.  H.,  one  of  the  founders  of  Dart- 
mouth College,  of  which  he  was  trustee  and  treasurer  for  forty  years,  and 
filled  many  important  trusts  in  the  history  of  the  State  and  nation. 

Dr.  Freeman  was  born  into  an  educational  and  patriotic  atmosphere, 
his  father  being  a  life-long  resident  and  office  holder  in  Hanover.  He 
prepared  for  college  at  the  Kimball  Union  Academy,  at  an  important 
anniversary  occasion  of  which  he  delivered  an  address  which  brought 
him  complimentary  words  from  Daniel  Webster  and  Oliver  Wendell 
Holmes,  who  were  present  as  participants  of  the  event.  He  was  gradu- 
ated from  Dartmouth  College,  as  valedictorian  of  his  class,  in  1843,  and 
studied  medicine  at  Dartmouth  Medical  College,  Dr.  Oliver  Wendell 
Holmes  being  then  connected  with  the  faculty;  he  filled  out  his  medical 
study  at  the  Albany  Medical  College,  for  which  Alden  March  had  won  a 
reputation  along  with  his  then  associates,  Armsby,  McNaughton,  Beck, 
Bedford  and  Amos  Dean,  graduating  in  the  class  of  1846. 

Albany  was  drawing  not  a  few  New  Englanders,  having  been  to  within 
forty  years  entirely  Dutch  in  its  usages,  population  and  architecture. 
There  were  already  numerous  names  in  the  county  medical  society,  which 


SAMUEL  HUNTINGTON  FREEMAN,  M.  D. 


Albany  Medical  Annals 

April,  1906 


IN   MEMO  RI  AM 


289 


had  been  established  forty  years  before,  of  New  England  origin  when 
Dr.  Freeman  became  a  member  in  1846.  He  became  closely  identified 
in  his  work,  as  a  man  of  education  beyond  that  of  the  majority  of  his 
time,  with  Dr.  March  and  Dr.  Armsby,  with  the  latter  of  whom  he  had 
for  twelve  years  a  partnership  in  professional  business,  and  with  whom 
he  formed  a  closer  relation  by  marriage  to  a  sister  of  his  wife,  Miss  Sarah 
Elizabeth  Hawley,  daughter  of  the  Hon.  Gideon  Hawley,  of  Albany,  in 
1851. 

In  1856  he  became  president  of  the  county  medical  society,  to  which 
he  was  long  an  active  contributor,  and  constantly  filled  its  trusts  of  office, 
among  them  delegate  to  the  State  Medical  Society,  becoming  a  permnnent 
member  thereof  when  it  was  a  prize  indeed  in  1862. 

Various  professional  offices  have  been  held,  by  him;  he  was  long  a 
curator  of  the  College,  and  a  professorship  was  offered  him  which  he 
never  accepted;  he  was  an  attending  physician  to  the  Albany  Hospital 
until  he  resigned  with  feebleness  of  health  in  later  life.  As  has  been  our 
custom,  his  fiftieth  year  in  practice  was  celebrated,  but  by  his  request  in 
a  modest  way,  in  1896. 

His  work  has  been  that  of  the  general  family  practitioner,  and  has  been 
large  and  appreciated.  He  was  a  devoted  member  of  the  Presbyterian 
church,  and  has  long  filled  the  office  of  elder,  and  his  voice  and  presence 
have  been  constant  in  the  varied  service  of  the  church.  In  various  activities 
of  the  city  work  has  come  to  him.  At  the  end  of  a  well  rounded  life  he 
could  look  back  upon  years  well  spent,  work  well  done,  friends  made 
afresh  and  held  as  those  of  earlier  time  have  dropped  away,  leaving 
behind  a  pleasant  memory  to  all  who  knew  him  and  whose  paths  have 
lain  for  various  periods  beside  his  along  the  lengthy  way. 

James  D.  Featherstonhaugh,  M.  D. 
A  Biographical  Sketch 
By  Willis  G.  Tucker,  M.  D. 

It  has  been  said  that  a  man's  education  should  begin  with  his  grand- 
parents and  certainly  he  is  fortunate  who  has  behind  him  a  line  of  edu- 
cated ancestors.  For  the  good  fortune  that  may  have  attended  his  birth 
a  man  can  claim  no  credit,  but  he  may  be  thankful  if,  through  the  influ- 
ences of  heredity,  he  has  been  the  recipient  of  those  capacities,  gentle 
traits  and  scholarly  instincts  which  make  it  the  easier  for  him  to  educate 
himself  and  which  predispose  to  the  formation  of  character.  For  a  man 
is  much  as  he  is  begotten,  and  heredity,  in  larger  measure  than  either 
environment  or  education,  determines  character  and  destiny.  We  owe 
much  to  our  ancestors  and  he  that  comes  of  a  good  stock  makes  an 
auspicious  entry  into  life.  Such  an  advantage  did  the  subject  of  this 
sketch  possess,  and  his  natural  abilities  were  developed  by  careful  train- 
ing, and  his  inborn  traits  by  self-discipline  and  the  experiences  of  life, 
and  ever  controlled  by  a  will  which  was  subservient  to  a  sound  reason. 

Dr.  James  Duane  Featherstonhaugh  was  born  at  the  house  of  the 
British  Legation  at  Washington,  D.  C,  January  24,  1845.  His  mother, 
Emily  Chapman,  was  a  native  of  Washington  and  a  niece  of  Dr.  Nathaniel 


IN  MEMORIAM 


Chapman  of  Philadelphia,  and  his  father,  who  was  attached  to  the  legation 
and  whose  name  he  bore,  was  a  civil  engineer  by  profession  and  the 
younger  son  of  George  William  Featherstonhaugh,  born  in  London  April 
9,  1780,  who  had  come  to  this  country  in  1806  for  travel  and  had  sub- 
sequently established  himself  at  Featherstonhaugh  Park  in  the  town  of 
Duanesburgh,  Schenectady  County,  N.  Y.,  where  he  married  Sarah, 
daughter  of  Judge  James  Duane,  November  6,  1808.  Featherstonhaugh 
Park  was  a  large  place  in  the  style  of  an  English  country  residence,  with 
a  fine  mansion,  stately  trees,  commanding  views  and  extended  drives. 
Here  he  resided  for  many  years  and  here  on  June  28,  1828,  his  wife  died. 
A  year  later  the  house  was  destroyed  by  fire  and  he  removed  to  New 
York  where  he  engaged  in  literary  work  and  later  to  Philadelphia  where 
in  1832  he  established  the  "Monthly  American  Journal  of  Geology  and 
Natural  Science,"  the  first  geological  periodical  issued  in  America.  In 
1833  he  was  appointed  the  first  United  States  Geologist.  In  1834  he 
carried  on  explorations  in  the  South  and  in  the  Northwest  and  published, 
in  1835,  his  "Geological  Report  of  the  Elevated  Country  Between  the 
Missouri  and  the  Red  Rivers;"  in  1844  his  "Excursion  Through  the 
Slave  States;"  and  in  1847  his  "Canoe  Voyage  up  the  Minnay  Soter." 
He  was  a  man  of  remarkable  and  diversified  attainments;  an  accom- 
plished scholar,  linquist  and  scientist.  Among  his  friends  were  Stephen 
Van  Rensselaer  of  Albany  and  with  them  originated  the  idea  of  a  railroad 
between  Albany  and  Schenectady  and  the  success  of  this  project  was 
largely  due  to  his  tireless  energy  in  enlisting  friends  for  the  enterprise 
and  overcoming  the  obstacles  which  hindered  the  work  at  its  inception. 
He  took  much  interest  in  agriculture  and  was  one  of  the  organizers  of  the 
State  Agricultural  Society.  In  1839  he  returned  to  England,  but  having 
been  appointed  one  of  the  commissioners  on  the  part  of  Great  Britain  to 
adjust  the  disputed  boundary  line  between  Canada  and  the  United  States 
he  came  back  to  America  to  engage  in  this  work.  In  1844  he  again 
returned  to  England  and  the  succeeding  year  was  appointed  Consul  of 
the  Department  of  the  Seine  and  Calvados,  France.  He  removed  to 
Havre  and  continued  in  this  office  until  his  death  in  1866.  His  wife, 
Sarah  Duane,  was  celebrated  for  her  beauty  and  accomplishments.  Her 
father's  position  had  given  her  a  wide  acquaintance  with  distinguished 
men  and  there  is  now  in  the  possession  of  one  of  her  descendants  an 
original  portrait  of  Washington  which  he  himself  presented  to  her  not 
long  before  his  death.  Her  mother  was  the  eldest  daughter  of  Robert 
Livingston  so  that  on  both  sides  she  was  descended  from  distinguished 
families  of  American  patriots.  She  left  two  sons,  of  whom  the  younger 
was  the  father  of  the  subject  of  this  sketch  and  in  1852  he  became,  upon 
the  death  of  her  sister,  Miss  Catherine  Duane,  the  possessor  of  the  Duane 
Mansion  which  she  had  built  about  18:0.  This  mansion  is  the  last  of 
the  old  family  mansions  located  in  Duanesburgh  and  is  still  in  the  posses- 
sion of  the  family.  It  is  a  large  and  imposing  house  with  a  piazza  seventy 
feet  in  length  supported  by  eight  massive  columns  and  surrounded  by 
beautiful  grounds,  shaded  by  stately  trees  and  commanding  an  extended 
view  of  a  beautiful  country.  To  this  place  Dr.  Featherstonhaugh  loved 
to  return  and  during  his  last  illness  he  constantly  planned  to  go  back  to  it, 


1 

Sip  /^^MB 

JAMES   DUANE   FEATHEFSTONHAUGH ,  M.  D. 


Albany  Medical  Annals 

April,  igob 


IN  MEMORIAM 


291 


hoping  that  in  the  quiet  atmosphere  of  this  old  homestead  he  might 
recover  the  health  and  regain  the  strength  that  was  ebbing  more  rapidly 
than  he  could  comprehend. 

Dr.  Featherstonhaugh's  father  was  born  in  Duanesburgh,  August  8, 
1815.  He  accompanied  his  parents  to  England  in  1826  and  returned  to 
America  in  1828  and  entered  Union  College  in  1830,  and  from  this  institu- 
tion he  was  graduated  in  1834,  and  associated  himself  with  his  father 
in  the  engineering  and  scientific  work  which  he  was  carrying  on.  He 
married  in  1844,  returned  to  England  in  1846  and  lived  in  England  and 
France  until  1855,  when  he  returned  to  Schenectady  and  there  resided 
until  his  death  in  1900.  Of  his  three  sons  Dr.  Featherstonhaugh  was  the 
eldest.  He  was  taken  abroad  with  his  parents  in  infancy  and  received 
his  early  education  in  England  and  France.  In  the  latter  country  great 
events  were  transpiring  and  his  retentive  memory  preserved  the  recollection 
of  some  of  the  exciting  scenes  which  attended  the  escape  of  Louis  Philippe 
from  Havre  and  in  which  his  father  and  grandfather  played  a  prominent 
part  and  of  which  he  was  himself  a  witness.  The  King  and  Queen  were 
secreted  in  a  small  pavilion  on  the  hills  on  the  other  side  of  the  Seine 
and  his  grandfather  at  the  Consulate  was  kept  informed  as  to  their  move- 
ments and  on  the  second  of  March,  1848,  sent  the  vice-consul  to  the  King 
with  the  details  of  the  plan  he  had  made  for  his  escape.  Dr.  Feather- 
stonhaugh remembered  being  present  at  a  consultation  which  was  held 
on  the  afternoon  of  that  day  to  perfect  these  plans,  and  also  in  the  evening 
when  the  boat  which  had  been  sent  back  to  Honrleur  brought  the  King 
and  Queen  in  disguise  to  Havre ;  and  he  recalled  accompanying  his  father 
to  the  dock  and  seeing  them  embark  upon  the  steamer  which  conveyed 
them  to  England,  where  they  found  a  refuge.  These  and  other  remark- 
able events  of  that  exciting  period  very  naturally  produced  a  deep  im- 
presssion  and  they  never  faded  from  his  mind  although  he  seldom  spoke 
of  them. 

Returning  to  this  country  with  his  parents  in  1855  he  attended  Walnut 
Hill  School  at  Geneva,  N.  Y.,  in  1857  and  1858  and  then  studied  with  a 
private  tutor  at  Duanesburgh  until  1861.  From  1861  to  1863  he  was 
again  at  school  in  Geneva  and  in  the  fall  of  the  latter  year  he  entered 
Union  College,  from  which  he  was  graduated  with  the  degree  of  B.  A. 
in  1867.  He  ranked  high  in  his  classes  and  made  many  friends  in  college 
among  men  who  have  become  well  known  as  leaders  in  the  professions 
and  in  other  fields  of  activity.  He  was  a  member  of  Sigma  Phi  and  was 
subsequently  elected  to  membership  in  Phi  Beta  Kappa.  On  leaving 
college  and  having  decided  to  study  medicine  he  entered  the  office  of  the 
late  Dr.  A.  M.  Vedder  of  Schenectady,  a  prominent  practitioner  and  a 
surgeon  of  distinguished  ability,  and  in  1868  he  attended  his  first  course 
of  lectures  at  the  Albany  Medical  College.  Here  the  writer  first  made 
his  acquaintance  and  a  friendship  began  which  remained  unbroken  until 
terminated  by  death.  In  Albany  he  made  many  friends  and  under  the 
the  tutelage  of  such  teachers  as  March,  Armsby,  McNaughton,  Quacken- 
bush  and  Mosher  he  made  rapid' progress.  Two  courses  of  lectures  only 
were  at  that  time  required  for  graduation  in  medicine,  and  the  next  year 
found  him  in  New  York  City  where  he  continued  his  studies  at  the  College 


292 


TN   ME  MORI  AM 


of  Physicians  and  Surgeons,  and  from  this  institution  he  was  graduated 
with  the  degree  of  M.  D.  in  the  class  of  1870.  The  same  year  he  received 
the  degree  of  A.  M.  from  Union  College.  He  removed  to  Cohoes,  N.  Y., 
where  a  good  opening  for  a  young  physician  seemed  to  present  itself, 
rented  an  office  and  laid  the  foundation  for  the  successful  practice  which 
he  subsequently  established.  The  same  year  he  was  elected  to  member- 
ship in  the  Medical  Society  of  the  County  of  Albany  and  this  society  he 
served  in  1875  as  vice-president  and  in  1884  as  president.  In  1874  the 
Albany  Medical  College  conferred  upon  him  the  honorary  degree  of  Doctor 
of  Medicine  and  in  1875  he  was  appointed  a  member  of  the  board  of 
curators  of  the  college  and  served  in  this  capacity  until  the  abolition  of 
the  board  in  1890.  It  was  the  duty  of  the  curators  to  examine  the 
candidates  for  graduation  who  had  been  passed  by  the  faculty,  the 
charter  of  the  college  requiring  that  they  should  join  with  the  faculty  in 
recommending  such  candidates  as  were  approved  by  them  to  the  board 
of  trustees  for  the  degree  of  doctor  of  medicine.  The  curators'  examina- 
tion, although  largely  a  matter  of  form  since  objection  was  seldom  raised 
to  any  candidate  who  had  passed  the  faculty,  was  greatly  dreaded  by 
the  students  who  could  have  no  idea  of  the  nature  of  the  questions  to  be 
asked  them  by  men  who  had  taken  no  part  in  their  instruction  and  who 
were  indeed  strangers  to  them,  and  the  writer  well  remembers  the  careful 
preparation  which  Dr.  Featherstonhaugh  always  made  for  the  discharge 
of  this  rather  distasteful  and  perfunctory  duty.  His  questions  were 
carefully  chosen  and  skillfully  propounded  and  so  put  as  to  draw  from 
the  candidate  the  best  that  was  in  him  and  exhibit  such  knowledge  as  he 
possessed  in  the  most  favorable  light.  There  was  no  assumption  of  supe- 
rior learning,  no  quibbling  nor  catch  questions,  but  rather  a  cordial  and 
courteous  interrogation  which  soon  put  the  student  at  ease  and  freed 
him  from  embarrassment .  The  delicacy  and  unfailing  tact  with  which  each 
year  he  performed  his  part  in  this  much-dreaded  ordeal  will  doubtless  be 
long  remembered  by  many  of  the  students  who  appeared  before  him. 

In  Cohoes  Dr.  Featherstonhaugh  soon  took  rank  with  the  leaders  in 
his  profession.  As  surgeon  to  the  Harmony  Mills  he  gained  a  large 
experience  in  the  surgery  of  accidents  and  his  skill  in  dealing  with  the 
complicated  cases  which  at  any  moment  he  was  called  upon  to  treat  soon 
established  his  reputation  as  a  surgeon.  Naturally  a  student  he  made 
careful  study  of  his  cases,  both  medical  and  surgical,  and  as  a  general 
practitioner  he  was  the  beloved  physician,  wise  counselor  and  faithful 
friend  in  hundreds  of  homes.  But  his  time  and  energies  were  not  ex- 
clusively devoted  to  his  profession  and,  as  a  public-spirited  citizen,  he 
found  time  to  give  to  public  duties  being  ever  ready  to  respond  to  the  calls 
made  upon  him  and  to  serve  the  public  when  his  services  were  needed  and 
to  the  best  of  his  ability.  He  was  a  member  of  the  board  of  Education  in 
1873  and  x^74  and  again  in  1880-1882.  In  1896  he  was  appointed  a 
member  of  the  Public  Improvement  Commission  and  secretary  of  the 
board;  was  reappointed  in  1889,  made  president,  and  continued  to  serve 
with  zeal  and  entire  devotion  to  the  public  interest  until  his  resignation  in 
1902.  He  was  one  of  the  founders  of  the  Cohoes  Hospital,  and  of  the 
Training  School  for  Nurses,  and  served  as  attonding  surgeon  to  the 


IN  MEMORIAM 


293 


former  and  one  of  the  instructors  in  the  latter.  For  a  time  he  was  health 
officer  of  the  city,  and  in  every  position  which  he  occupied  he  displayed 
that  conscientious,  intelligent  and  disinterested  devotion  to  duty  which 
characterized  all  his  public  and  private  acts  and  made  his  services  invalu- 
able to  the  community.  He  was  a  member  of  St.  John's  Episcopal 
church,  and  of  Cohoes  Lodge  No.  ri6,  F.  and  A.  M. 

On  September  22,  1891,  Dr.  Featherstonhaugh  married  Caroline  M., 
daughter  of  the  late  Robert  Johnston  of  Cohoes. ,  No  children  were  born 
to  them  but  their  married  life  was  marked  by  mutual  devotion  and  the 
tenderest  attachment,  and  there  can  be  little  doubt  that  the  knowledge 
that  her  husband  was  suffering  from  a  progressive  and  necessarily  fatal 
disease  shortened  the  life  of  the  devoted  wife  if  indeed  it  did  not  directly 
induce  the  seizure  which  terminated  an  ailment  that  had  long  been  recog- 
nized as  grave  but  had  not  greatly  interferred  with  her  comfort  or  with 
the  discharge  of  her  ordinary  household  and  social  duties.  She  died 
April  4,  1905,  and  up  to  within  a  few  days  of  her  death  had  been  actively 
engaged  in  ministering  with  loving  devotion  to  her  husband's  needs. 

Dr.  Featherstonhaugh 's  illness  dated  from  September,  1904.  Follow- 
ing the  lifting  of  a  heavy  weight,  which  he  regarded  as  the  cause  of  his 
difficulty  but  which  in  reality  may  have  but  rendered  active  a  latent 
tendency,  he  suffered  from  severe  pain  in  the  vicinity  of  the  hip-joint 
which  he  attributed  to  the  rupture  of  a  ligament  or  some  similar  lesion. 
During  the  fall  he  was  able  to  go  about  with  the  aid  of  crutches  but  with 
the  approach  of  winter  his  condition  grew  more  serious,  the  pain  became 
more  constant  and  distressing,  and  he  reluctantly  gave  up  his  work  and 
resigned  himself  to  his  bed.  A  consultation  was  held  and  his  disease 
diagnosed  but  since  no  relief  by  operation  was  possible  it  was  deemed 
wisest  by  his  friends  not  to  inform  him  of  his  condition  and.  almost  to  the 
end  he  was  encouraged  and  sustained  by  the  hope  of  recovery  and  in 
making  plans  for  the  future.  The  wisdom  of  such  a  concealment,  amount- 
ing almost  to  a  deception,  may  be  doubted  by  some,  but,  since  his 
affairs  were  in  order  and  no  interests  could  suffer,  those  who  knew  him 
best  were  clearly  of  opinion  that  it  was  the  wisest  course,  to  pursue.  The 
death  of  his  wife  was  a  great  blow,  and  the  last  time  he  left  his  room  it 
was  to  sit  by  her  casket  during  the  funeral  services  which  were  held  at  the 
house  and  which  preceded  those  at  the  church  on  the  opposite  side  of  the 
street.  These  he  was  able  to  watch  from  the  window  by  his  bed,  and  to 
this  bed  he  returned  never  to  leave  it  again.  During  the  spring  he  was 
entertained  by  visits  from  his  friends,  by  reading  and  being  read  to,  and 
when  not  in  pain  or  depressed  by  the  remedies  given  to  relieve  his  suffer- 
ing, he  was  wonderfully  cheerful  and  courageous,  enduring  all  his  trials 
with  infinite  patience  and  a  real  Christian  fortitude.  Gradually  his 
strength  failed  and  despite  all  that  the  loving  ministrations  of  relatives 
and  friends,  the  untiring  devotion  of  his  professional  advisers,  and  the 
intelligent  and  helpful  services  of  a  devoted  nurse  could  do  he  continued 
to  fail  and  finally  passed  quietly  away  on  the  afternoon  of  Saturday, 
October  21,  1905.  On  Tuesday,  October  24,  prayers  were  read  at  his 
residence  after  which  funeral  services  were  held  at  St.  John's  Episcopal 
church,  of  which  he  was  a  communicant,  conducted  bv  the  rector.  Dr. 


294 


IN  MEMORIAM 


F.  S.  Sill,  assisted  by  Dr.  O.  H.  Walser,  pastor  of  the  Reformed  Dutch 
Church,  of  which  his  wife  had  been  a  member.  The  bearers  were  Messrs. 
E.  Lansing,  D.  C.  McElwaine  and  E.  D.  Hay  ward  of  Cohoes,  and  Mr. 
E.  D.  Ronan,  and  Drs.  W.  H.  Murray  and  W.  G.  Tucker  of  Albany. 
Both  of  his  brothers,  Dr.  Thomas  Featherstonhaugh  of  Washington, 
and  Mr.  George  W.  Featherstonhaugh  of  Schenectady,  were  present,  and 
a  large  circle  of  relatives  and  intimate  friends,  professional  associates  and 
representative  citizens  filled  the  church  and  bore  testimony  by  their 
presence  to  the  respect  in  which  he  was  universally  held.  His  body  was 
interred  in  the  Albany  Rural  Cemetery  by  the  side  of  his  wife.  A  special 
meeting  of  the  Medical  Society  of  the  County  of  Albany  was  held  on  the 
ensuing  day,  at  which  his  many  professional  friends  found  opportunity  to 
express  their  admiration  of  his  character  and  sorrow  at  his  death,  and  a 
committee  consisting  of  Drs.  Archambeault,  Witbeck,  Mitchell,  Curtis 
and  Murray  was  appointed  to  prepare  a  memorial  minute  for  entry  upon 
the  records  of  the  society  to  the  successful  conduct  of  which  he  had  so 
largely  contributed. 

And  so  has  passed  from  earth  one  who  while  he  lived  did  much  to 
enrich  it.  Dr.  Featherstonhaugh  was  a  gentleman  of  the  old  school  and 
of  the  best  type.  Gentle  in  his  bearing,  unfailing  in  his  courtesy,  elegant 
in  his  manners,  distinguished  in  his  address,  never  aggressive  nor  osten- 
tatious but  always  receiving  the  respect  which  was  clearly  his  due,  he 
naturally  attracted  attention  and  made  many  friends.  And  those  who 
came  to  know  him  well  recognized  in  him  those  peculiar  tastes  and  traits 
which  made  his  conversation  delightful  and  his  sympathy  so  broad  and 
deep.  He  had  the  true  scholar's  love  of  literature  and  for  the  books  in 
which  the  world's  best  thought  is  enshrined.  His  retentive  memory 
enabled  him  to  quote  passages  from  his  favorite  authors  when  occasion 
rendered  it  appropriate,  and  his  conversation  was  enlivened  and  enriched 
by  such  quotations  and  by  similes  and  references  drawn  often  from 
foreign  writers  yet  in  a  way  so  natural  and  unaffected  as  to  be  free  from 
any  savor  of  pedantry.  He  was  fond  of  nature  and  no  less  fond  of  art 
and  being  denied,  by  the  demands  that  his  practice  made  upon  his  time, 
opportunities  for  travel  abroad  or  extended  travel  at  home,  he  surrounded 
himself  with  pictures,  curios  and  works  of  art,  and  he  derived  a  deep  if 
simple  pleasure  from  frequent  visits  to  the  White  Mountains,  the  Catskills 
and  other  much-loved  spots.  Everything  beautiful  appealed  to  him 
whether  in  art,  literature,  nature  or  character,  and  he  derived  a  genuine 
and  refined  pleasure  in  dwelling  upon  beautiful  things,  but  his  mind  wras 
open,  his  disposition  tolerant  and  his  spirit  catholic,  so  that  he  recognized 
the  good  in  everything  and  could  fellowship  with  honest  men  wherever 
he  found  them.  During  his  last  illness  his  mind  turned  often  to  the 
essentials  of  religious  faith  and  he  found  great  comfort  in  re-stating  his 
belief  in  Christianity  and  its  promise  of  a  future  life,  but  this  he  did 
neither  assertively  nor  dogmatically  but  deferentially  and  modestly 
and  in  this  spirit,  courageously  but  resignedly,  he  passed  from  the  known 
to  the  unknown  "in  the  comfort  of  a  reasonable  religious  and  holy  hope, 
in  favor  with  God,  and  in  perfect  charity  with  the  world." 


CURRENT  MEDICAL  LITERATURE 


295 


John  U.  Haynes,  M.D. 

Dr.  John  Udolpho  Haynes,  one  of  the  best  known  residents  of  Cohoes, 
died  February  23,  1906,  after  an  illness  which  extended  over  two  years. 
Dr.  Haynes  was  born  in  Nassau,  Rensselaer  county,  and  was  fifty-six 
years  of  age.  He  received  his  medical  education  at  the  Albany  Medical 
College,  from  which  institution  he  graduated  in  the  class  of  1872.  Thirty- 
three  years  ago  Dr.  Haynes  began  practice  in  Cohoes,  and  had  been  a 
practitioner  until  a  short  time  ago.  He  was  a  member  of  the  Albany 
County  Medical  Society  and  also  of  the  State  Medical  Society.  Dr. 
Haynes  was  a  public  spirited  citizen;  served  terms  as  alderman  and 
school  commissioner,  and  was  otherwise  connected  with  the  public  life 
of  Cohoes.  He  was  a  member  of  the  Silliman  Memorial  Presbyterian 
church,  and  one  of  the  trustees  of  that  church.  In  1875  he  married  Miss 
L.  C.  Hayward,  who  died  fourteen  years  ago.  One  sister,  Mrs.  Mary 
Warden  of  Rensselaer,  and  his  brother-in-law,  Dr.  Edward  Hayward. 
superintendent  of  the  public  schools  of  Cohoes.  survive. 


Current  /IDeMcal  literature 

REVIEWS  AND  NOTICES  OF  BOOKS 

Differential  Diagnosis  and  Treatment  of  Disease.  A  Textbook  for  Prac- 
titioners and  Advanced  Students.  By  Augustus  Caill£,  M.D.  D. 
Appleton  &  Company,  New  York  and  London,  1906. 

"To  bring  the  broad  domain  of  practical  medicine  within  the  grasp 
of  the  family  physician  and  to  assist  the  advanced  student  in  acquiring 
clinical  foundation"  has  been  the  aim  of  the  author  in  writing  this  book, 
which  is  intended  to  be  of  value  in  conveying  clinical  experience  "without 
the  exhaustive  and  often  purely  theoretical  details  to  be  found  and 
sought  for  in  monographs."  It  is  also  intended  "  to  re-establish  the  rela- 
tions of  internal  medicine,  surgery  and  the  several  specialties  " 

All  this  is  well,  but  it  is  to  be  feared  that  the  book  does  not  realize 
the  high  hopes  of  the  author  and  publishers.  The  arrangement  of  the 
subject  matter  is  complicated  and  unsatisfactory,  the  different  subjects 
have  not  been  considered  with  detail  at  all  proportionate  to  their  import- 
ance, the  illustrations  are  exceedingly  poor,  manv  omissions  of  import- 
ance are  to  be  noted  and  worst  of  all  many  serious  errors  are  to  be  found 
in  the  text.  If  the  author  had  not  attempted  to  cover  so  much  ground 
or  had  not  had  "the  bulk  of  the  work  from  his  pen,"  the  result  might 
have  been  better. 

The  book  is  prefaced  by  an  introduction  in  which  the  author  discusses 
the  present  day  status  of  medical  affairs  and  especially  the  position  of 
the  general  practitioner  in  his  relations  to  his  patients  and  to  specialists 
and  specialism.  We  hesitate  to  think  that  medical  affairs  are  in 
such  a  sad  state  as  he  attempts  to  prove. 

Dr.  CaiHe  advocates  the  divorce  of  obstetrics  and  general  practice  tor 
the  main  reason  that  a  "  general  practitioner  i9  at  all  times  in  contact 


2C)6 


CURRENT   MEDICAL  LITERATURE 


with  contagious  or  communicable  diseases  and  may,  in  fact  does,  infect 
parturient  women,"  when  "he  comes  from  a  case  of  scarlet  fever 
or  erysipelas."  In  almost  the  next  paragraph  however  he  says,  "to 
counterbalance  the  deficit  which  must  result  from  the  loss  of  fees  for 
obstetrical  work,  the  general  practitioner  will  have  time  and  ambition  to 
practice  minor  surgery.  The  practice  of  minor  surgery  is  easy  and  it  is 
generally  more  impressive  to  the  laity  than  the  writing  of  a  prescription 
for  a  lot  of  useless  superfluous  drugs.  Just  how  far  the  general  practi- 
tioner may  go  in  the  practice  of  surgical  handicraft  will  depend  upon  the 
taste  and  fancy  of  the  individual."  What  is  the  difference  between 
infecting  a  parturient  woman  and  infecting  a  patient  in  the  course  of 
practice  of  easy  and  impressive  surgical  handicraft? 

Chapter  1  and  chapter  I,  concluded,  deal  with  the  general  subject  of 
diagnosis  in  the  general  and  laboratory  bearing.  The  author  says,  "It 
should  be  the  aim  of  every  general  practitioner  to  become  a  good  all 
around  diagnostician,  and  if  he  fails  in  this  let  him  drift  into  a 
specialty." 

As  a  whole  this  chapter  is  very  unsatisfactory,  especially  the  parts 
devoted  to  laboratory  methods.  Much  useless  matter  is  here  presented 
and  many  things  are  omitted.  The  statement  that  "cylindroids  from  the 
urine  of  cystitis  have  the  same  significance  as  hyaline  casts"  is  certainly 
a  new  view.  When  he  states  that  "  white  or  clay  colored  stools  are  due 
to  alcoholic  conditions  in  which  there  is  an  obstructive  jaundice,"  does 
he  mean  alcoholic?  Animal  parasites  are  very  briefly  and  very  poorly 
described.  Among  other  matters  for  comment  are  the  following :  In 
the  section  upon  sputum  are  found  these  two  sentences,  which  in  the  case 
of  the  latter  is  the  only  description  of  the  body.  "Actinomyces  colonies 
appear  as  small  white  partly  calcified  granules  resisting  considerable 
pressure;"  "Curschman's  spirals  can  usually  be  detected  by  the  naked 
eye  as  whitish  opaque  spiral  threads  1-10  millimeters  in  length."  In  the  dis- 
cussion of  the  examination  of  pharyngeal  exudate  for  diphtheria  bacilli 
occurs  the  sentence,  "the  morphological  characterises  must  be  typical  " 
but  nowhere  does  he  give  the  slightest  hint  as  to  what  these  are. 

Chapter  II  is  headed  "  General  Therapeutical  Management."  The 
author's  principal  therapeutic  remedies  seem  to  be  enteroclysis,  calomel 
and  quinine  aa  gr.  x.  given  either  at  the  onset  of  any  disease  or  as  a 
"therapeutic  feeler"  in  the  course  of  any  fever,  and  "five  drops  of  dilute 
hydrochloric  acid  in  sweetened  water  after  meals  to  aid  digestion."  These 
remedies  seem  to  have  his  almost  universal  use.  Under  diaphoretics  he 
says,  "The  most  powerful  diaphoretic  drug  is  pilocarpine  which  may  be 
given  in  one  twelfth  to  one  eighth  grain  doses  to  children  and  adults  every 
two  or  three  hours  until  the  desired  effect  is  produced." 

Chapter  III  is  devoted  to  Paediatrics.  We  do  not  agree  with  the 
author  in  his  statement  in  regard  to  the  little  value  of  bacteriological 
examinations  of  throat  cultures  in  diphtheria.  Would  it  be  too  much  to 
inquire  why  masturbation  in  infants  is  placed  under  the  general  heading 
of  eruptive  fevers,  to  say  nothing  of  vulvo-vaginitis  and  malaria.  The 
classification  of  meningitis  is  extremely  poor.  The  subject  of  cretinism 
demands  too  a  better  discussion  than  it  here  receives. 


CURRENT  MEDICAL  LITERATURE 


297 


Chapters  IV  to  X  inclusive  are  devoted  to  the  digestive  system.  Under 
appendicitis  the  author  says  "  One  broad  rule  governing  the  question  of 
operative  interference  in  appendicitis  should  be  not  to  operate  in  chronic 
cases  unless  you  can  feel  the  diseased  appendix,  nor  in  acute  cases  unless 
by  palpation  you  can  recognize  either  the  diseased  appendix  or  the  pres- 
ence of  a  tumor.  Anaesthesia  may  be  necessary  in  exceptional  instances 
to  decide  the  question."  Were  this  rule  adhered  to  it  is  to  be  feared 
that  the  present  mortality  from  this  condition  would  be  even  greater  than 
it  is.  Perhaps  this  is  an  example  of  the  minor  surgery  which  a  general 
practitioner  should  do.  "Gall-stones  may  be  divided  into  two  classes, 
those  produced  by  the  colon  bacillus  and  those  bv  the  typhoid  bacillus." 
Acute  haemorrhagic  pancreatitis  is  discussed  in  nine  lines  ;  surgical  treat- 
ment is  not  mentioned.  Intestinal  parasites  deserve  a  more  thorough 
and  accurate  discussion  than  they  receive  especially  in  view  of  their  more 
general  presence  in  this  country  since  the  acquisition  of  tropical  terri- 
tory by  the  United  States,  and  the  notable  work  of  Stiles  in  the  United 
States  and  Ashburn  in  Porto  Rico  upon  the  Uncinaria  Americana  or  hook- 
worm. 

Chapters  XI  to  XIV  inclusive  arc  devoted  to  the  circulatory  system. 
Personally  we  see  no  reason  for  placing  all  the  diseases  of  the  blood  in 
this  section,  but  this  may  perhaps  be  a  matter  for  discussion ;  however, 
there  is  surely  no  reason  for  including  the  discussion  of  all  oedemas,  or 
collections  of  fluids,  cystic  or  otherwise,  among  which  may  here  be  found 
such  diverse  conditions  as  hydrocephalus,  spina  bifida,  pulmonary  oedema, 
malignant  oedema  (and  anthrax)  myxoedema  (?)  hydatid  cysts 
hydronephrosis  and  retention  cysts  of  the  kidney,  hydrosalpinx,  ovarian 
cysts,  etc.  Chronic  endocarditis  is  considered  separately  from  chronic 
valvular  disease.  Under  diagnostic  methods  the  author  considers  a  stetho- 
scope as  only  "an  aid  to  a  dull  ear."  lie  advises  the  exploratory  needle 
puncture  of  a  suspected  aneurysm  as  a  routine  method  of  examination. 
Under  a  treatment  of  aneurysms  he  make  no  mention  of  the  Tufnell  diet 
or  other  dietetic  methods. 

Septicaemia  and  pyaemia  are  briefly  referred  to  in  this  section,  but 
septic  wounds  are  found  under  miscellaneous  affections  in  Chapter  XXXI. 

Chapters  XV  and  XVI  are  given  over  to  the  respiratory  system.  We 
notice  here  under  acute  lobar  pneumonia  a  new  classification*  for  the 
stages  of  pneumonic  consolidation.  It  is,  one.  catarrhal  stage;  two, 
haemorrhagic  stage ;  three,  stage  of  red  hepatization ;  four,  stage  of  reso- 
lution. He  says  "  The  haemorrhagic  stage  is  followed  by  a  stage  of  red 
hepatization;  the  alveoli  become  filled  with  red  blood  corpuscles  and  fibrin. 
The  latter  coagulates  and  the  whole  haemorrhagic  contents  of  the  alveolus 
becomes  a  firm  red  plug.  In  the  stage  of  resolution  the  fibrin  undergoes 
granular  disintegration  and  the  cells  undergo  fatty  metamorphosis." 

In  chapters  XVII  to  XIX  inclusive  the  Genito-Urinary  System  is  dis- 
cussed including  gynecology. 

Chapters  XX  to  XXV  inclusive  are  devoted  to  the  osseous  and  muscular 
and  articular  systems,  including  orthopedic  memoranda,  massage,  Swedish 
movements,  hot  air  treatment,  etc. 

Chapter  XXV  is  given  over  to  infectious  and  contagious  fevers.    As  a 


298 


CURRENT  MEDICAL  LITERATURE 


whole  this  section  is  pretty  good  but  there  are  several  points  which  we 
feel  need  comment.  We  fail  to  see  the  necessity  for  disinfecting  an 
ambulance  in  which  a  typhoid  fever  case  has  been  transported.  It  is 
surprising  to  find  that  the  author  states  that  the  pulse  in  (uncomplicated) 
cases  of  typhoid  fever  rises  to  no  in  the  first  week  of  the  disease  and 
to  120  to  130  in  the  second  week,  as  it  is  pointed  out  by  all  authorities 
that  in  this  disease  the  pulse  is  usually  very  low  in  proportion  to  the 
temperature  and  rarely  exceeds  100  to  no  per  minute.  In  the  tempera- 
ture and  pulse  chart  which  accompany  the  article  we  note  that  the  pulse 
never  but  cnce  exceeds  no  and  rarely  reaches  100.  In  the  discussion  of 
malarial  fever,  both  in  irs  clinical  and  laboratory  aspects,  the  malarial 
parasite  is  never  described,  nor  are  any  definite  statements  made  in  regard 
to  the  nature  of  the  infecting  organism.  In  the  author's  remarks  upon 
yellow  fever  however,  the  most  striking  omissi6ns  and  errors  are  found. 
The  author  credits  the  bacillus  of  Sanarelli  as  being  the  probable  causa- 
tive agent  and  dwells  upon  the  positive  agglutinative  reaction  of  the  blood 
against  this  organism.  He  says,  '  The  infection  is  disseminated  by  the 
excreta  and  by  the  mosquitoes  which  carry  the  blood  and  inoculate  those 
who  are  subsequently  attacked."'  He  refers  briefly  in  the  discussion  of 
the  prophylaxis,  to  the  "drainage  and  attention  to  other  details  of  the 
health  of  a  city'*  as  exemplified  by  Havana,  but  he  says  not  a  word, 
except  those  in  italics,  upon  the  etiology  and  mode  of  transmission  of  the 
disease  mosquitoes  as  based  upon  the  work  or  the  United  States  Army 
Board  in  Cuba  and  their  epoch  making  studies,  and  leaves  one  the  impres- 
sion that  yellow  fever  is  transmitted  from  person  to  person  very  much  as 
is  typhoid  fever. 

Such  errors  in  an  American  work  are  well  nigh  inexcusable. 

Chapter  XXVI  concerns  diseases  due  to  faulty  metabolism,  to  faulty 
internal  secretions  and  to  derangements  of  the  ductless  glands.  Chapter 
XXVII  deals  with  the  diseases  of  the  nervous  system  in  which  are  dis- 
cussed puerperal  eclampsia  and  sleeping  sickness  ( Trypanosomaisis)  among 
the  purely  neurological  ailments.  Chapters  XXVIII  to  XXX  are  headed 
respectively — Dermatological  memoranda, Otic  memoranda  and  Ophthalmic 
memoranda.  Chapter  XXXI  deals  with  miscellaneous  affections  which 
for  reasons  best  known  to  the  author,  were  not  considered  eleswhere. 
In  Chapter  XXVIII  we  note  the  author  considers  elephantiasis  under 
vegetable  parasitic  skin  diseases. 

The  illustrations  with  which  the  book  abound  may  be  divided  into  the 
following  classes :  One,  those  that  would  not  show  anything  of  value 
were  the  photographs  well  taken  or  the  plates  well  reproduced;  two,  those 
that  are  useless  on  account  of  the  photographs  being  poorly  taken,  (light- 
ing or  arrangement  of  subject)  or  the  plates  poorly  made;  three, 
satisfactory  illustrations.  The  last  class  is  by  far  the  smallest.  In  the 
photographs  several  are  apparently  excellent  portraits  of  nurses  or  the 
attending  physicians  in  the  clinics  but  this  feature  hardly  makes  them 
suitable  illustrations  for  a  text  book. 

The  book  contains  many  good  sections  but  they  p.re  so  buried  in  material 
of  less  merit  that  they  are  difficult  to  find. 

c.  k.  w..  JR. 


CURRENT    MEDICAL  LITERATURE 


299 


Cleft  Palate  and  Hare  Lip.  By  \V.  Arbuthnot  Lane,  M.S.,  F.R.C.S., 
Surgeon  to  Guy's  Hospital,  and  Senior  Surgeon  to  the  Hospital  for 
Children,  Great  Ormond  Street.  The  Medical  P  Company,  Limited, 
London.  1905. 

In  this  extremely  and  interesting  and  valuable  monograph  the  author 
begins  with  a  careful  study  of  the  factors  which  influence  the  growth 
of  the  naso-pharnyx  and  the  mouth  and  the  bones  which  surround  these 
cavities.  He  demonstrates  conclusively  that,  the  mechanical  influence 
of  the  passage  of  air  is  of  the  greatest  importance  in  the  development 
not  only  of  the  naso-pharynx.  but  also  to  the  bones  of  the  face.  Sec- 
ondary to  such  disturbances  of  development  the  jaws  become  more  or 
less  misshapen  and  the  teeth  irregular  and  deformed.  The  influence  of 
faulty  development  of  the  mouth  and  naso-pharynx  upon  the  general 
attitude  of  the  patient  is  pointed  out  and  certain  postural  deformities 
are  shown  to  bear  direct  relationship  to  them. 

When,  as  in  cleft  palate,  the  septum  between  the  mouth  and  the  naso- 
pharynx is  incomplete  the  development  of  the  bones  of  the  jaws  and  face 
will  be  more  or  less  faulty  and  deformed.  This  demonstrates  the  neces- 
sity for  the  correction  of  such  deformities  as  early  in  life  as  possible. 
The  writer  calls  attention  to  the  generally  accepted  belief  that  the  most 
favorable  time  for  such  operations  is  between  the  ages  of  three  and  six, 
and  states  it  as  his  belief  that  this  is  an  untrue  statement  and  a  dangerous 
doctrine.  He  urges  the  performance  of  the  operation  for  cleft  palate 
as  soon  after  birth  as  possible,  preferably  within  a  day  or  two.  The 
hemorrhage  is  insignificant,  the  capacity  for  repair  is  the  best,  the  diges- 
tion unimpaired  and  the  risk  of  life  ordinarily  trivial. 

The  operation  performed  by  the  writer  is  described  in  detail,  the  essen- 
tial characteristic  of  it  being  the  raising  of  a  flap  upon  one  side  of  the 
cleft  sufficiently  large  to  completely  close  the  opening.  He  advises  the 
closure  of  the  cleft  palate  first  in  all  cases,  the  closure  of  the  hare  lip,  if 
one  exists,  being  left  until  the  palate  is  healed.  The  monograph  is  well 
illustrated, -and  on  the  whole  is  perhaps  the  most  satisfactory  presentation 
of  the  subject  which  has  yet  appeared.  a.  w.  e. 


Abdominal  Operations.  By  B.  G.  A.  Moynihan,  M.  S.  (London),  F. 
R.  C.  S.,  Senior  Assistant  Surgeon  to  Leeds  General  Infirmary,  Eng- 
land. Octavo  of  695  pages,  with  250  original  illustrations.  Phila- 
delphia and  London :  W.  B.  Saunders  &  Company,  1905  Cloth, 
$1.00  net. 

This  volume  represents  largely  the  author's  methods  of  abdominal  opera- 
tions as  based  upon  his  own  experience.  No  gynecological  operations 
are  described,  nor  is  the  surgery  of  those  organs.,  such  as  the  kidney  and 
bladder,  which  are  partly  intraperitoneal  and  partly  extraperitoneal, 
included.  No  mention  is  made  of  the  operations  for  hernia.  The  volume 
i:  subdivided  into  five  sections. 

Section  cne  presents  the  so-called  "general  considerations,"  such  as  the 


3oo 


CURRENT  MEDICAL  LITERATURE 


preparation  of  operator  and  patient,  the  complications  of  abdominal  opera- 
tions, modes  of  incision  of  the  abdomen,  the  operations  for  peritonitis, 
subphrenic  abscess,  penetrating  wounds  and  visceral  prolapse.  The  tech- 
nique described  is  excellent  and  the  methods  proposed  are  on  the  whole 
satisfactory. 

Section  two  deals  with  the  operations  upon  the  stomach,  which  have 
come  to  play  such  an  important  role  in  abdominal  work.  In  this  section 
the  author  is  perhaps  at  his  best,  because  of  his  wide  experience. 

In  section  three  the  operations  upon  the  intestine  are  described.  Neither 
in  this  nor  the  preceding  section  is  any  mention  made  of  mechanical 
devices  for  intestinal  anastomosis.  The  author  distinctly  states  that  this 
omission  is  deliberate,  because  he  regards  these  devices  as  of  historical 
interest  only,  their  practical  utility  having  ceased ;  a  view  to  which  many 
surgeons  will  not  readily  subscribe. 

In  section  four  operations  upon  the  liver  and  bile  passages  receive 
adequate  consideration,  and  here,  too,  the  author's  vast  personal  experience 
makes  his  methods  of  especial  value. 

The  concluding  section  deals  with  the  operations  upon  the  pancreas  and 
spleen,  and  presents  the  rather  limited  surgery  of  these  organs  in  a 
satisfactory  fashion. 

Practically  no  attention  is  paid  to  etiology,  pathology,  diagnosis  or  prog- 
nosis of  the  conditions  referred  to  in  the  volume,  the  subject  matter  being 
occupied  entirely  with  the  more  practical  side  of  abdominal  surgery.  The 
views  of  other  surgeons  are  not  infrequently  presented,  but  that  method 
is  always  regarded  as  the  best  which  has  proven  of  the  greatest  service 
in  the  hands  of  the  author,  so  that  his  individuality  is  stamped  upon  every 
page.  While  the  volume  presents  comparatively  little  that  is  new,  it  is 
nevertheless  a  valuable  contribution  to  the  subject  of  abdominal  sur- 
gery and  will  prove  a  handy  reference  book  for  the  surgeon. 

It  contains  694  pages  and  235  illustrations  and  is  in  every  way  a  splendid 
example  of  book  making.  The  illustrations  are  well  executed  and  add 
greatly  to  the  value  of  the  work.  To  every  practicing  surgeon  the  volume 
will  be  welcome  because  it  presents  the  results  of  the  experience  of  one 
of  the  best  surgeons  of  this  generation.  a.  w.  e. 


Minor  and  Operative  Surgery,  including  Bandaging.  By  Henry  R.  Whar- 
ton, M.  D.,  Professor  of  Clinical  Surgery  in  the  Woman's  College; 
Surgeon  to  the  Presbyterian  Hospital,  Philadelphia,  etc.  New  (6th) 
edition,  enlarged  and  thoroughly  revised.  In  one  i2mo  volume  of 
642  pages,  with  532  illustrations.  Cloth,  $3.00,  net.  Lea  Brothers 
&  Co.,  Publishers,  Philadelphia  and  New  York,  1905. 

Wharton's  Surgery  does  not  need  an  introduction  to  the  student  or 
practitioner  of  medicine.  It  has  been  too  long  before  the  medical  world 
not  to  be  well  known,  and  that  the  book  is  needed  and  appreciated  is 
attested  by  the  fact  that  this  is  the  sixth  edition  of  the  work. 

It  comes  from  the  publisher's  hands  with  a  new  name,  both  title  and 
scope  being  broadened,  and  will  no  doubt  meet  the  greater  demands 


CURRENT   MEDICAL   LITERATURE  301 

made  upon  it.  This  edition  takes  up  Minor  and  Operative  Surgery  and 
includes  Bandaging. 

The  subject  of  bandaging  is  treated  in  detail,  after  giving  some  general 
considerations  as  definitions,  varieties  of  bandages,  etc.  Bandages  for 
every  part  of  the  body  are  carefully  described,  the  name,  dimensions, 
method  of  application  and  use  being  given.  Excellent  illustrative  plates 
accompany  each  description  and  aid  not  a  little  toward  a  more  ready 
understanding  of  some  of  the  different  bandages.  Some  valuable  points 
may  be  obtained  from  reading  the  chapter  on  hardening  bandages,  as 
this  deals  with  the  method  of  preparation  and  application  of  plaster  of 
Paris  dressings. 

Part  II  takes  up  Minor  Surgery,  and  under  this  heading  are  included 
materials  used  in  surgical  dressings,  most  of  the  minor  surgical  proced- 
ure's, the  x-rays,  anesthetics,  catheters  and  bougies,  treatment  of  hem- 
orrhages, shock,  abscess,  wounds,  burns,  scalds  and  sprains. 

In  Part  III  are  considered  asepsis  and  antisepsis,  and  there  is  a  thorough 
discussion  in  regard  to  surgical  bacteriology,  included  under  which  are 
immunity  and  varieties  of  bacteria,  and  the  agents  employed  for  the 
destruction  of  the  latter,  also  a  detailed  description  of  the  preparation 
of  materials  used  in  aseptic  operations. 

Parts  IV  and  V  deal  with  fractures  and  dislocations  respectively,  and 
in  each  a  concise  manner  give  the  more  improved  methods  for  treating 
each. 

Part  VI  treats  of  ligation  of  the  more  important  arteries,  and  Part 
VII  of  amputations. 

Part  VIII,  the  last  portion  of  the  book,  deals  with  excisions  and 
resections  and  some  of  the  special  operations.  Under  the  latter  the 
author  includes  a  number  of  operations  which  are  frequently  required  in 
practice,  such  as  the  operations  for  strangulated  hernia,  appendicitis,  also 
tracheotomy  and  intubation  of  the  larynx. 

Just  why  some  major  operative  procedures  are  included  and  others 
omitted,  is  hard  to  say,  although  the  author  undoubtedly  included  those 
which  he  considered  necessary.  As  only  a  few,  comparatively,  of  the 
special  operations  are  described,  there  is  no  attempt  made  of  a  proper 
classification,  and  this  gives  the  closing  chapter  of  the  book  a  somewhat 
jumbled  appearance. 

There  are  over  six  hundred  pages  in  the  volume  and  it  is  plentifully 
supplied  with  good  illustrative  plates.  The  index  at  the  back  is  well 
done.  e.  f.  s. 


A  Text-Book  of  Physiology.  For  Medical  Students  and  Physicians.  By 
William  H.  Howell,  Ph.  D.,  M.  D.,  LL.  D.,  Professor  of  Physi- 
ology, Johns  Hopkins  University,  Baltimore.  Octavo  volume  of 
005  pages,  fully  illustrated.  Philadelphia  and  London:  W.  B. 
Saunders  &  Company,  1005.  Cloth.  $4.00  net;  Half  Morocco, 
$5.00  net. 


A  volume  of  886  pages  with  271  illustrations  which  presents  the  funda- 
mental facts  of  physiology,  its  principles  and  mcde  of  reasoning,  in  so 


302  CURRENT  MEDICAL  LITERATURE 

clear  and  comprehensive  a  manner  that  it  must  be  considered  the  most 
satisfactory  of  English  textbooks  on  this  subject 

The  writer,  in  order  to  reduce  the  vast  knowledge  of  physiology  to  the 
needs  of  the  elementary  student  has  adopted  a  policy  of  elimination  and 
selection  rather  than  one  of  condensation.  The  results  of  this  method 
are  most  happy.  Dr.  Howell  has  not  been  content  with  the  presentation  of 
the  well  known  principles  of  physiology  concerning  which  there  is  a 
unanimous  opinion  but  has  attempted  also  to  bring  the  student  in  touch 
with  those  problems  which  indicate  the  continual  readjustment  of  the 
theories,  not  only  of  physiology,  but  of  medicine  in  general.  Short 
historical  resumes  give  the  student  a  knowledge  of  the  development  of 
various  phases  of  physiology  while  well  selected  references  offer  him  an 
opportunity  to  readily  examine  original  sources. 


Nervous  and  Mental  Diseases.  By  Archibald  Church,  M.  D..  Professor 
of  Nervous  and  Mental  Diseases  and  Medical  Jurisprudence  in 
Northwestern  University  Medical  School.  Chicago;  and  Fred- 
erick Peterson,  M.  D.,  President  of  the  State  Commission  in 
Lunacy,  New  York;  Clinical  Professor  of  Neurology  and  Psychia- 
try, Columbia  University.  Fifth  edition,  revised  and  enlarged.  Octavo 
volume  of  937  pages,  with  341  illustrations.  Philadelphia  and  Lon- 
don ;  W.  B.  Saunders  &  Company.  T005.  Cloth.  $5.00  net ;  Half 
Morocco,  $6.00  net. 

The.  eminently  practical  character  of  this  work  justifies  its  popularity 
and  explains  the  rapid  issue  of  necessary  editions — five  in  five  years.  Dr. 
Church  has  prepared  chapters  on  Zoster,  in  conformity  with  Head's 
investigations,  Hereditary  Trophic  Oedema,  Intermittent  Limping,  Family 
Pereodic  Paralysis  and  Family  Tremor.  Dr.  Peterson  gives  a  short  out- 
line of  his  understanding  of  Dementia  Praecox  and  Manic  Depressive 
Insanity,  but  with  rare  good  judgment  in  these  days  of  stress,  adheres 
to  his  original  plan  of  a  comprehensible  description  of  mental  disorders, 
the  philosophical  description  of  the  views  of  the  German  School  being 
arrayed  in  parenthetical  small  type,  so  that  the  reader  interested  may 
study  this  academic  disquisition  if  he  desires. 


Modern  Clinical  Medicine.  Diseases  of  Metabolism  and  of  the  Blood, 
Animal  Parasites,  Toxicology,  Edited  by  Richard  C.  Cabot,  M.  D., 
Instructor  in  Clinical  Medicine  in  the  Medical  School  of  Harvard 
University.  An  authorized  translation  from  "Die  Deutsche 
Klinik,"  under  the  General  Editorial  Supervision  of  Julius  L.  Sal- 
inger, M.  D.  With  one  colored  plate  and  fifty-eight  illustrations  in 
the  text.  New  York  and  London :  D.  Appleton  &  Company,  1006. 

A  volume  of  649  pages,  translated  directly  from  "  Die  Deutsche  Klinik  " 
and  comprising  nineteen  contributions  concerning  Constitutional  Diseases. 
Except  in  chapters  devoted  to  diseases  of  the  Blood,  practically  no  changes 
have  been  made  by  the  editor. 

The  subjects  treated  are  as  follows  : 

The  Quantitative  Analysis  ot  Disturbances  of  Metabolism  in  the  Clinic 


CURRENT  MEDICAL  LITERATURE  303 

(Weintrand)  ;  Over-Nuitrition  and  Under-Nuitrition  (v.  Noorden)  ;  Dia- 
betes Mellitus  (Naunyn)  ;  Diabetes  Insipidus  (Gerhardt)  ;  Gout  and 
Obesity  (Ebstein)  ;  Myxedema  with  Special  Reference  to  Organotherapy 
(Ewald);  Addison's  Disease  (Reiss);  Acromegalia  (Benda);  Chronic 
Articular  Rheumatism  (W.  His)  ;  Pentosuria  (Elumenthal)  ;  Blood  and 
Blood  Examination  (Lazarus);  The  Anaemias  (Ehrlich);  Chlorosis  (E. 
Grawitz)  ;  Leukaemia  (v.  Leube)  ;  Pseudo-leukaemia  (Hodgkin's  Disease 
and  Banti's  Disease),  (Senator);  The  Haemorrhagic  Diatheses  (Litten)  ; 
The  Animal  Parasites  of  Man  (Peiper)  ;  Important  Poisons  and  Their 
Treatment  (v.  Jaksch). 

In  each  contribution  the  object  has  been  to  present  clearly  the  rationale 
oi  the  symptomatology  and  treatment  of  the  conditions  under  considera- 
tion. The  volume  is  therefor  of  inestimable  value  to  physicians  seeking 
an  authoritive  discussion  of  the  care  of  those  still  more  or  less  obscure 
conditions.  A  well  arranged  and  comprehensive  general  index  adds  greatly 
to  the  value  of  the  work. 


Lectures  on  Auto-Intoxication  in  Disease,  or  Self-Poisoning  of  the  Indi- 
vidual. By  Ch.  Bouchard,  Professor  of  Pathology  and  Therapeu- 
tics; Member  of  the  Academy  of  Medicine  and  Physician  to  the 
Hospitals,  Paris.  Translated,  with  a  Preface  and  New  Chapters 
added,  by  Thomas  Oliver,  M.A.,  M.D.,  F.R.C.P.,  Professor  of 
Physiology,  University  of  Durham ;  Physicir.n  to  the  Royal  Infirm- 
ary, Newcastle-Upon-Tyne ;  Formerly  Examiner  in  Medicine, 
Royal  College  of  Physicians,  London.  Second  Revised  Edition. 
Crown  Octavo  342  pages,  Extra  Cloth.  Price,  $2.00  net.  F.  A. 
Davis  Company,  Publishers,  1914-16  Cherry  Street,  Philadelphia. 

The  second  English  edition  of  this  work  appears  without  revision  by  Pro- 
fessor Bouchard.  While  this  has  resulted  in  the  retention  of  the  original 
text  Dr.  Oliver  by  careful  revision  of  the  translation  and  by  the  addition  of 
new  material  has  prepared  a  very  satisfactory  summary  of  the  subject  of 
auto-intoxication.  The  additions  include  paragraphs  on  the  intestinal 
toxins,  the  toxaemia  of  pregnancy,  the  toxicity  of  indol,  etc.  In  an 
appendix  Dr.  Oliver  presents  a  chapter  on  the  "Natural  Defense  of  the 
Organism  against  Disease "  and  one  on  "Auto-intoxication  of  Intestinal 
Origin.'' 


The  Physical  Exaynination  of  Infants  and  Young  Children.  By  Theron 
Wendell  Kilmer,  M.  D.,  Adjunct  Attending  Pediatric  to  the 
Sydenham  Hospital ;  Instructor  in  Pediatrics  in  the  New  York 
Polyclinic  Medical  School  and  Hospital,  New  York;  Attending 
Physician  to  the  Summer  Home  of  St.  Giles,  Garden  City,  New 
York.  Illustrated  with  59  Half-tone  Engravings.  121110.,  86  Pages. 
Bound  in  Extra  Cloth.  Price,  75  cents  net.  F.  A.  Davis  Company, 
Publishers,  1914-16  Cherry  Street,  Philadelphia,  Pa. 

The  object  of  the  author  so  stated  in  the  preface  is  to  instruct  the 
students  and  physicians  how  to  examine  a  baby.  To  accomplish  this  he 
has  prepared  the  small  treatise  before  us.    It  consists  of  eighty-five  pages 


304 


CURRENT  MEDICAL  LITERATURE 


in  all,  a  considerable  portion  of  which  is  taken  up  by  fifty-nine  half-tone 
engravings  and  a  number  of  tables.  Suspection,  palpation,  auscultation 
and  percussion  are  taken  up  in  succession  and  a  few  pages  are  devoted 
to  the  examination  of  the  throat,  nose,  ears  and  eyes.  The  author  gives 
a  number  of  valuable  suggestions  which  have  been  gleaned  from  an 
extensive  experience  with  children.  A  work  as  outlined  by  the  author 
is  much  to  be  desired  and  would  fill  a  decided  need.  Our  criticism  of  the 
present  volume  is  that  it  lacks  the  thoroughness  and  scientific  value  which 
would  be  expected  from  one  who  has  had  the  clinical  experience  of  the 
author.  h.  l.  k.  s. 

OPHTHALMOLOGY 
Edited  by  Charles  M.  Culver,  M.  D. 

Is  the  Use  of  Electric  Light  Injurious  to  the  Human  Eye? 
Drake-Brockman.    The  Ophthalmoscope  (London),  October,  /905. 

This  question  has  presented  itself  to  the  ophthalmologist,  with  increas- 
ing insistency,  since  electricity  has  become  used  as  a  source  of  artificial 
illumination.  The  author  says  that  cases  have  come  under  his  observa- 
tion, in  which  impairment  of  vision  seemed  ascribable  to  no  other  cause 
than  the  use  of  electric  light.  Such  patients  have  been,  oftenest,  young 
persons  at  schools.  Not  having  had  opportunity  to  test,  experimentally, 
the  effects  of  electric  light  on  the  optic  nerve,  the  author's  suspicions  of 
its  pernicious  influence  have  been  aroused  merely  by  clinical  observation 
of  the  cases  reported  in  this  article. 

An  article  by  Ed.  Mettey,  in  the  Archives  d' Ophthalmologic,  for  April, 
1904,  is  quoted.  The  article  was  entitled:  "Experimental  Researches  upon 
Injury,  of  the  Eye,  produced  by  Electric  Light;"  its  conclusion  is  as  fol- 
lows :  "It  may  be  assumed  that  the  human  eye,  exposed  to  electric  light, 
comports  itself  as  does  the  eye  of  rabbits  and  dogs  under  similar  circum- 
stances. Slight  cases  of  electric  dazzling,  where  recovery  is  the  rule,  are 
due  to  reparable  lesions.  On  the  other  hand,  severe  cases,  accompanied 
by  diminution  or  loss  of  visual  functions,  are  due  to  irreparable  lesions, 
leading  to  descending  degeneration  of  the  fibres  of  the  optic  nerve.  No 
definite  statement  can  be  made  as  regards  the  particular  rays  that  cause 
the  mischief." 

Sufficient  evidence  is  to  be  found,  in  the  current  medical  literature  of 
the  day,  pointing  to  the  injurious  effects  upon  the  skin  and  structures 
developed  from  epiblast,  when  these  have  been  exposed  to  the  X-rays, 
and  it  may  be  concluded  that  similar  injurious  effects  are  likely  to  be  pro- 
duced upon  the  retina  and  optic  nerve  fibres,  when  exposed  to  the  influ- 
ence of  electric  light  as  an  illuninating  agent  in  ordinary,  every-day 
work.  In  using  electricity  we  are  dealing  with  a  force  of  the  properties 
of  which  we  have  but  limited  knowledge  and  it  is  not  unreasonable  to 
fear  that,  in  the  ordinary  lighting  of  rooms  by  electricity,  and  more  so  in 
schools  and  similar  public  places,  some  rays  may  act  injuriously  on  the 
retina  and  optic  nerve  fibres,  as  they  undoubtedly  do  on  the  skin  struc- 
tures.   Concerning  this,  the  last  sentence  of  the  above  quotation  from 


CURRENT   MEDICAL  LITERATURE 


305 


Mettey's  article  is  repeated  in  the  one  being  abstracted.  The  title  of  the 
article  is  a  question  concerning  a  matter  on  which  the  author  hopes  others, 
more  capable  than  himself,  may  be  willing  to  throw  more  light.  Another 
quotation,  from  an  article  on  "Chronic  X-ray  Dermatitis"  is  made.  This 
seems  to  the  present  writer  to  be  of  doubtful  pertinency.  Six  cases  arc 
reported : 

Case  1.  Male,  aged  20,  consulted  the  author  at  the  end  of  September, 
1901,  because  of  impaired  vision  for  study  and  reading;  is  a  student  at 
a  large  public  school  where  electric  lighting '  obtains.  Vision  steadily 
failing.  When  the  right  eye  had  a  minus  sphere  and  the  left  a  minus 
cylinder,  of  one  dioptry  and  half  a  dioptry,  respectively,  the  patient  had 
normal  visual  acuity.  The  conjunctivae  were  congested  and  the  eyes 
easily  irritated  by  exposure  to  electric  light.  He  was  advised  to  abandon 
the  use  of  electric  light  and  to  use  a  good  kerosene  lamp  or  candles. 
The  patient  reported  later  that  he  had  acted  on  that  advice  and  that  all 
inconvenience  had  ceased. 

Case  2.  Male,  aged  18,  consulted  the  author  in  April,  1904;  was  a  stu- 
dent undei  similar  conditions  with  those  of  Case  1 ;  was  studying  for  the 
army,  needed  to  use  electric  light,  was  well  developed  and  athletic.  Had 
lately  experienced  increasing  difficulty  in  studying  evenings.  Was  myopic 
by  one  dioptry,  in  each  eye.  Was  advised  to  use  lamp  or  candle  light 
when  an  artificial  one  was  necessary.  Two  months  later  all  difficulty 
in  use  of  eyes  had  ceased,  in  consequence  of  acting  on  the  author's  advice. 

Case  3.  Male,  aged  13,  consulted  early  in  May,  1904,  with  the  same  com- 
plaint as  in  the  two  cases  already  noted ;  the  symptoms,  also,  were  the 
same,  except  that  epiphora  likewise  existed.  His  refraction  was  normal. 
The  prescription  was  abstinence  from  work  by  electric  light;  likewise  a 
collyrium  of  cocaine  and  boric  acid.  Fourteen  weeks  later  all  symptoms 
had  been  "removed"  and  the  patient  was  quite  well. 

Case  4.  Sex  not  stated,  age  13,  consulted  in  November,  1903.  History 
nearly  identical  with  that  of  Case  3.  Prescription  and  result  also  the 
same. 

Case  5.  Girl,  aged  10,  consulted  late  in  November,  1904.  History  the 
same  as  in  Cases  3  and  4,  except  that  there  was  no  lachrymal  obstruction. 
Treatment  also  the  same  as  in  those  cases.   Result  not  reported. 

Case  6.  Male,  aged  69,  consulted  in  March,  1904,  in  great  distress  be- 
cause of  his  diminished  power  to  read  at  night.  Had  lately  had  electric 
light  installed  at  his  home  and  frequented  a  club  in  which  that  light  was 
used.  Had  never,  previously,  had  trouble  in  reading  by  artificial  illumina- 
tion ;  was  myopic ;  had  no  lenticular  opacity.  The  treatment  was  identical 
with  that  described  in  Cases  1  and  2,  with  an  optical  prescription  added. 
After  following  the  author's  instructions  for  a  month,  the  patient  reported 
that  all  his  difficulties  had  been  removed. 


A  New  Operation  for  Moderate  Shortsight. 

E.  E.  Maddox.    British  Medical  Journal,  October  21,  1905. 

The  patient  was  a  boy  of  sixteen,  disqualified  for  entrance  to  Woolwich 
by  myopia  of  low  grade.  Maddox  decreased  this,  to  the  extent  of  enabling 
the  patient  to  pass  the  required  examination.    The  treatment  was  opera- 


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CURRENT   MEDICAL  LITERATURE 


tive  and  consisted  in  flattening  two  mutually  perpendicular  meridians 
of  the  cornea,  with  an  interval  of  forty-six  days,  between  the  operations. 
The  method  adopted  was  to  dissect  up  a  flap  of  the  conjunctiva,  in  the 
transverse  meridian  of  the  eye,  and  pass  a  keratome  between  the  con- 
junctiva and  sclera,  into  the  anterior  chamber.  The  incision  was  enlarged, 
above  and  below,  with  a  probe-pointed  knife,  in  order  to  extend  it  as 
much  as  possible.  The  second  operation  consisted  of  a  large  incision, 
made  at  the  lower  margin  of  the  cornea,  with  an  ordinary  cataract  knife. 

Trunecek's  Serum,  in  the  Treatment  of  Glaucoma.  (El  Suero  de  Trunecek 

en  el  trotamiento  del  Glaucoma.) 
G.  Sanchez  Agui'era.    Archivos  de  Oftalmologia  Hispano- Americanos, 

September,  1905. 

After  a  historical  review  of  more  than  a  dozen  relatively  unsatisfactory 
operative  forms  of  treatment  of  chronic  glaucoma,  the  author  considers 
the  more  modern  serum-therapy  of  Trunecek,  which  has  given  such  fine 
results  in  tuberculous  osteo-arthritis.  Likewise  in  arterio-sclerosis  has 
this  therapy  shown  good  effects.  Valude  used  this  serum  in  cases  oi  ret- 
inal detachment,  injecting  it,  under  cocain  analgesia,  into  Tenon's  cap- 
sule. In  view  of  the  relation  between  arterio-sclerosis  and  glaucoma,  it 
became  naturally  suggested  to  use  the  same  method  in  the  latter  disease. 

Trunecek's  serum  consists  of  a  solution  of  the  unorganic  salts  of  the 
blood-serum  and  one  hundred  grams  of  distilled  water  contain: 
0.44  sodium  sulphate ; 
4.92  sodium  chloride; 
0.15  sodium  phosphate  ; 
0.21  sodium  carbonate; 
0.40  potassium  sulphide. 
This  was  used  by  subcutaneous  injection,  at  first  in  doses  of  three 
grams,  in  a  few  days  increasing  this  to  five  grams  of  the  solution 

As  to  the  results!  Nine  cases  were  so  treated,  all  of  chronic  glaucoma 
simplex  Myotics  were  used  at  the  same  time;  there  were  no  operations. 
The  treatment  lasted  for  ten  months.  In  six  cases  the  visual  acuity 
remained  unchanged,  in  two  cases  it  diminished  considerably,  while  in 
one  case  it  rose  from  0.2  to  0.4,  according  to  Landolt's  method  of  enumer- 
ation. The  tension,  which,  in  six  cases,  was  plus  one,  became  normal. 
The  general  condition  was  improved,  in  most  of  the  cases.  The  author 
compares  these  results  with  those  in  nine  other  similar  cases  of  the 
same  disease,  which  were  treated  with  myotics  and  the  lodid.^  In  these 
latter,  the  acuteness  of  vision  did  not  remain  the  same  for  six  months 
in  more  than  three  cases,  while  it  slowly  decreased  in  the  six  others. 
The  tension  changed  in  but  four  cases,  remaining  the  same  in  all  the 
others  One  of  these  patients  died  of  apoplexy.  There  is  not  much  to 
be  concluded  from  these  cases  and  their  comparison,  because,  in  the 
first  place,  they  are  too  few  and,  again,  the  time,  during  which  they 
have  been  observed,  is  too  short.  At  the  same  time  they  suffice  to 
justify  the  use  of  Trunecek's  serum. 


Vol.  xxvii 


MAY,  1906 


No  5. 


ALBANY 
MEDICAL  ANNALS 


Original  Communications 

UTERINE    MYOMATA    SIMULATING    PREGNANCY ; 
WITH  SPECIAL  REFERENCE  TO  THE 
SUBMUCOUS  VARIETY. 

Read  before  the  Medical  Society  of  the  County  of  Albany,  January  10,  1906. 
By  JOHN  A.  SAMPSON,  M.  D., 

Gynecologist  to  the  Albany  Hospital;  Lecturer  on  Gynecology,  Albany  Medical  College. 

The  differential  diagnosis  between  uterine  myomata  and  preg- 
nancy may  be  so  difficult  that  the  best  diagnosticians,  after  a  most 
careful  study  of  the  case,  may  be  uncertain  as  to  the  condition 
present.  Before  definitely  ascertaining  which  it  is,  it  may  be 
necessary  to  study  the  case  over  a  long  period  of  time,  or  make 
an  examination  under  ether,  or  even  an  exploratory  laparotomy. 
After  all  these  precautions  have  been  taken  the  abdomen  may  be 
opened  and  closed  without  removing  a  myomatous  uterus  or  the 
more  serious  mistake  may  be  made  of  removing  a  pregnant  uterus 
thinking  that  the  uterine  enlargement  was  due  to  a  fibroid  tumor. 
On  the  other  hand,  if  the  cases  are  very  carefully  studied,  these 
mistakes  should  rarely  occur. 

The  following  groups  of  cases  may  be  considered  as  sometimes 
offering  difficulties  in  the  differential  diagnosis  between  pregnancy 
and  conditions  simulating  it: 

(I)  uterine  pregnancy,  normal  or  atypical,  or  with  complica- 
tions other  than  tumors ; 

(II)  uterine  pregnancy  complicated  by  myomata  or  other 
tumors : 

(III)  extra-uterine  pregnancy,  alone  or  with  other  tumor 
formations ; 

(IV)  tumors  other  than  uterine  myomata  simulating  preg- 
nancy ; 


3o8 


UTERINE   MYOMATA   SIMULATING  PREGNANCY 


(V)  adipose  tissue  in  the  abdominal  wall  and  omentum, 
especially  if  there  is  a  rapid  increase  in  weight,  may  simulate 
pregnancy  or  an  abdominal  tumor; 

(VI)  myomata  unaccompanied  by  pregnancy. 

I.  Uterine  Pregnancy  Simulating  a  Myomatous  Uterus. 
Pregnancy  occurring  under  conditions  where  it  seems  impos- 
sible, especially  if  the  patient  purposely  misleads  the  physician, 
may  render  the  differential  diagnosis  difficult.  If  the  pregnancy 
is  atypical,  the  diagnosis  may  also  be  difficult.  It  may  occur  in 
a  bicornuate  uterus  or  develop  in  one  portion  of  the  uterus  more 
than  another,  thus  giving  rise  to  an  asymmetrical  enlargement  of 
that  organ ;  or  the  uterus  may  be  retroflexed ;  or  the  menses  may 
persist  (rare)  ;  or  there  may  be  irregular  bleeding  due  to  some 
associated  condition  such  as  a  cervical  polyp.  Any  of  the 
above  may  be  confusing,  and  unless  the  case  is  carefully 
studied  an  error  in  the  diagnosis  may  be  easily  made. 

II.  Uterine  Pregnancy  Complicated  by  Myomata  or  other 
Tumors.  The  gradual  increase  in  the  size  of  a  previously  known 
case  of  a  myomatous  uterus  may  be  due  to  an  associated  preg- 
nancy and  also  an  ovarian  cyst  may  become  evident  by  being  dis- 
placed by  a  pregnant  uterus.  While  myomata  may  be  looked 
upon  as  a  cause  of  abortion  and  faulty  presentations,  and  should 
the  pregnancy  continue  until  term,  even  offer  such  a  serious 
obstacle  to  labor  as  to  demand  operative  interference ;  neverthe- 
less many  children  are  born  every  year  from  myomatous  uteri, 
and  the  myomata,  if  large,  have  become  softened  by  the  preg- 
nancy, and  were  so  situated,  or  so  adjusted  themselves,  as  to  in 
no  way  interfere  with  the  natural  course  of  the  pregnancy  or 
labor. 

Pregnancy  complicated  by  a  uterine  or  ovarian  tumor  may 
easily  be  overlooked,  especially  in  the  early  months  of  pregnancy, 
as  shown  by  one  of  my  cases  at  the  Johns  Hopkins  Hospital  (at 
that  time  I  was  resident  gynecologist  to  the  hospital). 

Gyn.  No.  10760.  The  patient,  who  was  40  years  old,  a  XII  Para 
(19  years  to  21  months),  very  large,  and  whose  menstrual  periods  were 
irregular,  complained  of  abdominal  pain.  On  bimanual  examination,  a 
tumor,  the  size  of  one's  fist,  was  felt  to  the  left  of  the  uterus  and  the 
latter  seemed  slightly  enlarged  and  adherent ;  the  cervix  was  hard.  A 
diagnosis  of  a  myomatous  uterus  or  an  ovarian  cyst  with  pelvic  adhesions 
was  made  and  pregnancy  was  not  considered.  On  opening  the  abdominal 
cavity,  a  pregnant  uterus  of  about  six  weeks  duration  was  found  and  a 
paro-ovarian  cyst.    The  adhesions  about  the  uterus  were  severed,  and 


JOHN  A.  SAMPSON 


3°9 


the  cyst  removed.  The  patient  did  not  abort  but  left  the  hospital  at 
the  end  of  twenty-one  days  feeling  well  and  free  from  pain. 

III.  Extra-uterine  Pregnancy  Simulating  a  Myomatous  Uterus. 
This  condition  may  simulate  an  intra-uterine  pregnancy  or  a 

myoma.  This  is  especially  true  when  a  tumor  is  formed  by  the 
encapsulation  of  a  collection  of  blood  resulting  from  a  tubal  abor- 
tion or  rupture.  The  tumor  mass  may  be  situated  mesially,  thus 
simulating  a  pregnancy  or  laterally,  thus  more  closely  imitating 
a  myomatous  uterus,  and  its  usual  intimate  association  with  the 
uterus  may  sometimes  make  the  differential  diagnosis  very  diffi- 
cult between  intra-uterine  pregnancy,  ruptured  encapsulated 
extra-uterine  pregnancy  and  a  myomatous  uterus. 

The  above  is  well  shown  in  the  following  two  of  my  cases. 

Case  I. — Age  34,  /•  Para  (16  years),  was  admitted  to  the  Johns  Hop- 
kins Hospital  in  July  1904,  Gyn.  No.  11,410.  She  complained  of  abdominal 
pain,  and  thought  that  she  might  be  pregnant. 

Patient  had  not  menstruated  for  ten  months,  when  about  four  months 
pregnant  she  was  admitted  to  another  hospital  for  threatened  abortion. 
The  bleeding  ceased  in  a  few  days  and  she  considered  herself  pregnant 
because  she  could  feel  the  abdominal  tumor,  and  her  physicians  assured 
her  that  she  was.  She  waited  ten  months  and  as  the  tumor  had  not 
increased  in  size  she  came  to  the  Johns  Hopkins  Hospital. 

On  examination,  the  breasts  contained  colostrum,  the  cervix  was  found 
to  be  hard  and  the  body  of  the  uterus  was  drawn  to  the  right  and  con- 
tinuous with  a  mass  extending  as  high  as  the  umbilicus,  the  mass  felt 
like  a  pregnant  uterus,  a  soft  myoma  or  an  ovarian  cyst. 

At  operation  the  uterus,  tubes  and  ovaries  together  with  a  mass  of 
encapsulated  blood  clot  containing  a  partially  mummified  four  months 
foetus  were  removed.    (See  Fig.  1).    Convalesence  was  uneventful. 

Case  II. — Age  30,  a  nullipara,  zcas  admitted  to  the  Johns  Hopkins  Hos- 
pital two  days  after  the  previous  one;  Gyn.  No.  11,411. 

Complained  of  an  abdominal  tumor  which  had  been  diagnosed  as  a 
myomatous  uterus  by  one  of  the  foremost  gynecologists  of  this  country. 
The  patient  missed  her  menstrual  period  seven  months  ago,  thought  she 
was  pregnant  and  three  months  later  an  apparent  abortion  took  place.  On 
examination  a  condition  very  similar  to  the  previous  case  was  found  and 
st  operation  the  right  tube  and  ovary,  with  blood  clots  and  a  three 
months  foetus  were  removed.    Convalescence  was  uneventful. 

IV.  Tumors  other  than  Myomata  Simulating  both  Pregnancy 
and  Uterine  Myomata.  The  differential  diagnosis  between  these 
three  possible  conditions  may  be  very  difficult,  as  shown  by  the 
cases  reported  under  extra-uterine  pregnancy  and  also  the  follow- 
ing case,  which  I  saw  in  consultation  with  Dr.  J.  P.  Boyd. 


3IO  UTERINE   MYOMATA  SIMULATING  PREGNANCY 

Patient  aged  46,  a  III  Para  (21-11  years),  complained  of  uterine  bleed- 
ing of  seven  or  eight  months'  duration.  She  had  had  a  miscarriage  two 
years  ago,  previous  to  which  the  bleeding  had  been  very  severe  for 
over  a  month.  On  account  of  the  more  or  less  constant  flow,  she  was 
unable  to  date  her  last  menstrual  period. 

Patient  was  anemic,  50  per  cent,  haemoglobin.  On  bimanual  examina- 
tion the  vagina  was  pale,  cervix  firm  and  protruding  from  the  external 
os  could  be  felt  several  cervical  polypi.  A  median  tumor  was  felt, 
apparently  rising  from  the  uterus,  and  simulating,  as  far  as  palpation 


Fig.  1. — Uterine  Pregnancy  Simulated  by  a  Pelvic  Hsematocele,  X  1-3. 

The  patient,  age  34,  was  four  months  pregnant,  when  she  had  abdominal 
pain  and  uterine  bleeding.  A  diagnosis  of  threatened  abortion  was  made 
(really  the  abortion  or  rupture  of  a  tubal  pregnancy).  The  pains  and 
bleeding  ceased  in  a  few  days  and  she  was  assured  by  her  physicians 
that  she  was  still  pregnant.  She  waited  in  vain,  ten  months,  for  the 
expected  labor.  At  operation,  it  was  found  that  the  pregnant  uterus  was 
simulated  by  a  pelvic  hsematocele. 


JOHN  A.  SAMPSON 


was  concerned,  a  five  or  six  months  pregnane}-.  It  was  thought  that 
increased  vascularity  of  pregnancy  might  account  for  the  bleeding  from 
the  cervical  polypi.  As  none  of  the  other  signs  of  pregnancy  were  found, 
this  was  excluded  and  a  probable  diagnosis  was  made  of  either  a 
malignant  intra-uterine  growth  or,  what  was  still  more  likely,  a  large, 
soft  submucous  myoma. 

At  the  operation  on  May  10,  1905,  at  the  Albany  Hospital,  a  dermoid 
cyst  of  the  right  ovary  was  found  which  was  situated  in  the  median 
line  and  had  moulded  itself  about  the  fundus  of  the  uterus,  thus  ap- 
parently forming  an  uterine  tumor.    (See  Fig.  II.)     The  tumor  was 


Fig.  II. — Pregnancy  Simulated  by  a  Dermoid  Cyst,  X  1-3. 

Patient  aged  46,  complained  of  uterine  bleeding  arising  from  cervical 
polypi.  On  examination  a  condition  simulating  a  five  to  six  months 
pregnant  uterus  was  found.  At  operation  this  simulation  was  found  to 
be  due  to  a  dermoid  cyst  of  the  right  ovary,  the  walls  of  which  were 
flaccid,  thus  moulding  themselves  to  the  fundus  of  the  uterus  so  that 
it  apparently  formed  a  part  of  that  organ,  and  felt  like  the  soft  fundus 
of  a  pregnant  uterus. 


312  UTERINE  MYOMATA  SIMULATING  PREGNANCY 


removed,  together  with  the  rest  of  the  pelvic  organs  (the  uterus  con- 
tained polypi  and  the  opposite  ovary  was  cystic).  Convalescence  was 
uneventful. 

V.  Adipose  Tissue  in  the  Abdominal  Walls  and  Omentum, 
Simulating  Pregnancy.  This  is  apt  to  occur  in  elderly  women 
who  greatly  desire  children.  An  increase  in  weight,  especially  if 
associated  with  the  cessation  of  the  menstrual  flow  due  either  to 
a  natural  or  permature  menopause,  may  make  such  a  person 
believe  that  she  is  pregnant.    Such  a  person,  recently  seen  by 


Fig.  III. — Pregnancy  Simulated  by  Adipose  Tissue  in  the  Abdominal 
Wall  and  Omentum,  X  1-3. 

The  patient  believed  herself  six  months  pregnant.  She  had  measured 
herself  each  month  and  noted  the  increase  in  size,  she  had  "  felt  life " 
and  her  breasts  had  become  enlarged.  Her  belief  was  so  firm  that  I  was 
unable  to  persuade  her  that  she  was  not  pregnant. 


JOHN  A.  SAMPSON 


313 


me,  thought  she  was  six  months  pregnant.  She  had  measured 
her  abdomen  each  month  and  had  noted,  with  pleasure,  the 
increase  in  her  waist  measure.  She  assured  me  that  her 
breasts  had  become  swollen  and  painful  and  that  she  had  "  felt 
life."  Her  belief  in  her  condition  was  so  firm  that  I  was  unable 
to  persuade  her  that  she  was  not  pregnant.  The  entire  en- 
largement was  due  to  the  deposit  of  fat  in  the  abdominal  walls 
and  omentum .  The  uterus  was  normal  in  size  and  in  retro- 
position.    (See  Fig.  III.) 

VI.  Uterine  Myomata  Simulating  Pregnancy.  Under  this 
heading  we  may  consider  two  groups  of  cases : 

1.  The  rarer  and  therefore  the  less  important  group  comprises 
those  cases  where  a  multinodular  myomatous  uterus  simulates 
the  various  parts  of  the  child.  If  ascites  is  present,  the  ballotte- 
ment  may  be  as  perfect  as  in  the  pregnant  uterus.  (See  Fig.  IV.) 
This  condition,  with  report  of  cases,  have  been  very  carefully  con- 
sidered by  Kelly  in  an  article  appearing  in  the  American  Gyne- 
cology of  November,  1902,  entitled  "  The  Mimicry  of  Preg- 
nancy by  Fibroid  and  Ovarian  Tumors." 

2.  The  second  group  of  cases  where  the  uterine  enlargement 
is  mainly  due  to  a  solitary  myoma,  and  usually  of  the  submucous 
variety,  is  the  most  important  group  of  all,  because  it  is  the 
largest  and  also  because  in  these  cases  the  differential  diagnosis 
may  be  the  most  difficult.  Mistakes  in  this  group  may  lead  to 
the  error  of  not  removing  a  myomatous  uterus  on  account  of  its 
resemblance  to  a  pregnancy,  or  to  the  more  serious  one  of  remov- 
ing a  pregnant  uterus,  thinking  that  the  enlargement  is  due  to 
a  myoma. 

The  following  two  cases  illustrate  how  a  submucous  myoma 
may  simulate  a  pregnant  uterus  and  for  that  reason  are  worth 
considering  in  detail : 

Case  I. — Age  46,  a  nullipara  and  unmarried,  complained  of  profuse 
bleeding,  and  severe  bearing  down  pains  at  the  menstrual  period. 

Past  history  was  unimportant  except  for  her  menstrual  history.  Menses 
began  at  the  age  of  thirteen,  always  regular  and  normal;  and  previous  to 
present  illness  accompanied  with  only  a  slight  amount  of  pain.  She  still 
menstruates  regularly. 

Present  illness  is  of  about  two  years'  duration.  During  this  time  her 
menstrual  periods  have  been  becoming  more  profuse  and  also  the  pain 
has  been  increasing  in  severity.  The  flow  now  lasts  one  week  or  over 
instead  of  a  few  days,  as  previously,  and  is  very  profuse,  the  bleeding 
being  so  severe  as  to  greatly  weaken  her  so  that  she  is  unable  to  regain 


3M 


UTERINE   MYOMATA  SIMULATING  PREGNANCY 


her  strength  in  the  intervals.  The  pain  is  also  very  severe,  bearing  down 
in  character  as  though  the  uterus  was  trying  to  expel  something  and 
could  not. 

On  examination,  the  uterus  was  found  to  be  enlarged  to  the  size  of 
about  a  two  months  pregnancy,  freely  movable  and  during  the  examination 
it  seemed  to  vary  in  consistency  as  though  contracting  and  relaxing.  The 
vagina  was  pale,  the  cervix  hard,  but  the  upper  portion  of  the  cervix 
seemed  very  flexible,  i.  e.,  where  the  cervix  joined  the  enlarged  fundus. 
Breasts  were  normal.  The  patient  was  anemic,  haemoglobin  40  per  cent, 
but  otherwise  her  condition  was  about  the  same  as  it  had  been  for  years. 

On  July  26,  1905,  a  myomatous  uterus  was  removed  at  the  Albany  Hos- 


Fig.  IV. — Pregnancy  Simulated  by  a  Multinodular  Myomatous  Uterus 
with  Ascites,  X  1-3. 

Such  cases  have  been  reported  and  the  illustration  shows  how  the 
nodules  might  be  taken  for  the  foetal  parts,  the  large  one  the  head  and 
the  small  one  a  knee  or  elbow.  The  ascites  permits  ballottement,  as 
perfect  as  in  the  pregnant  uterus. 


JOHN  A.  SAMPSON 


pital.  Convalescence  was  uneventful.  Specimen  removed  shows  a  myo- 
matous uterus,  in  which  the  main  enlargement  is  due  to  a  submucous 
myoma  about  5  cm.  in  diameter  arising  in  the  posterior  uterine  wall  and 
protruding  into  the  uterine  cavity.    (See  Fig.  V). 

Remarks.  This  case  is  described  not  because  there  was 
any  difficulty  in  the  diagnosis  previous  to  the  operation,  but 
because  it  shows  how  changes  in  the  uterus,  similar  to  these 
caused  by  pregnancy  may  occur.    In  this  instance  a  tumor 


Fig.  V. — Early  Pregnancy  Simulated  by  a  Small  Submucous  Myoma, 
X  1-3. 

Patient,  age  46,  complained  of  severe  bearing  down  pains  with 
haemorrhages  at  the  time  of  the  menstrual  periods.  The  myoma  altered  the 
form  of  the  uterus  so  that  it  simulated  an  early  pregnancy  and  as  an  intra- 
uterine tumor  stimulated  that  organ  to  contractions,,  hence  the  symp- 
toms resembling  an  attempted  abortion  at  the  time  of  menstruation. 


3i6 


UTERINE  MYOMATA  SIMULATING  PREGNANCY 


developing  in  the  posterior  uterine  wall  and  protruding  into  the 
uterine  cavity  gave  rise  to  some  of  the  signs  of  a  symmetrical 
tumor  within  the  uterine  cavity  such  as  a  pregnancy.  There  was 
present  in  this  instance  the  uniform  enlargement  of  the  uterus, 
and  the  variations  in  consistency  caused  by  the  uterus  attempting 
to  expel  the  foreign  body  and,  in  addition,  at  the  time  of  the  mens- 
trual period  these  contractions  became  more  violent,  amounting 
to  labor  pains,  and  there  were  present  the  clinical  symptoms  of 
threatened  abortion,  i.  c,  the  bleeding  and  the  violent  attempts 
of  the  uterus  to  give  birth  to  the  tumor. 

Case  II. — Patient  age  40,  II  Para  ( 11  and  9  years),  and  two  miscarriages 
induced  at  the  third  month,  seven  and  five  years  ago,  complained  of  the 
same  symptoms  as  the  previous  case,  except  that  the  bleeding  was  much 
more  severe,  and  in  addition  the  patient  noticed  an  abdominal  tumor 
extending  up  to  the  umbilicus  and  so  closely  simulating  a  pregnancy  that 
her  friends  thought  she  was  in  that  condition. 

For  the  last  three  years,  the  patient's  menstrual  flow  has  been  getting 
more  profuse  and  painful ;  previously  it  lasted  two  or  three  days  and  was 
painless  and  not  profuse.  It  now  lasts  from  one  to  two  weeks  and  the 
bleeding  is  as  severe  as  would  occur  at  labor  and  in  addition  the  pains 
are  in  every  way  similar  to  labor  pains.  The  tumor  has  been  noticed 
for  at  least  six  months  and  its  growth  has  been  slow.  There  has  been 
none  of  the  subjective  symptoms  of  pregnancy  except  the  presence  of 
the  tumor  and  the  frequency  of  micturition  caused  by  the  tumor  press- 
ing on  the  bladder.  Aside  from  the  great  weakness  caused  by  the  severe 
hemorrhages  at  the  menstrual  period,  the  patient  feels  very  well. 

The  patient  was  referred  to  me  by  Dr.  A.  E.  Beale  of  Schaghticoke, 
N.  Y.,  and  was  first  seen  op  August  21,  1905.  She  seemed  very  anaemic 
and  somewhat  emaciated.  Her  breasts  contained  milk  at  the  time,  but 
otherwise  did  not  resemble  those  of  pregnancy.  The  abdominal  dis- 
tension caused  by  a  median  tumor  extending  up  to  about  2  cm.  above 
the  umbilicus  could  be  seen  and  the  tumor  easily  palpable.  It  simulated 
in  many  ways  a  pregnant  uterus  of  six  months'  duration.  The  tumor 
was  uterine,  symmetrical,  slightly  movable  and  soft.  On  palpation  one 
could  distinctly  feel  it  change  in  consistency,  becoming  harder  and  at 
the  same  time  smaller  and  then  relaxing  and  becoming  larger  and 
softer,  i.  e.,  the  so-called  contractions  of  Braxton-Hicks,  which  in  this 
instance  were  also  painless. 

It  was  impossible  to  map  out  the  child  or  obtain  any  evidence  of  bal- 
lottement.  On  auscultation  the  so-called  uterine  souffle  was  distinctly 
heard  at  the  uterine  cornua  and  in  the  region  of  the  cervix  on  each  side; 
cn  the  other  hand  nothing  was  heard  suggesting  foetal  heart  sounds.  On 
vaginal  examination,  the  vaginal  mucosa  was  pale,  the  cervix  of  moderate 
consistency,  and  the  external  os  readily  admitted  the  tip  of  one's  finger. 
The  tumor  was  apparently  uterine  in  origin  and  the  portion  of  the  cer- 
vix above  the  vagina  felt  flexible,  suggesting  the  so-called  Hegar's  sign. 


JOHN  A.  SAMPSON 


3*7 


A  diagnosis  of  a  submucous  myoma  was  made  but  on  account  of  its 
similarity  to  pregnancy  and  especially  as  the  patient  made  some  contra- 
dictory statements  as  to  the  duration  of  the  tumor,  etc.,  and  had  had  two 
miscarriages,  seven  and  five  years  ago,  which  had  been  induced,  it  was 


Fig.  VI. — Pregnancy  Simulated  by  a  Large  Submucous  Myoma,  X  1-3. 

Patient,  age  40,  complained  of  abdominal  tumor  and  severe  bearing 
down  pains  with  haemorrhages  at  the  menstrual  periods.  Pregnancy  was 
simulated  by:  the  milk  in  the  breasts;  the  symmetrical  enlarged  uterus 
of  the  form  and  consistency  of  pregnancy ;  intermittent  uterine  contrac- 
tions, the  so-called  contractions  of  Braxton-Hicks,  which  could  be  felt 
at  any  time;  the  uterine  souffle;  a  flail  cervix  simulating  Hegar's  sign; 
a  patent  cervix  and  a  smooth,  soft  body  within  the  uterine  cavity  feeling 
somewhat  like  the  distended  membranes  of  pregnancy;  the  threatened  abor- 
tion, i.  e.,  the  labor  pains  and  bleeding  occurring  at  the  menstrual  periods; 
the  frequency  of  micturition  caused  by  the  pressure  of  the  enlarged 
uterus  on  the  bladder. 


318  UTERINE   MYOMATA  SIMULATING  PREGNANCY 

thought  best  to  wait  until  after  the  next  period  with  the  understanding 
that  the  patient's  physician  should  visit  her  at  that  time  and  ascertain 
the  nature  and  severity  of  the  flow. 

A  little  over  a  month  later  the  patient  returned.  She  had  menstruated 
two  weeks  previously  and  had  nearly  bled  to  death.  The  bleeding  was 
much  more  severe  than  any  of  the  previous  ones,  and  although  the  vagina 
at  this  time  had  been  packed  tightly  with  gauze  by  her  physician,  it 
did  not  seem  to  have  any  influence  on  the  amount  of  blood  lost.  During 
the  menstrual  flow  the  uterine  cavity  would  seem  to  become  filled  with 
blood,  the  fundus  rising  five  to  six  cm.  above  the  umbilicus,  and  it  would 
then  contract  with  severe  labor  pains  and  the  blood  would  be  forced 
out  of  the  cervix  like  water  out  of  a  faucet.  On  examination  the  find- 
ings were  similar  to  those  of  the  previous  examination,  except  that  the 
top  of  the  uterus  was  found  to  be  about  2  cm.  below  the  umbilicus  in- 
stead of  that  distance  above  it,  as  found  at  the  previous  examination. 

The  patient  was  admitted  to  the  Albany  Hospital  September  28,  1905, 
and  after  resting  in  bed,  with  forced  feeding,  iron  and  tonics,  the  uterus 
with  myoma  was  removed,  October  5th,  by  a  supravaginal  hysterectomy, 
with  hemoglobin  at  45  per  cent. 

On  examination  under  ether,  just  before  the  operation,  the  upper  por- 
tion of  the  cervix  felt  very  soft,  closely  simulating  Hegar's  sign,  and 
in  addition  the  submucous  myoma  could  be  palpated  through  the  patent 
cervix  and  its  soft  consistency  felt  not  unlike  the  distended  membranes 
of  a  normal  pregnancy. 

On  opening  the  abdominal  cavity  the  uterus  felt  even  more  like  a 
pregnant  uterus  than  on  palpation  through  the  abdominal  walls.  The 
convalescence  was  uneventful. 

The  symmetrical  enlargement  of  the  uterus  which  so  closely  simulated 
a  pregnancy  was  found  to  be  due  to  a  submucous  myoma  oval  in  shape 
with  a  long  diameter  of  17  cm.,  which  had  developed  in  the  anterior 
uterine  wall.  (See  Figs.  VI  and  VII).  The  tumor  was  found  to  be  cede- 
matous  and  in  places  to  have  undergone  myxomatous  changes  which  ac- 
counted for  its  soft  consistency.  The  bleeding,  which  occurred  only  at 
the  time  of  the  menstrual  flow,  came  entirely  from  the  endometrium. 
This  is  probably  due  to  several  factors;  first,  the  enormously  increased 
area  to  bleed  from  the  uterine  cavity  being  22  cm.  deep  instead  of  6  or  7 
cm.  deep,  as  in  a  multipara  of  that  age;  secondly,  the  congestion  of  the 
endometrium  caused  by  the  tumor  pressing  on  the  veins  of  the  uterine 
wall  and  thus  interfering  with  the  return  flow  from  the  endometrium, 
and,  thirdly,  from  actual  changes  in  the  blood  vessels  of  the  endometrium 
permitting  a  greater  escape  of  blood  at  this  time  or  an  actual  bursting 
of  some  of  its  blood  vessels  causing  a  free  hemorrhage. 

Pregnancy  was  simulated  in  this  case  by: 

(I)  — the  milk  in  the  breasts; 

(II)  — the  symmetrically  enlarged  uterus  of  the  form  and  consistency 
of  pregnancy; 

(III)  — intermittent  uterine  contractions,  the  so-called  contractions  of 
Braxton-Hicks ; 


JOHN   A.  SAMPSON 


3*9 


(IV)  — the  uterine  souffle,  heard  both  over  the  upper  and  also  the  lower 
portion  of  the  uterus; 

(V)  — a  flail  uterine  cervix  simulating  Hegar's  sign; 

(VI)  — a  patent  cervix  which  admitted  the  finger  and  a  smooth  rounded 
body  within  the  uterine  cavity,  which  felt  somewhat  like  the  distended 
membranes  of  a  pregnant  uterus,  but  in  this  instance  was  the  smooth 
endo-mentrium  covering  a  soft  submucous  myoma; 

(VII)  — the  threatened  abortion,  i.  e.,  the  labor  pains  and  bleeding  occur- 
ing  at  the  menstrual  periods; 

(VIII)  — the  frequency  of  micturition  caused  by  the  pressure  of  an 
enlarged  uterus  against  the  bladder. 

Pregnancy  was  excluded  by : 

(I)  — the  clinical  history  of  the  case,  i.  e.,  the  long  duration  of  the 
tumor,  the  regular  menstruation  with  severe  haemorrhages  and  the  ab- 
sence of  the  subjective  symptoms  of  pregnancy; 

(II)  — the  inability  to  map  out  the  child,  obtain  ballottement,  hear  the 
foetal  heart  sounds  or  feel  life; 


Fig.  VII. — Changes  in  the  Uterus  Caused  by  a  La^ge  Submucous  Myoma 
Similar  to  those  Caused  by  Pregnancy,  X  1-3. 

The  myoma  has  been  removed  from  the  uterus  shown  in  Fig.  VI.  It 
has  left  a  cavity  similar  to  the  enlarged  uterine  cavity  of  pregnancy, 
except  that  it  is  not  lined  by  mucous  membrane  and  does  not  communi- 
cate with  the  cervical  canal.  As  in  pregnancy  the  uterus  has  been  uni- 
formly enlarged  by  the  distension  caused  by  the  growth  of  an  intra-uterine 
tumor. 


320  .    UTERINE   MYOMATA   SIMULATING  PREGNANCY 

(III)— the  rather  hard  cervix,  pale  vagina  and  breasts  which  did  not 
show  any  of  the  signs  of  pregnancy  except  the  milk. 
A  probable  diagnosis  of  submucous  myoma  was  made  from : 

(I)  — the  clinical  history  of  the  case; 

(II)  — the  eight  ways  given  above  in  which  the  case  simulated  preg- 
nancy, but  which  were  more  characteristic  of  this  form  of  myoma,  espe- 
cially as  each  symptom  or  manifestation  lacked  the  typical  manifesta- 
tion of  a  pregnancy; 

(HI) — the  absence  of  the  positive  signs  of  pregnancy. 

Conclusions. 

No  attempt  has  been  made  to  review  all  the  conditions 
which  may  simulate  either  uterine  myomata  or  uterine  preg- 
nancy, but  only  to  call  attention  to  some  of  the  more  common 
conditions  causing  difficulties  in  the  differential  diagnosis,  and 
also  to  emphasize  the  important  part  played  by  uterine  myomata 
in  the  simulation  of  pregnancy,  and  therefore  the  importance  of 
carefully  studying  these  cases.  We  must  bear  in  mind  (and 
here  I  am  not  presenting  anything  new)  that  uterine  myomata, 
through  the  alterations  in  the  form  of  the  uterus  caused  by  the 
tumor,  the  increased  vascularity  in  that  organ  and  surrounding 
parts  necessary  to  nourish  the  uterus  and  tumor,  and  the  stimulus 
due  to  a  submucous  myoma,  thus  giving  rise  to  uterine  contrac- 
tions, may  cause  symptoms  which  may  simulate  any  or  all  of 
those  caused  by  pregnancy  except  the  actual  heart  beat  of  the 
living  child. 

However,  these  simulations  nearly  always  lack  the  stamp  of 
genuineness,  and.  if  they  alone  are  carefully  studied,  should  teach 
us  that  they  are,  in  the  particular  case  under  study,  much  more 
characteristic  of  a  myomatous  uterus  than  a  pregnancy,  the  above, 
together  with  a  history  of  the  case,  should  make  the  diagnosis 
clear  in  nearly  every  instance.  When  mistakes  are  made  it  is 
nearly  always  our  fault,  the  signs  were  all  there  only  we  would 
not  see  or  heed  them  or  would  insist  in  incorrectly  interpreting 
them. 


METHODS   FOR  USE  OF  SPINAL  ANAESTHESIA  321 

THE  METHODS  AND  INDICATIONS  FOR  THE  USE  OF 
SPINAL  ANAESTHESIA. 

By  ARTHUR  W.  ELTING,  M.  D., 

Surgeon  to  the  Albany  Hospital,  Surgeon  to  St.  Peter's  Hospital,  Surgeon  to  the  Child's 
Hospital,  Albany,  N.  Y. 

The  earliest  recorded  attempt  to  secure  anaesthesia  by  the 
action  of  anaesthetic  drugs  upon  the  spinal  cord  was  that  of 
Corning,  who  in  1885  injected  a  solution  of  cocaine  between  the 
spinous  processes  of  the  lower  dorsal  vertebrae,  where  the  exten- 
sive venous  plexuses  favored  a  rapid  absorption  of  the  drug. 
These  experiments  were  at  first  performed  upon  dogs  and  later 
upon  human  beings,  with  the  production  of  anaesthesia  of  the 
lower  half  of  the  body.  Although  published  by  Corning,  this 
work  attracted  practically  no  attention  and  was  not  accepted  as 
a  feasible  surgical  procedure  until  1899,  when  Bier,  entirely 
ignorant  of  the  work  of  Corning,  using  the  method  of  spinal 
puncture  proposed  by  Quincke,  introduced  a  solution  of  cocaine 
into  the  subarachnoid  space.  Bier  found  that  in  this  way  a 
very  satisfactory  anaesthesia  could  be  produced  in  the  legs  and 
lower  part  of  the  trunk  and  that  under  such  an  anaesthesia  opera- 
tions could  be  safely  and  painlessly  performed.  To  Bier,  there- 
fore, belongs  the  credit  for  the  introduction  and  perfection  of 
the  method  of  spinal  anaesthesia,  although  his  work  was  ante- 
dated by  that  of  Corning,  which,  however,  was  not  productive 
of  any  practical  results. 

Still  a  third  name  should  be  mentioned  in  connection  with 
the  early  history  of  this  method  of  anaesthesia,  and  that  is  that 
of  Tuffier,  the  brilliant  French  surgeon.  He  was  one  of  the 
first  to  employ  the  method  advocated  by  Bier  and  at  once  became 
one  of  its  most  enthusiastic  advocates,  a  position  which  he  has 
maintained  ever  since,  as  evidenced  by  his  exhaustive  mono- 
graph upon  the  subject.  In  France,  Italy  and  Austria  the  method 
is  usually  spoken  of  as  that  of  Tuffier,  and  it  was  Tuffier  who 
was  perhaps  the  most  influential  in  calling  the  attention  of 
American  surgeons  to  the  advantages  of  spinal  anaesthesia. 
The  method  soon  found  enthusiastic  advocates,  as  well  as 
strong  opponents. 

Three  different  types  of  sentiment  with  regard  to  the  method 
may  be  said  to  have  been  assumed  by  surgeons  throughout  the 


4 


322  METHODS   FOR  USE  OF   SPINAL  ANAESTHESIA 

world.  The  first  type  is  that  of  the  enthusiastic  advocate,  of 
whom  there  have  been  comparatively  few,  with  Turner  as  the  most 
prominent,  for  he  alone  has  used  it  in  over  one  thousand  cases. 
The  second  type  is  that  of  the  great  majority  of  surgeons,  who 
condemn  its  use,  most  of  whom  have  either  never  made  use  of  the 
method  or  else  have  condemned  it  after  a  relatively  brief  and 
imperfect  trial.  The  third  type  is  represented  by  a  considerable 
number  of  the  ablest  surgeons,  among  whom  Bier  himself  may 
be  numbered,  who  believe  that  in  many  instances  it  is  a  most 
desirable  and  valuable  method  of  anaesthesia,  and  who  further- 
more believe  that  it  will  become  more  and  more  universally 
practiced  as  the  method  of  its  employment  is  perfected.  As 
very  often  happens  after  the  promulgation  of  any  new  and 
brilliant  idea  in  surgery,  many  surgeons  immediately  adopted 
and  began  to  promiscuously  practice  the  method,  which  was  but 
imperfectly  developed  or  understood,  with  the  result  that  dis- 
tressing accidents  and  in  a  few  instances  death  followed  its  use. 
This  led  these  same  surgeons  to  immediately  discard  the  method 
without  attempting  to  perfect  it  or  discover  why  the  results 
were  not  all  that  was  desired.  These  same  individuals  now 
became  the  enemies  of  spinal  anaesthesia  and  have  continued  to 
denounce  its  use,  when  perhaps  the  failure  depended  far  more 
upon  themselves  than  upon  the  method.  Within  a  year  after  the 
publication  of  his  original  article  Bier  published  a  second  article, 
in  which  he  deplored  the  indiscriminate  use  which  had  been  made 
of  the  method,  then  in  its  infancy,  and  urged  that  it  be  prac- 
ticed only  with  caution  and  with  a  view  to  the  elimination  of  the 
unfavorable  features. 

From  tremendous  enthusiasm  the  pendulum  swung  back  to  a 
position  of  general  apathy,  until  within  the  past  year  and  a  half, 
when,  with  better  methods  and  more  conservatism,  the  method 
has  again  come  into  vogue  and  is  being  more  generally  used. 
During  all  this  time  Bier  and  his  followers  have  been  at  work 
to  eliminate  so  far  as  possible  the  dangerous  or  unsatisfactory 
features,  and  in  this  they  have  in  great  measure  succeeded, 
although  still  further  improvement  in  the  technique  is  to  be 
expected.  Although  the  method  was  introduced  by  a  German, 
it  found  its  most  enthusiastic  advocates  in  France  and  America, 
and  only  within  the  past  two  years  has  it  begun  to  be  generally 
practiced  by  German  surgeons.  That  it  is  constantly  winning 
favor  is  demonstrated  by  the  attitude  assumed  by  many  of  the 


ARTHUR  W.   ELTING  323 

leading  continental  surgeons  at  the  last  German  congress  of 
surgery,  when  favorable  reports  from  many  of  the  leading  surgi- 
cal clinics  were  presented  and  over  twelve  hundred  cases  reported 
in  which  this  method  had  been  employed.  Zahradnicky,  in 
1902,  collected  from  the  literature  forty-six  hundred  and  seventy- 
nine  cases  of  spinal  anaesthesia,  in  two  hundred  and  twelve  of 
which  there  was  a  failure  to  induce  a  satisfactory  anaesthesia, 
while  in  fifty-eight  cases  there  were  severe  toxic  symptoms. 
Death  occurred  in  twelve  cases,  in  eleven  of  which  cocaine  was 
used,  and  in  one  eucaine. 

Because  of  the  toxic  action  of  cocaine,  attempts  have  been 
made  to  replace  it  by  other  of  the  so-called  local  anaesthetics, 
such  as  tropoccocaine,  eucaine,  A.  and  B.,  peronin,  anaesthesin, 
and  latterly  stovaine.  Of  all  the  substitutes  proposed,  stovaine 
appears  to  be.  the  most  satisfactory  and  the  results  of  its  use 
would  seem  to  indicate  that  it  will  largely  replace  cocaine  in 
spinal  anaesthesia. 

Stovaine  is  a  synthetic  compound  first  discovered  by  For- 
neau,  a  French  chemist,  and  demonstrated  by  animal  experi- 
ments, as  well  as  its  use  in  the  human  individual,  to  be  but 
slightly  toxic  and  to  possess  anaesthetic  properties  almost 
equal  to  those  of  cocaine. 

As  a  result  of  careful  study  and  investigation  the  methods 
of  spinal  anaesthesia  have  recently  been  greatly  improved,  and 
chiefly  in  two  ways :  First,  by  the  use  of  the  adrenal  prepara- 
tions ;  and  secondly,  by  the  use  of  stovaine. 

Soon  after  the  discovery  of  adrenalin  its  value  as  an  adjuvant 
to  cocaine  for  local  anaesthesia  was  demonstrated,  and  Bier 
conceived  the  idea  that  by  its  use  in  spinal  anaesthesia  the 
rapidity  of  absorption  of  the  cocaine  could  be  retarded  and  the 
local  effect  increased,  while  the  toxic  symptoms  were  decreased, 
an  idea  which  was  amply  confirmed  by  its  use.  At  first  Bier 
injected  the  adrenalin  solution  into  the  subarachnoid  space  and, 
after  allowing  five  or  six  minutes  to  elapse,  injected  the  solu- 
tion of  cocaine.  Later,  however,  he  combined  the  two  drugs  and 
injected  them  at  the  same  time,  and  this  is  the  method  which  he 
now  employs  in  the  use  of  stovaine.  As  Donitz  has  clearly  stated, 
there  are  three  ends  to  be  attained  in  perfecting  the  method  of 
spinal  anaesthesia:  i,  to  reduce  the  failures  to  a  minimum  or 
to  avoid  them  entirely ;  2 ,  to  secure  the  desired  result  with  the 
smallest  possible  dose  of  the  anaesthetic,  thereby  avoiding  the 


324  METHODS   FOR   USE  OF  SPINAL  ANAESTHESIA 

danger  of  symptoms  or  after  effects;  and,  3,  to  secure  an  anaes- 
thesia extending  well  up  on  the  body  and  thereby  increase  the 
range  of  usefulness  of  the  method. 

The  cases  in  which  the  anaesthesia  has  not  been  satisfactory 
may  be  divided  into  two  groups :  One,  unilateral  anaesthesia ; 
and,  two,  incomplete  anaesthesia.  The  occurrence  of  unilateral 
anaesthesia  is  probably  due  in  most  instances  to  the  fact  that 
the  needle  strikes  one  side  of  the  cauda  instead  of  the  middle, 
and  this  side  becomes  anaesthetic,  while  the  other  does  not. 
In  other  cases  it  has  been  assumed  to  be  the  result  of  gravity  in 
that,  the  puncture  being  made  with  the  patient  upon  the  side, 
that  side  of  the  body  becomes  anaesthetic  which  is  undermost. 
This  explanation  in  all  probability  holds  in  only  very  few  cases. 

It  has  been  definitely  shown  that  when  the  spinal  fluid  flows 
freely  the  anaesthesia  is  much  more  apt  to  be  complete  than 
when  it  flows  slowly.  If  the  cases  of  failure  to  secure  satisfac- 
tory anaesthesia  are  carefully  analyzed,  it  will  be  found  that  in 
most  instances  little  or  no  spinal  fluid  has  escaped  through  the 
needle.  In  such  cases  it  is  well  to  move  the  needle  around,  with- 
draw it  somewhat,  or  even  make  a  new  puncture,  for  the  failure 
to  secure  a  satisfactory  flow  of  spinal  fluid  is  more  apt  to  be 
due  to  an  imperfect  insertion  of  the  needle  than  an  abnormally 
low  pressure  of  the  spinal  fluid.  For  this  a  satisfactory  anatomi- 
cal explanation  has  been  offered  by  Donitz.  The  two  halves  of 
the  cauda  equina  do  not  lie  in  immediate  contact  with  each  other, 
but  between  them  exists  an  elongated  space  filled  with  spinal 
fluid.  If  the  needle  penetrates  this  space  the  flow  of  fluid  will  be 
free.  If,  however,  the  needle  should  penetrate  the  nerves  on 
either  side  the  flow  might  be  more  or  less  obstructed,  and  in  the 
same  way  the  injected  anaesthetic  will  not  have  free  access  to 
all  the  nerves  and  hence  a  unilateral  or  incomplete  anaesthesia 
might  result.  An  attempt  should,  therefore,  be  made  to  have 
the  needle  enter  the  subarachnoid  space  as  near  the  middle  line 
as  possible  and  care  should  be  taken  to  see  that  the  spinal  fluid 
flows  freely.  Another  important  anatomical  fact  to  be  borne  in 
mind  is  that  the  sensory  fibers  of  the  cauda  are  grouped 
together  in  its  posterior  part,  while  the  motor  fibers  occupy  the 
anterior  part.  Inasmuch,  therefore,  as  we  wish  the  effect  of  the 
anaesthetic  to  be  exerted  upon  the  sensory  fibers,  care  should 
be  taken  that  the  needle  does  not  penetrate  the  cauda.  In  this 
way,  too,  an  haematoma  of  the  cauda  can  be  avoided.    It  has 


ARTHUR  W.  ELTING 


325 


also  been  shown  that  if  a  colored  solution  is  injected  into  the 
anterior  or  posterior  part  of  the  cauda,  it  tends  to  extend  up- 
ward and  downward  in  this  part  without  involving  the  other, 
and  thus  certain  failures  to  obtain  complete  anaesthesia  can  be 
explained  by  the  fact  that  the  anaesthetic  reached  only  the 
motor  and  not  the  sensory  fibers.  This  is  especially  true  of 
stovaine,  which  appears  to  act  more  intensely  upon  the  motor 
nerves  than  does  cocaine. 

In  other  instances  failure  may  have  been  due  to  the  use  of  anaes- 
thetics which  had  to  a  greater  or  lesser  extent  lost  their  properties, 
either  as  a  result  of  their  being  too  old,  or  because  they  were  sub- 
jected to  too  great  and  too  long  continued  heat  for  the  purpose  of 
sterilization.  In  probably  only  very  few  cases  has  an  idiosyn- 
cracy  of  the  individual  been  responsible  for  the  failure  to  secure 
satisfactory  anaesthesia.  This  is  clearly  demonstrated  by  the 
fact  that  coincident  with  a  better  understanding  of  the  anatomical 
and  physiological  features  of  the  subarachnoid  space,  as  well  as 
a  perfection  of  the  method  of  spinal  anaesthesia,  the  percentage 
of  failure  to  obtain  a  satisfactory  anaesthesia  has  fallen  from 
eight  or  ten  per  cent,  to  two  or  four  per  cent.,  and  in  Bier's  own 
clinic  almost  to  nil.  When  the  most  perfect  methods  are  em- 
ployed, failures  will  be  relatively  infrequent. 

The  toxic  symptoms  incident  to  the  use  of  spinal  anaesthesia 
have  been  the  most  deterrent  factor  in  its  development  and  more 
general  adoption.  These  symptoms  may  vary  from  very  slight 
transitory,  hardly  noticeable  disturbances  of  respiration  and  cir- 
culation, to  a  most  profound  collapse  from  which  the  patient  may 
not  rally.  The  alarming  symptoms  are  those  of  collapse ;  a  small, 
oftentimes  almost  imperceptible  pulse,  which  may  be  much  slowed 
in  some  cases,  while  in  others  the  rate  is  increased.  The  face  is 
pale ;  the  lips  are  cyanotic ;  the  respiration  is  more  or  less  labored ; 
the  sensorium  is  disturbed.  Nausea  and  vomiting,  with  a  profuse 
cold  clammy  perspiration,  and  paresis  of  the  sphincters  as  well 
as  of  the  legs  may  also  occur.  These  are  the  immediate  toxic 
symptoms,  to  which  in  a  short  time,  one  to  three  hours,  may  be 
added  an  intense  headache,  restlessness  and  elevation  of  the  tem- 
perature. When  such  symptoms  are  present  the  patient  is  apt 
to  be  more  or  less  uncomfortable  for  from  a  few  hours  to  several 
days,,  the  headache  and  restlessness  being  the  symptoms  which 
show  the  most  marked  tendency  to  persist.  The  treatment  of  this 
toxaemia  is  essentially  symptomatic  and  the  usual  measures  for 


326  .  METHODS   FOR  USE   OF   SPINAL  ANAESTHESIA 

combating  shock  should  be  employed.  Those  symptoms,  i.  e.,  head- 
ache, restlessness,  spinal  irritation,  referable  to  the  central  nervous 
system,  which  occasionally  persist  for  several  days  after  the 
anaesthesia,  suggest  an  aseptic  meningitis,  and  can  be  avoided  in 
practically  every  instance  if  care  is  taken  to  select  a  non-irritant 
anaesthetic,  which  should  be  administered  in  the  smallest  possible 
dose  in  a  non-irritating  solution.  Cocaine  sometimes  causes  after 
effects  which  are  evidently  due  to  an  irritant  action  of  the  drug. 
Eucaine  acts  in  practically  the  same  manner,  while  tropacocaine 
does  this  to  a  lesser  extent.  Stovaine,  on  the  other  hand,  in 
doses  three  or  four  times  that  of  cocaine,  is  much  less  of  an 
irritant  than  any  of  the  drugs  mentioned.  Attempts  have  also 
been  made  to  introduce  the  drug  in  solution  as  nearly  isotonic 
with  the  spinal  fluid  as  possible  in  order  that  irritation  from  this 
source  may  be  avoided.  To  this  end  some  surgeons  introduce  the 
necessary  amount  of  sterile  cocaine  crystals  into  the  barrel  of  the 
syringe,  after  which  the  spinal  puncture  is  made  and  enough 
spinal  fluid  drawn  into  the  syringe  to  dissolve  the  cocaine,  after 
which  the  solution  is  reinjected.  Normal  salt  solution  would 
appear  to  be  the  most  universally  available  and  satisfactory 
menstruum  for  the  solution  of  the  anaesthetic  drug.  It  is  also 
evident  fom  the  literature  that  symptoms  of  spinal  irritation  may 
occur  from  simple  spinal  puncture  without  the  injection  of  any 
solution  whatever.  The  symptoms  referable  to  this  irritant  action 
of  the  anaesthetic  practically  always  disappear  in  a  short  time  and 
no  permanent  disturbance  results.  In  a  very  few  instances  the 
post-operative  symptoms  have  indicated  a  septic  meningitis,  which 
in  two  or  three  instances  has  been  confirmed  by  autopsy.  There 
is,  however,  no  need  of  such  a  complication  if  care  is  exercised 
and  an  asceptic  technique  is  employed. 

The  practical  range  of  usefulness  of  spinal  anaesthesia  may 
be  said  to  be  from  the  level  of  the  umbilicus  downward.  The 
most  constant  and  satisfactory  results  have  been  when  the  method 
was  employed  below  the  level  of  the  anterior-superior  iliac  spines. 
Above  this  level  the  anaesthesia  is  more  or  less  uncertain. 
Theoretically  it  would  seem  most  desirable  to  inject  the  anaes- 
thetic at  the  level  of  the  segments  which  supply  sensation  to  the 
region  to  be  operated  upon,  but  this  is  impossible  because  of  the 
danger  of  wounding  the  cord.  The  nearest  approximation  to  this 
ideal  is  obtained  by  injecting  the  anaesthetic  between  the  first  and 
second,  or  second  and  third  lumbar  verterbrae,  followed  by  ele- 


ARTHUR  W.  ELTING 


327 


vating  the  pelvis.  In  this  way  the  diffusion  of  the  anaesthetic 
upward  in  the  subarachnoid  space  is  favored  and  a  higher  level 
of  anaesthesia  may  be  obtained.  Donitz  employs  in  conjunction 
with  this  still  another  device  to  heighten  the  level  of  anaesthesia. 
By  placing  an  elastic  band  around  the  neck  an  obstruction  to  the 
return  flow  of  blood  from  the  cranial  cavity  is  produced  which 
results  in  raising  the  pressure  of  the  cerebro-spinal  fluid.  If 
after  this  elastic  bandage  is  placed,  the  puncture  is  done,  the 
anaesthetic  injected,  and  the  elastic  bandage  then  removed, 
the  anaesthetic  solution  will  be  drawn  upward  in  the  sub- 
arachnoid space  and  a  higher  level  of  anaesthesia  induced. 
This  procedure,  combined  with  elevation  of  the  pelvis,  will 
usually  give  a  satisfactory  anaesthesia  as  high  as  the  level  of 
the  umbilicus. 

The  general  consensus  of  opinion  is  that  spinal  anaesthesia 
is  indicated  in  all  classes  of  cases  except  the  very  young,  i.  e., 
under  ten  to  fifteen  years  of  age.  Circulatory  or  pulmonary  dis- 
ease is  not  a  contraindication,  but  on  the  other  hand  this  mode 
of  anaesthesia  would  appear  to  be  especially  indicated  in  this 
class  of  cases.  It  appears  to  be  an  especially  valuable  mode  of 
anaesthesia  in  cases  in  which  there  is  already  a  profound  shock, 
as  after  crushing  injuries  to  the  legs,  cases  in  which  the  use  of  a 
general  anaesthetic  is  not  infrequently  attended  with  serious  con- 
sequences. In  the  writer's  own  personal  experience  it  has  been 
of  the  greatest  service  perhaps  in  this  class  of  cases,  and  in  none 
of  them  was  the  amputation  of  the  leg  attended  with  any  further 
increase  of  the  shock.  The  researches  of  Crile  and  others  have 
demonstrated  of  how  great  importance  the  shock  attendant  upon 
the  cutting  of  large  nerve  trunks  is,  and  to  prevent  this  shock  a 
preliminary  exposure  of  the  large  nerve  trunks  above  the  pro- 
posed site  of  severance,  followed  by  the  injection  of  a  solution 
of  cocaine  directlv  into  the  nerve,  is  not  infrequently  practiced. 
In  this  way  the  afferent  impulses  are  effectually  blocked  and 
the  resulting  shock  is  materially  diminished.  Spinal  anaesthesia 
allows  the  blocking  of  all  the  nerves  that  might  be  encountered 
in  such  an  operation,  in  a  far  more  effectual  fashion  than  that 
proposed  by  Crile,  and  it  is  fair  to  assume  that  the  absence  of 
shock  after  such  an  operation  is  in  part  due  to  the  blocking  of 
the  nerves. 

The  method  of  induction  of  spinal  anaesthesia  as  practiced  by 
the  writer  is  in  detail  as  follows : 


328  METHODS   FOR  USE  OF  SPINAL  ANAESTHESIA 

The  patient  either  sits  with  the  shoulders  bent  forward  and  the 
spine  arched  backward,  or  lies  upon  the  side  in  such  a  fashion  as 
to  produce  the  greatest  amount  of  arching  of  the  dorso-lumbar 
spine.  This  is  best  obtained  with  the  head  and  shoulders  bent 
forward  and  the  thighs  flexed  upon  the  abdomen.  The  skin 
over  the  dorso-lumbar  region  of  the  spine  is  carefully  disin- 
fected. The  posterior  iliac  crests  are  determined  and  the  fourth 
lumbar  spine  slightly  above  this  level  is  readily  located.  Depend- 
ing upon  whether  a  high  level  of  anaesthesia  is  desired  or  not, 
the  spines  of  the  first,  second,  third  or  fourth  lumbar  vertebrae 
are  located  and  the  point  of  the  needle  inserted  either  just  below 
the  spine  or  slightly  to  one  side.  The  needle  is  carefully  pushed 
forward  between  the  vertebrae  until  the  region  of  the  dura  is 
reached,  when  the  needle  is  so  directed  as  to  enter  the  sub-dural 
space  as  nearly  in  the  median  line  as  possible.  Occasionally 
some  difficulty  is  experienced  in  directing  the  needle  between  the 
vertebrae  and  it  may  have  to  be  withdrawn  slightly,  or  even 
entirely,  and  deflected  in  one  direction  or  another.  The  entrance 
of  the  needle  into  the  subarachnoid  space  is  usually  readily  felt, 
and  the  withdrawal  of  the  stilet  followed  by  the  escape  of  the 
spinal  fluid  demonstrates  that  the  subarachnoid  space  has  been 
entered.  If  the  fluid  flows  slowly  or  not  at  all,  the  needle  should 
be  moved  around  or  even  partly  withdrawn,  and  these  movements 
should  be  continued  until  the  fluid  flows  freely,  for,  as  above 
mentioned,  failure  to  obtain  satisfactory  anaesthesia  has  usually 
occurred  in  the  cases  where  the  fluid  flowed  but  slowly.  Often 
a  slight  change  in  the  position  of  the  needle  will  remedy  this 
condition.  An  amount  of  spinal  fluid  is  allowed  to  escape  about 
equal  to  that  of  the  anaesthetic  solution  to  be  injected.  From  ten 
to  twenty  milligrams  of  cocaine  or  forty  to  sixty  milligrams  of 
stovaine  dissolved  in  one  and  one-half  to  two  cubic  centi- 
meters of  sterile  salt  solution,  to  which  one-half  cubic  centi- 
meter of  a  one  to  one  thousand  solution  of  adrenalin  has  been 
added,  are  then  slowly  injected  and  the  needle  withdrawn. 

The  sterilization  of  the  injected  solution  is  of  considerable- 
importance,  and  it  is  the  writer's  custom  to  prepare  the  solution 
containing  the  anaesthetic  and  the  adrenalin  in  a  small  test  tube, 
which  is  then  held  in  boiling  water  for  two  or  three  minutes. 
This  has  been  found  to  be  an  effectual  method  of  sterilization,  and 
at  the  same  time  it  does  not  impair  the  activity  of  the  drugs 
employed. 


ARTHUR  W.  ELTING 


329 


Formerly  it  was  the  writer's  custom  to  inject  the  adrenalin 
first,  and  five  or  six  minutes  later  the  cocaine  of  stovaine  were 
injected.  The  injection  of  both  drugs  at  once,  however,  saves 
time  and  has  proven  to  be  quite  as  satisfactory  as  the  method  of 
separate  injection. 

The  adrenalin  has  a  threefold  action;  it  prevents  the  rapid 
absorption  of  the  cocaine  or  stovaine  and  thus  lessons  the  tend- 
ency to  toxic  symptoms :  it  intensifies  the  local  action  of  the 
anaesthetic,  and  it  prolongs  the  period  of  anaesthesia.  In  from 
five  to  ten  minutes  after  the  injection  of  the  cocaine  or  stovaine, 
anaethesia  of  the  legs  and  lower  part  of  the  trunk  is  complete. 
As  already  remarked,  the  zone  of  anaesthesia  can  be  materially 
heightened  by  elevation  of  the  pelvis  after  the  injection  of  the 
anaesthetic. 

The  following  is  a  list  of  the  cases  in  which  spinal  anaesthesia 
has  been  practiced  by  the  writer: 

Case  No.  I  ;  age,  58  years :  Amputation  at  upper  and  middle 
thirds  of  thigh  for  ununited  fracture  and  ulceration  of  leg.  Per- 
fect anaesthesia.    No  toxic  symptoms. 

Case  No.  2 ;  age,  82  years :  Perineal  section  for  urinary  reten  - 
tion. Perfect  anaesthesia.  Slight  post-operative  nausea  and 
vomiting. 

Case  No.  3 ;  age,  35  years :  Radical  cure  of  right  inguinal 
hernia.    Perfect  anaesthesia.    No  toxic  symptoms. 

Case  No.  4 ;  age,  70  years :  Wiring  of  fractured  patella.  Per- 
fect anaesthesia.    Hysterical  patient.    No  toxic  symptoms. 

Case  No.  5;  age,  55  years:  Amputation  at  middle  and  lower 
thirds  of  leg  for  crush.  Perfect  anaesthesia.  Slight  nausea  and 
vomiting. 

Case  No.  6 ;  age,  55  years :  Resection  of  distal  ends  of  first 
metatarsal  bones  of  both  feet  for  hallux  valgus.  Perfect  anaes- 
thesia.  No  toxic  symptoms. 

Case  No.  7;  age,  70  years:  Prostatectomy  for  hypertrophied 
prostate  and  urinary  retention.  Perfect  anaesthesia.  Nausea  and 
vomiting. 

Case  No.  8;  age,  71  years:  Amputation  of  leg  in  upper  third 
for  gangrene  of  foot.    Perfect  anaesthesia.    No  toxic  symptoms. 

Case  No.  9;  age,  51  years:  Amputation  at.  middle  of  thigh  for 
gangrene  of  leg.  Perfect  anaesthesia.  Slight  nausea  and  vomit- 
ing. 

Case  No.  10 ;  age,  74  years :   Amputation  of  great  toe  and  re- 


330  METHODS   FOR   USE   OF  SPINAL  ANAESTHESIA 


section  of  first  metatarsal  bone  for  necrosis.  Perfect  anaesthesia. 
No  toxic  symptoms. 

Case  No.  1 1 ;  age,  74  years :  Amputation  at  middle  of  leg  for 
gangrene  of  foot.  Perfect  anaesthesia.    No  toxic  symptoms. 

Case  No.  12;  age,  74  years:  Amputation  at  middle  of  femur 
for  gangrene  of  leg.    Perfect  anaesthesia.    No  toxic  symptoms. 

Case  No.  13;  age,  23  years:  Curettement  of  tuberculous  sin- 
uses about  knee  joint.  Perfect  anaesthesia.  Nausea,  vomiting, 
profuse  sweat ;  headache  for  three  days. 

Case  No.  14 ;  age,  50  years :  Resection  of  distal  end  of  first 
metatarsal  bone  of  each  foot  for  hallux  valgus.  Perfect  anaes- 
thesia.   No  toxic  symptoms. 

Case  No.  15;  age,  58  years:  Amputation  at  middle  of  thigh 
for  diabetic  gangrene  of  foot.  Perfect  anaesthesia.  No  toxic 
symptoms. 

Case  No.  16;  age,  46  years:  Excision  of  inguinal  glands  for 
recurrent  sarcoma.  Perfect  anaesthesia.  Nausea,  vomiting,  pro- 
fuse sweat,  pallor;  small  pulse,  rate  normal;  prostration. 

Case  No.  17;  age,  28  years:  Excision  of  sequestrum  from 
femur  following  osteomyelitis.  Perfect  anaesthesia.  Nausea, 
vomiting. 

Case  No.  18 ;  age,  23  years :  Amputation  at  knee  joint — Gritti 
method,  for  crush  of  leg.  Perfect  anaesthesia.  No  toxic  symp- 
toms. 

Case  No.  19;  age,  27  years:  Amputation  at  lower  third  of 
thigh  for  crush  of  leg.   Perfect  anaesthesia.   No  toxic  symptoms. 

Case  No.  20 ;  age,  36  years :  Amputation  at  lower  third  of  leg 
for  crushed  foot.   Perfect  anaesthesia.   No  toxic  symptoms. 

Case  No.  21 ;  age,  40  years:  Wiring  of  both  patellae  for  frac- 
ture.   Perfect  anaesthesia.    No  toxic  symptoms. 

Case  No.  22 ;  age,  78  years :  Wiring  of  patella  for  fracture. 
Perfect  anaesthesia.  Slight  disturbance  of  vision.  Slow  pulse, 
scarcely  felt  at  wrist.    No  other  symptoms. 

Case  No.  23 ;  age,  25  years :  Skin  grafting  of  heel — Thiersch 
method,  for  extensive  ulceration  following  crush.  Perfect  anaes- 
thesia :  slight  nausea  and  vomiting ;  transitory  motor  paralysis. 

Case  No.  24 ;  age,  52  years :  Prostatectomy  for  hypertrophied 
prostate  and  retention  of  urine.  Very  satisfactory  anaesthesia. 
No  toxic  symptoms. 

Case  No.  25  ;  age,  53  years :   Whitehead  operation  and  curette- 


ARTHUR  W.  ELTING 


331 


ment  of  sinuses  for  fistula  in  ano  and  hemorrhoids.  Perfect 
anaesthesia.    No  toxic  symptoms. 

Case  No.  26;  age,  27  years:  Reamputation  of  tibia  and  fibula 
at  upper  and  middle  thirds  for  ulceration  of  stump.  Perfect 
anaesthesia.   No  toxic  symptoms. 

Case  No.  27 ;  age,  41  years :  Whitehead  operation  and  curette- 
ment  of  sinus  for  fistula  in  ano  and  hemorrhoids.  Perfect  anaes- 
thesia.   No  toxic  symptoms. 

Case  No.  28;  age,  32  years:  Reamputation  of  tibia  and  fibula 
at  upper  part  of  middle  third  for  extensive  ulceration  of  stump. 
In  this  case  for  the  first  time  in  the  writer's  experience  there  was 
no  escape  of  cerebro-spinal  fluid,  although  several  punctures  were 
made.  Being  satisfied  that  the  point  of  the  needle  was  in  the  sub- 
dural space,  the  anaesthetic  was  injected  and  satisfactory  anaes- 
thesia was  induced,  although  it  was  not  absolutely  perfect.  No 
toxic  symptoms. 

Case  No.  29;  age,  29  years:  Radical  cure  of  right  inguinal 
hernia.   Perfect  anaesthesia.   No  toxic  symptoms. 

Case  No.  30 ;  age,  30  years :  Wiring  of  fractured  right  patella 
and  radical  cure  of  right  inguinal  hernia.  Slight  nausea  and 
vomiting.    Perfect  anaesthesia. 

In  the  first  seventeen  of  the  above  cases  cocaine  was  the  anaes- 
thetic employed,  and  from  ten  to  twenty  milligrams  were  used. 
In  the  last  thirteen  cases  stovaine  was  the  anaesthetic  employed, 
in  doses  of  from  forty  to  eighty  milligrams. 

In  both  series  of  cases  the  dosage  was  rather  high,  and  yet 
no  severe  toxic  symptoms  resulted.  There  were,  however,  more 
slight  toxic  disturbances  following  the  use  of  cocaine  than  after 
the  use  of  stovaine,  and  since  the  anaesthesia  produced  by  the 
latter  was  perfect  in  each  instance,  we  are  inclined  to  regard  it 
as  decidedly  preferable  to  cocaine,  which  bears  out  the  opinion 
expressed  by  practically  all  those  who  have  used  it.  In  one 
case  spinal  anaesthesia  was  performed  three  times  upon  the  same 
patient  within  a  period  of  five  weeks  without  the  production  of 
any  toxic  or  irritative  symptoms,  and  with  the  production  of 
perfect  anaesthesia  in  each  instance. 

It  might  be  further  observed  that  the  above-mentioned  cases 
were  selectedly  bad  ones.  In  many  instances  the  age  was  ad- 
vanced and  severe  cardiac  and  circulatory  disturbances  were 
present.    Some  of  the  patients  were  pronounced  alcoholics,  while 


332 


ALBANY  HOSPITAL 


still  others  were  suffering  from  severe  shock  as  the  result  of 
crushes  of  the  legs  or  hemorrhage.  The  immediate  result  in 
every  instance  in  which  spinal  anaesthesia  was  employed  was 
most  satisfactory,  and  in  no  instance  has  there  been  any  post- 
operative evidence  of  disturbance  of  the  spinal  cord  or  nerves. 
We  feel  therefore  that,  while  the  range  of  usefulness  of  spinal 
anasthesia  will  always  remain  somewhat  restricted,  it  is  neverthe- 
less a  valuable  addition  to  the  methods  of  inducing  anaesthesia 
and  one  which  is  deserving  of  more  extended  trial. 


In  nature  there's  no  blemish  but  the  mind. — Twelfth  Sight,  Act  iii,Sc.iv. 

ALBANY  HOSPITAL. 

Fourth  Annual  Report  of  Pavilion  F,  Department 
for  Mental  Diseases,  for  the  Year  Ending 
February  28,  1906. 

By  J.  MONTGOMERY  MOSHER,  M.  D., 

Attending  Specialist  in  Mental  Diseases. 

To  the  Board  of  Governors: 

I  have  the  honor  to  present  the  fourth  annual  report  of  the 
operations  of  Pavilion  F,  for  the  year  ending  February  28, 
1906. 

There  remained  in  the  Pavilion  on  March  1,  1905,  twenty- 
three  patients,  eleven  men  and  twelve  women.  There  have  been 
admitted  during  the  year  one  hundred  and  twenty-one  men  and 
ninety-three  women.  The  whole  number  of  patients  under  treat- 
ment during  the  year  was,  therefore,  two  hundred  and  thirty- 
seven. 

There  have  been  discharged  two  hundred  and  twenty-three 
patients,  one  hundred  and  twenty-five  men  and  ninety-eight 
women;  and  there  remained  in  the  Pavilion  at  the  end  of  the 
year  seven  men  and  seven  women. 

The  following  tables  show  the  forms  of  disease  and  the  re- 
sults of  treatment  for  the  year,  and  since  the  opening  of  the 
Pavilion : 


J.   MONTGOMERY  MOSHER 


333 


TABLE  I. — Showing  the  Forms  of  Disease  and  the  Results  op 
Treatment  for  the  Year. 


FORM  OF  DISEASE. 


Acute  delirium  

Confusional  insanity.. 

Melancholia  

Mania  

Primary  dementia. .  . 


Recurrent  insanity  

Chronic  delusional  in- 
sanity  

General  paralysis  

Terminal  dementia  

Imbecility  and  idiocy. 


Acute  alcoholic  d  elirium 

Alcoholism  

Drug  addiction  


Eclampsia  

Epilepsy  

Neurasthenia  

Hysteria  

Chorea  minor  

Hypochondriasis  

Organic  brain' disease 
Cerebral  concussion. . 
Locomotor  ataxia. 

Myelitis  

Pneumonia  

Pernicious  anaemia. . 

Uraemia  

Gastro-enteritis  

Fracture  of  skull  

No  diagnosis  


Totals 


Recov- 
ered 


M  W 


28 


Im- 
proved 


M  W 


47 


38 


Unim- 
proved 


M  W 


37 


3  7 


Died 
M  W 


Re- 
maining 


M  W 


132 


1 


334 


FOURTH    REPORT  OF  PAVILION  F 


TABLE  II. — Showing  the  Forms  of  Disease  and  the  Results  of 
Treatment  Since  the  Opening  of  the  Pavilion, 
February  18,  1902. 


FORM  OF  DISEASE. 


Acute  delirium  

Confusional  insanity 

Melancholia  

Mania  

Primary  dementia  . 


Recurrent  insanity  .  .  . 
Chronic  delusional  in 

sanity  

General  paralysis  

Terminal  dementia  

Imbecility  and  idiocy. 


Acute  alcoholic  delir- 
ium   

Alcoholism  

Drug  addiction  


Ptomaine  poisoning. . 

Uraemia  

Eclampsia  

Epilepsy  

Neurasthenia  

Hysteria  

Chorea  minor  

Exophthalmic  goitre. 

Nervousness  

Hypochondriasis  

Pseudo-paresis  

Organic  brain  disease. 
Cerebral  concussion . . 

Locomotor  ataxia  

Myelitis  

Hydrophobia  

Tuberculosis  

Jaundice  

Pneumonia  

Pernicious  anaemia. . 

Gastro-enteritis  

Fracture  of  skull  

Malingering  

No  diagnosis  


Totals, 


Recov- 
ered 


If  w 


Im- 
proved 


M  W 


6  1 1 
5  36 


155;  56 


139,106 


Unim- 
proved 


M  W 


17 


3i  32 
5  3 


1 19;  120 

I 


Died 


M  W 


41  25 


Re- 
maining 


M  W 


Total 


116 

57 
6 

1 

2 
1 

1  2 
18 
2 
1 


467 


3i7 


784 


J.   MONTGOMERY  MOSHER 


335 


Admissions 

The  number  of  admissions  was  two  hundred  and  fourteen. 
There  were  one  hundred  and  seventy-four  admissions  the  first 
year,  one  hundred  and  seventy-one  the  second,  and  two  hundred 
and  thirty-nine  the  third.  Sixteen  patients  were  transferred  from 
other  wards  of  the  hospital.  Of  these  twelve  were  dis- 
tinctly nervous  cases,  and  four  were  medical  or  surgical  cases, 
complicated  by  nervous  symptoms.  Nineteen  patients  were  re- 
admitted, having  been  treated  in  Pavilion  F  in  previous  years. 

The  patients  admitted  may  be  arranged  in  two  groups.  In 
one  group  are  cases  brought  to  the  Pavilion  upon  the  order  of 
the  Superintendent  of  the  Poor  of  Albany  County.  These 
patients  have  manifested  some  form  of  mental  disorder,  and  are 
placed  in  Pavilion  F  for  observation  as  to  its  probable  perma- 
nence, or,  having  been  legally  adjudged  insane,  pending  arrange- 
ments for  the  transfer  to  a  State  hospital.  In  many  instances 
improvement  has  occurred,  need  of  legal  measures  obviated,  and 
the  patient  has  returned  to  his  home  and  his  occupation  after 
a  short  period  of  recuperation  in  Pavilion  F.  In  some  cases  it 
has  been  a  matter  for  regret  that  the  period  of  observation  or 
preliminary  treatment  (for  treatment  is  always  instituted  at 
once)  could  not  have  been  longer.  Prompt,  early  treatment  of 
mental  diseases  is  of  the  greatest  importance,  and  it  has  been 
hoped  that  Pavilion  F  would  open  a  way  to  secure  this  not 
heretofore  available  boon.  But  the  different  counties  meet  a  pro 
rata  State  tax  for  the  care  of  the  insane  in  the  State  hospitals, 
and  the  Superintendent  of  the  Poor  is  very  properly  cautious  as 
to  the  duplication  of  the  expenditure. 

The  county  of  Albany  cannot  be  expected  to  make  payment 
for  the  care  of  its  insane  in  a  State  hospital,  and  at  the  same 
time  maintain  a  local  institution  to  do  the  work.  Unless,  there- 
fore, our  public  patients  improve  so  rapidly  as  to  keep  the  cost 
of  care  within  that  of  commitment  and  transfer  to  a  State  hos- 
pital, they  are  obliged  to  leave.  This  condition  has  arisen  in  the 
logical  sequence  of  events,  and  is  unfortunate.  It  is  a  dis- 
crimination against  the  victim  of  mental  disease,  who  is  not  yet 
placed  upon  the  same  footing  as  the  sufferer  from  a  physical 
ailment,  although  even  more  entitled  to  every  effort  for  his 
restoration  to  hea1th.  Many  individuals  who  are  threatened  with 
mental  disorder,  and  need  just  such  care  as  Pavilion  F  can  give 


336  FOURTH  REPORT  OF  PAVILION  F 

to  avert  a  calamity,  cannot  obtain  this  care,  but  must  wait  until 
enough  advanced  to  satisfy  a  court  of  record  that  they  are 
incapable  of  managing  their  affairs  or  unsafe  to  be  at  large.  In 
other  words,  laws  and  conditions  have  developed  to  provide 
custody  for  incompetent  or  dangerous  persons,  but  there  is  no 
statutory  recognition  of  methods  of  prevention  of  insanity,  or  of 
efforts  to  anticipate  its  baneful  tendencies  when  threatened  in 
the  individual.  A  curious  paradox  is  revealed  by  the  State  laws 
governing  the  care  of  the  insane  and  the  administration  of  the 
State  hospitals.  The  legislation  of  recent  years  provides  com- 
plete supervision  and  scrutiny  of  all  that  takes  place  in  the 
hospitals  for  the  insane,  and  the  power  of  the  supervising  body, 
the  State  Commission  in  Lunacy,  is  autocratic  to  an  extreme. 
And  yet,  with  all  this  care  and  all  this  protection  of  the  inalien- 
able rights  of  the  patients,  it  has  been  made  more  difficult  for 
them  to  get  in.  It  would  seem  that  the  State,  after  adopting 
a  most  complicated  system  of  legislating,  ruling,  supervising, 
and  commissionerizing,  looking  to  perfection  of  administration, 
realizes  the  imperfections  of  bureaucracy  and  mistrusts  its  own 
power.  Apart  from  the  sentimental  or  charitable  aspect  of 
the  question,  a  practical  or  economic  side  is  presented.  It  is  an 
accepted  postulate  by  specialists  who  have  examined  the  ques- 
tion that  every  recovery  from  mental  disease,  no  matter  what 
the  cost  of  obtaining  it,  is  a  saving  to  the  State.  When  it  is 
borne  in  mind  that  there  are  twenty-five  thousand  patients  in  the 
care  of  the  State  hospitals  of  Xew  York,  maintained  at  an  annual 
expenditure  of  over  five  millions  of  dollars,  the  force  of  this 
statement  may  be  appreciated.  The  necessity  of  early  treatment 
is  urgent,  and  it  is  the  object  of  Pavilion  F  to  give  the  oppor- 
tunity. Whether  the  financial  problem  is  to  be  met  by  public 
or  by  private  generosity  is  still  to  be  determined,  but  a  real 
source  of  regret  lies  in  the  fact  that  not  all  the  good  possible 
is  being  accomplished. 

The  second  group  of  patients  are  of  the  private  class.  For 
their  admission  there  is  no  technicality  or  no  intervention  of 
public  officials.  They,  or  their  friends  for  them,  seek  volun- 
tarily the  care  of  the  hospital.  The  transaction  must  not  be 
resisted  by  the  patient  or  he  cannot  remain.  The  number  who 
decline  to  accept  this  situation  is  strikingly  small.  In  fact 
there  are  few  patients  in  the  earlier  stages  of  mental  disease  who 
do  not  recognize  their  abnormal  processes  of  thought  and  are  not 


J.   MONTGOMERY  MOSHER 


337 


apprehensive  of  the  result.  But  any  individual,  even  though 
standing  upon  this  frightful  brink,  doubly  needs  assurance  that 
in  the  event  of  his  utter  incompetency  he  will  be  fairly  and  dis- 
interestedly treated  and  will  have  protection  of  both  his  affairs 
and  his  person.  If  he  is  able  to  comprehend  his  situation,  he  is 
permitted  to  enter  Pavilion  F  only  upon  his  own  request,  and 
with  his  own  acquiescence.  If  he  cannot  appreciate  what  he  is 
doing,  needs  such  care  as  can  be  given  in  Pavilion  F.  and  his 
responsible  friends  stand  sponsor,  he  is  received,  but  only  on 
condition  that  those  most  reliable  and  most  concerned  keep  them- 
selves in  close  touch  with  the  developments  of  his  case.  Many 
patients  pass  into  a  condition  of  exhaustion  in  which  life  is 
threatened.  It  is  doubly  necessary  in  such  cases  that  the  doors 
be  thrown  open  and  that  every  step  of  treatment  is  made  known 
to  those  most  interested.  Exclusion  and  secrecy  can  only  work 
harm,  and  the  more  difficult  and  more  threatening  the  case, 
the  greater  the  need  of  the  sympathy  and  cooperation  of  the 
family  or  friends. 

There  is  an  unfortunate  minority  who  are  manifestly  dis- 
ordered but  who  understand  what  is  going  on  and  decline  to  sub- 
ject themselves  to  needed  treatment.  No  control  of  these 
patients  can  be  exercised  until  judicial  disposition  of  the  cases 
is  made.  Pavilion  F  is  frequently  requested  to  receive  and  detain 
such  patients,  whether  they  assent  or  not.  In  fact  there  is 
resort  to  many  subterfuges  to  encompass  the  unwilling  patient. 
In  one  instance  recently  a  physician  was  requested  to  etherize 
the  patient  and  convey  him  unconscious  to  the  hospital.  It 
may  not  be  necessary  to  repeat  for  the  use  of  people  thus  situated, 
sorely  tried  though  they  be.  that  Pavilion  F  is  not  permitted 
to  forcibly  restrain  any  individual  of  his  liberty. 

The  scheme  thought  feasible  by  Sir  Toby  Belch,  in  the  days 
when  Twelfth  Xight  was  written,  is  hardly  practical  now : 

"  Come,  we'll  have  him  in  a  dark  room  and  bound.  My  niece 
is  already  in  the  belief  that  he's  mad :  we  may  carry  it  thus, 
for  our  pleasure  and  his  penance,  till  our  very  pastime,  tired 
out  of  breath,  prompt  us  to  have  mercy  on  him." 

Thus  two  privileges  are  secured  to  patients  by  Pavilion  F, 
which  makes  this  department  unique  in  general  hospital  adminis- 
tration. An  opportunity  is  given  to  patients  for  treatment  in 
their  home  locality,  under  the  scrutinizing  eye  of  their  friends, 
and  under  the  regulations  of  an  institution  for  treatment  of 


5 


33« 


FOURTH   REPORT  OF   PAVILION  F 


all  forms  of  disease;  and  secondly,  for  treatment  in  the  early 
stages  of  disease  without  recourse  to  the  tedious  technicalities 
of  legal  procedure. 

A  natural  aversion  from  persons  of  disordered  mind  pre- 
vails in  the  community,  and  no  doubt  patients  do  not  always 
avail  themselves  as  promptly  as  they  might  for  fear  of  unpleasant 
associates  or  surroundings.  Occasionally  a  lawyer  or  priest  is 
seen  surreptitiously  entering  the  building  to  assure  himself  that 
no  advantage  of  some  unfortunate  being  is  taken.  But  such 
suspicions  are  fading  away,  and  each  new  case  brings  acquaint- 
ance of  an  ever  widening  circle  of  friends,  confidence  is  estab- 
lished, and  more  and  more  is  the  sympathy  of  the  community 
taking  the  place  of  the  horror  with  which  mental  affections  are 
popularly  associated. 

Discharges 

Of  the  two  hundred  and  twenty-three  patients  discharged 
during  the  year  forty-one  recovered  and  eighty-five  were  im- 
proved. The  percentage  of  cases  thus  distinctly  benefited  is 
fifty-six.  Since  the  opening  of  the  Pavilion  the  percentage  of 
patients  discharged  as  recovered  and  improved  has  been 
fifty-eight. 

Seventy-four  patients  were  discharged  unimproved  and 
twenty  died.  The  causes  of  death  were :  exhaustion  from  melan- 
cholia, two;  general  paralysis,  one;  acute  alcoholic  delirium, 
two;  drug  addiction,  one;  organic  disease  of  the  brain,  two; 
myelitis,  one;  fracture  of  the  skull,  one;  nephritis,  two;  acute 
pneumonia,  three ;  gastro-enteritis,  one ;  pernicious  anaemia,  one ; 
old  age,  three. 

Treatment 

Nothing  is  to  be  added  to  the  principles  enunciated  in  the 
report  of  last  year.  The  cases  which  promise  the  best  results 
are  those  who  present  some  definite  cause  of  mental  deteriora- 
tion. They  have  been  normal  and  have  succumbed  to  the 
stress  of  life.  The  condition  is  one  of  nervous  or  general 
debility,  with  exhaustion  of  the  vital  power,  defective  action  of 
the  organs,  particularly  those  of  eliminative  function,  compli- 
cated by  mental  symptoms.  The  mental  state  may  be  one  of 
excitement,  depression,  of  stupor  or  of  active  delirium.  The 
pathological  process  is  the  same,  so  far  as  is  known,  whether 
manifested  by  turbulence  or  by  apathy.    In  either  event  rest 


J.   MONTGOMERY   MOSHER  339 

and  quiet  with  a  plan  of  reconstruction  or  building  up  is 
the  indicated  line  of  treatment.  It  is  necessary  to  rid  the 
body  of  the  accumulations  of  effete  material,  and  to  adminis- 
ter in  as  large  quantities  as  can  be  assimilated,  nutritious 
and  easily  digested  food.  Liquids  are  used  at  first,  and  milk, 
milk  with  eggs  and  broths  are  given  in  abundance.  Water  is 
required  to  be  used  in  large  quantities,  the  indication  of  suffi- 
ciency being  the  moisture  and  cleanliness  of  the  tongue.  The 
eliminative  function  of  the  skin  is  promoted  by  frequent  bathing. 
Sponge  baths  in  bed  are  given  by  the  nurses  when  advisable.  If 
the  patient  is  strong,  immersion  in  warm  water  is  recommended  at 
night,  followed  by  a  warm  drink.  This  serves  the  additional 
purpose  of  promoting  sleep.  All  of  these  measures  are  hygienic 
and  come  within  the  sphere  of  the  activities  of  the  trained  nurse. 
In  fact,  the  application  of  the  routine  practice  of  trained  nurs- 
ing proves  the  most  effective  means  of  restoring  health,  and  the 
success  attained  is  especially  due  to  the  intelligent  work  of  the 
nurses.  Drugs  are  of  quite  subordinate  value.  Those  used  are 
principally  tonic  in  action.  An  occasional  sedative  is  given, 
if  the  patient  asks  for  temporary  relief  from  restlessness,  but 
stupefying  doses  are  never  permitted,  and  in  delirium  and  other 
forms  of  restlessness  from  exhaustion  these  drugs  are  entirely 
prohibited.  In  the  last  report  mention  was  made  of  sub- 
cutaneous and  rectal  injections  of  normal  salt  solution,  so- 
called  saline  infusions.  The  results  were  beneficial  and  en- 
couraging. During  the  past  year  no  case  presented  in  which 
the  subcutaneous  method  was  indicated,  but  in  several  in- 
stances the  introduction  into  the  bowel  was  practiced  with 
gratifying  results. 

As  may  be  seen  in  the  accompanying  tables,  many  forms  of 
disease  or  defect  are  represented  which  offer  no  prospect  of 
cure.  In  every  community  are  individuals  below  the  average  in 
mental  attainments,  who,  from  time  to  time,  are  unable  to  associ- 
ate with  others  or  to  remain  at  large.  Such,  for  instance,  are 
the  cases  of  recurrent  insanity,  or  of  imbecility  and  feeble- 
mindedness. Their  defection  does  not  follow  a  palpable  excit- 
ing cause,  but  represents  a  natural  instability  of  the  nervous 
system,  or  the  rhythmical  variation  characteristic  of  nervous 
function.  Although  the  first  conception  of  Pavilion  F  was  based 
upon  the  idea  of  active  hospital  treatment,  a  larger  view  has 
opened  its  doors  to  all  of  the  mental  emergencies  of  the  people 


34o 


FOURTH    REPORT  OF   PAVILION  F 


in  whose  midst,  and  bv  whose  generosity  it  was  built.  Many 
a  period  of  unrest  and  turbulence  has  been  calmed,  and  it 
has  been  found  desirable  to  admit  certain  patients  for  tempor- 
ary care  until  conditions  justify  a  return  home.  Thus  one 
young  woman,  subject  to  recurring  attacks  of  mania,  has,  on 
several  occasions,  presented  herself  when  the  premonitory  symp- 
toms of  the  attack  were  felt,  and  has  remained  until  restored  to 
her  usual  state  of  health.  For  the  same  reason  patients  breaking 
down  in  old  age  have  often  been  received,  and  their  restless  con- 
dition has  been  made  more  bearable. 

Administration 
When  Pavilion  F  was  opened  for  patients  in  February,  1902, 
Dr.  Henry  Hun  was  appointed  a  special  committee  on  its  affairs 
by  the  governors  of  the  hospital.  As  it  was  a  departure  in  hos- 
pital organization,  and  had  no  precedents  upon  which  to  base 
regulations  for  management,  the  following  special  rules  were 
tentatively  adopted  by  the  Governors  on  March  9,  1902,  and 
amended  on  April  13th  of  the  same  year: 

(1)  The  attending  specialist  in  mental  diseases  shall  have  general  super- 
vision of  the  pavilion  and  shall  have  medical  charge  of  all  the  public 
patients  in  it. 

(2)  Any  physician  may  at  a  private  patient's  or  private  patient's 
friend's  request  have  medical  charge  of  a  patient  in  this  ward,  provided 
he  conforms  to  the  rules  adopted  for  its  administration. 

(3)  All  nurses  and  orderlies  in  charge  of  patients  in  this  ward  shall  be 
furnished  by,  or  approved  by,  the  Superintendent  of  Training  School  for 
Nurses. 

(4)  The  physician  in  charge  of  each  case  shall  decide  who  shall  visit 
his  patient. 

(5)  On  admission,  the  superintendent  shall  obtain  from  the  patient  or 
liis  friends,  a  list  of  persons  whom  they  would  like  to  have  see  the  patient; 
but  shall  consult  the  physician  in  charge  before  allowing  any  such  person 
to  visit  the  patient. 

(6.)  The  price  of  care  of  a  parent  (not  on  county  order)  in  the  wards 
shall  be  $8  or  $10  per  week  according  to  circumstances.  The  price  of  the 
East  room  on  each  floor  shall  be  $20  per  wtek.  of  the  Southwest  room 
in  each  floor  $25  per  week,  of  the  Northwest  room  on  each  floor  $30  per 
week,  of  isolation  rooms  $30  per  week.  The  physician  in  charge  of  the 
pavilion,  with  the  superintendent,  shall  have  power  to  give  a  reduction  of 
30  per  cent,  from  these  prices. 

(7.)  The  physician  in  charge  may  in  his  discretion  transfer  any  patient 
from  the  ward  to  a  private  room,  or  from  one  room  to  another  in  Pavilion 
F,  temporarily,  without  increase  in.  price. 

(8.)  The  senior  and  junior  house  physicians  shall  be  house  physicians 
for  Pavilion  F. 


J.   MONTGOMERY  MOSHER 


341 


After  several  months  of  trial  the  plan  was  found  to  have 
difficulties.  There  was  no  way  of  fixing  responsibility.  It  was 
shown  that  the  setting  aside  of  a  building  for  this  special  pur- 
pose is  not  sufficient,  and  that  it  was  impossible  to  treat  one 
patient  without  regard  for  the  others,  and  that  all  of  the  resources 
of  the  pavilion  are  called  into  use  and  need  to  be  harmoniously 
exercised,  if  quiet  and  order  are  to  prevail.  The  rules  were 
consequently  amended  to  read  as  follows : 

(1.)  No  physician  or  surgeon,  except  the  physician-in-charge,  shall  be 
allowed  to  treat  patients  in  Pavilion  F,  except  when  they  have  been  trans- 
ferred from  other  pavilions  on  account  of  a  sudden  attack  of  insanity, 
when  their  attending  physician  or  surgeon  may  continue  to  treat  the 
original  disease. 

(2.)  In  Pavilion  F  the  price  for  patients  in  the  general  ward  shall  be 
ten  dollars;  for  patients  in  a  private  room,  twenty-five  dollars.  This  price 
for  a  private  room  may  be  reduced  by  the  superintendent,  with  the  con- 
sent of  the  physician-in-charge,  but  no  patient  shall  be  kept  in  "F"  for  less 
than  ten  dollars  per  week. 

(3.)  Patients  paying  less  than  ten  dollars  per  week  shall  be  moved  to 
"F"  only  when  they  cannot  be  kept  in  the  isolating  rooms  without 
detriment  to  the  other  patients,  and  then,  only  until  their  friends  can  be 
notified,  so  that  these  latter  may  make  other  arrangements. 

The  rule  as  it  now  stands  provides  for  skilled  treatment 
of  surgical  or  other  local  disease.  The  hospital  recognizes  the 
specialties  -  and  has  appointed  experts  at  the  head  of  each 
department.  If  a  mental  complication  occurs  in  a  patient  under 
care  for  some  local  condition,  and  transfer  to  Pavilion  F  is 
necessary,  the  physician  in  charge  of  the  case  follows  to  ensure 
continuation  of  the  treatment  of  the  special  condition.  In  the 
deliria  of  post-operative  states,  for  example,  it  is  preeminently 
desirable  that  the  wound  or  other  surgical  lesion  should  be  cared 
for  by  the  surgeon.  This  rule  has  been  found  to  present  great 
advantages  when  regarded  from  the  other  aspect.  It  permits 
Pavilion  F  to  secure  the  services  of  specialists  in  other  depart- 
ments for  the  benefit  of  its  patients.  Calls  are  not  infrequently 
made  upon  the  surgeons,  gynecologists,  obstetricians,  elec- 
tricians and  specialists  in  diseases  of  the  eye,  ear,  nose  and  throat, 
and  such  demands  have  always  been  promptly  and  courteously 
met.  From  the  standpoint  of  the  patient  the  situation  is  ideal, 
and  the  best  advice  is  always  obtainable. 


342 


FOURTH   REPORT   OF   PAVILION  F 


Financial  Statement 

Received  from  public  patients   $2,202  86 

Received  from  private  patients   7»397  05 

Total    $9-599  91 


The  number  of  days'  treatment   5>°93 

The  average  income  for  each  patient  per  week   $11.80 


Endowment  Fund 

The  gift  of  five  hundred  dollars  from  Mrs.  McCartee,  which 
was  set  aside  as  the  nucleus  of  an  endowment  fund,  remains 
untouched.  It  is  hoped  that  this  fund  may  be  increased  so  as  to 
yield  an  income  for  the  maintenance  of  deserving  patients.  In 
a  large  city  like  Albany  there  are  not  infrequent  cases  of  mental 
break-down  resulting  from  overwork,  worry  and  privation,  and 
for  them  the  care  given  by  Pavilion  F  would  effect  a  speedy 
restoration  to  health.  Several  such  patients  have  been  received, 
who  occasionally  have  been  found  to  be  young  men  or  women 
away  from  home  seeking  to  support  themselves  in  clerical  or 
other  positions. 

Acknowledgment 

The  interest  of  the  Board  of  Governors  of  the  Hospital  and 
Managers  of  the  Training  School  for  Nurses  continues  un- 
abated. Visits  of  inspection  and  inquiry  have  been  regularly 
made,  and  the  details  of  administration  fully  considered.  The 
work  of  the  nurses  merits  the  greatest  approbation.  There  has 
been  no  indication  of  unwillingness,  even  when  arduous  and  un- 
pleasant tasks  are  required.  Patience  and  persistence  have  been 
almost  invariable.  Under  the  discreet  and  faithful  direction  of 
Miss  Anna  Dewar,  the  nurse  in  charge,  the  affairs  of  the  year 
have  been  conducted  with  unvarying  smoothness.  Great  credit 
is  due  Miss  Dewar  for  the  establishment  of  an  orderly  routine, 
and  for  great  exactness  in  the  details  of  individual  treatment. 

To  the  Superintendent  of  the  Poor  of  the  County,  Commis- 
sioner William  H.  Storrs,  the  hospital  is  indebted  for  unvary- 
ing courtesy  and  discrimination.  He  has  shown  intelligent 
appreciation  of  the  real  purposes  of  Pavilion  F,  and  has  steadily 


TREATMENT  OF   MAXILLARY  SINUSITIS  343 

resisted  attempts  of  undeserving  and  improper  cases  for 
admission. 

The  following  gifts  have  been  received :  Subscriptions  to 
The  Argus,  Munsey's  Magazine,  The  Argosy,  The  Strand  Maga- 
zine, The  Ladies'  Home  Journal  and  Pearson's  Magazine  have 
been  continued  by  Mr.  and  Mrs.  P.  K.  Dederick,  jr. ;  from  Miss 
Wilson  has  been  received  a  table  cover ;  from  Mr.  James  Hogan, 
Mrs.  William  B.  Jones  and  Mrs.  Frederick  Tillinghast,  maga- 
zines ;  from  Mrs.  Henry  L.  Woodward,  books ;  from  Mrs.  Simp- 
son, photographs ;  from  Mrs.  Samuel  B.  Ward,  two  games  of 
parchesi.  two  checker  boards,  two  games  each  of  tiddledy 
winks,  logomachy  and  dominoes,  and  one  Shakesperian  game; 
and  from  Mr.  J.  Townsend  Lansing,  two  framed  pictures. 
These  have  been  appreciated  by  the  patients,  and  it  is  hoped  that 
generosity  in  the  direction  of  beautifying  the  ward  and  pro- 
viding recreation  may  be  abundantly  manifested  in  the  future  as 
in  the  past. 


THE  TREATMENT  OF  ACUTE  AND  CHRONIC  MAXIL- 
LARY SINUSITIS. 

Read  at  the  Annual  Meeting  of  the  American  Laryngological,  Rhinologi- 
cal  and  Otological  Society  {Eastern  section),  at  Syracuse,  N.  Y.,  February 
10,  1906. 

By  CLEMENT  F.  THEISEN,  M.  D., 

Lecturer  on  Diseases  of  the  Nose  and  Throat,  Albany  Medical  College. 

The  treatment  of  a  maxillary  sinusitis  will  of  course  depend 
to  a  certain  extent  upon  the  cause,  and  for  this  reason,  all 
pathological  processes  about  the  roots  of  the  teeth  must  be 
carefully  looked  into,  and  when  present,  removed.  Diseased 
roots,  however,  are  not  frequent  etiological  factors,  as  by  far 
the  larger  number  of  cases  of  antral  disease  are  secondary  to 
pathologic  conditions  in  the  nose. 

Treatment  of  acute  maxillary  sinusitis. — In  the  majority  of 
the  cases  of  acute  inflammation  of  the  antral  mucous  membrane, 
a  policy  of  conservative  non-interference  is  best.  Bv  this  I  do 
not  wish  to  be  understood  that  nothing  should  be  done,  but 
that  not  too  much  should  be  done  at  first.  We  are  probably  all 
agreed  on  this  point.  Proper  treatment  of  the  nasal  condition 
will  in  the  majority  of  the  cases  be  all  that  is  necessary.  When 


344 


TREATMENT  OF   MAXILLARY  SINUSITIS 


the  mucous  membrane  is  much  congested,  particularly  in  the 
middle  meatus,  the  use  of  equal  parts  of  a  weak  cocaine  and 
adrenalin  solution  is  extremely  useful.  I  am  in  the  habit  of 
saturating  pledgets  of  cotton  with  this  solution,  allowing  it  to 
remain  in  the  nose  for  a  time.  As  there  is  usually  a  certain 
amount  of  pus  in  the  nostrils,  and  as  acute  maxillary  sinusitis 
so  commonly  complicates  influenza,  when  the  nasal  mucous 
membrane  is  very  much  congested  anyway,  the  use  of  sprays, 
particularly  coarse  sprays,  is  not  without  the  danger  of  carrying 
infection  to  the  middle  ear.  A  very  fine  spray  of  a  1-20,000  or 
1-30,000  adrenalin,  with  a  little  cocaine,  may  be  used  after  the 
acute  symptoms  have  partially  subsided,  but  during  the  acute 
stage  the  cotton  pledgets  are  safer. 

I  wish  to  take  this  opportunity  to  say  a  word  against  the  use 
of  the  ordinary  douche,  by  patients  themselves,  in  the  treat- 
ment of  acute  conditions  of  the  sinuses.  In  a  patient's  hand 
this  is  sometimes  a  dangerous  thing  to  use.  The  writer  has  had 
two  severe  cases  of  otitis  media  resulting  from  the  use  of  the 
douche,  the  patients,  in  both  cases,  having  received  the  douches 
from  a  general  practitioner.  During  an  acute  sinusitis,  the 
nasal  mucosa  is  usually  very  much  inflamed  and  with  the 
presence  of  pus,  an  infection  can,  as  before  stated,  be  readily 
conveyed  to  the  middle  ear  by  way  of  the  Eustachian  tube. 
If  it  is  necessary  to  wash  out  the  nose,  it  should  be  done  by 
the  attending  physician  and  not  by  the  patient. 

Inhalations  from  a  steam  atomizer  or  croup  kettle,  and  hot 
external  applications  to  the  antral  region,  are  very  useful.  I 
am  in  the  habit  of  using  a  mixture  of  compound  tincture  of 
benzoin,  oil  of  turpentine  and  tincture  of  hyoscyamus  in  a  steam 
atomizer  or  croup  kettle,  and  having  it  inhaled  through  the 
nose.  If  free  drainage  and  some  relief  from  pain  should  not 
be  obtained  by  these  measures  in  forty-eight  hours,  paracentesis 
may  have  to  be  resorted  to,  particularly  if  the  tension  symptoms 
are  great. 

Puncturing  the  antrum  through  the  inferior  meatus  where 
the  naso-antral  wall  is  thinnest,  usually  about  an  inch  back, 
is  a  simple  procedure,  but  should  be  performed  with  strict 
asepsis.  A  sterile,  warm,  saline  solution,  answers  very  well 
for  irrigating  the  antrum.  In  some  acute  cases,  a  single  irriga- 
tion will  suffice,  in  others,  if  the  discharge  from  the  antrum 
persists,  it  may  have  to  be  done  a  number  of  times.    In  such 


CLEMENT   F.  THJSISEN 


345 


cases  a  temporary  opening  through  the  inferior  meatus,  at  the 
lowest  possible  point  in  order  to  obtain  good  drainage,  may 
have  to  be  made.    The  antrum  can  then  be  easily  washed  out. 

We  read  much  about  washing  out  the  antrum  through  the 
natural  opening.  Now,  while  this  can  be  done  in  cases  of  chronic 
empyema,  I  must  confess  that  when  the  nasal  mucosa  is  much 
congested,  except  in  exceptional  cases,  I  believe  it  is  not  at  all 
as  easily  accomplished  in  acute  cases,  as  we  are  often  led  to 
believe.  An  oil  spray  of  menthol  and  albolene,  or  menthol, 
albolene  and  hydrocarbolene,  to  which  is  added  a  small  amount 
of  cocaine  or  adrenalin,  is  very  useful  while  the  nasal  mucosa 
is  much  congested. 

Perhaps  something  should  be  said  concerning  the  constitu- 
tional treatment  of  acute  maxillary  sinusitis.  In  the  beginning 
of  an  attack,  calomel,  followed  by  a  saline,  and  drop  doses  of 
aconite  repeated  until  the  patient  perspires  freely,  are  useful 
in  relieving  the  congestion  of  the  mucous  membrane.  I  do  not 
believe  that  the  coal  tar  products  are  of  much  service  in  con- 
trolling the  pain,  although  occasionally  five-grain  doses  of 
phenacetine,  or  migraine  tablets,  repeated  as  often  as  neces- 
sary, will  afford  some  relief.  It  is  always  wise  to  stimulate 
patients  somewhat  while  giving  coal  tar  products,  because 
symptoms  of  cardiac  depression  have  been  known  to  develop 
after  comparatively  small  doses  of  such  drugs,  particularly 
acetanilid.  Morphine  should  not  be  used,  because  just  as  in 
acute  frontal  sinusitis,  or  mastoiditis,  it  masks  the  symptoms 
to  such  an  extent  at  times,  that  well  marked  tension  symptoms 
might  be  overlooked. 

In  connection  with  the  question  of  irrigating  the  maxillary 
antrum,  it  is  interesting  to  determine  whether  it  is  possible  as 
stated  by  Lermoyez  (Annates  de  Maladies  de  Voreille  du  Larynx, 
du  Nez,  etc.,  November,  1902)  for  the  frontal  sinus  to  become 
infected  by  carrying  some  infected  material  into  the  sinus, 
during  irrigations  of  the  antrum  of  Highmore,  either  by  way 
of  the  hiatus  semilunaris,  or  even  more  directly,  when  a  direct 
communication  exists  between  the  frontal  sinus  and  the  antrum. 
Menzel  (Archiv  fur  Laryngologie  und  Rhinologie,  Bd.  XVII,  Heft 
III,  1905)  has  shown  by  his  experiments  on  cadavers,  that  this 
is  not  possible.  His  conclusions  are  briefly  as  follows:  The 
irrigating  fluid  injected  through  an  opening  into  the  antrum  of 
Highmore  only  reached  the   frontal  sinus,  when  an  external 


346  TREATMENT   OF  MAXILLARY  SINUSITIS 

opening  had  also  been  made  into  the  sinus.  In  all  the  trials 
made  in  which  no  external  opening  had  been  made  into  the 
frontal  sinus,  there  was  not  a  single  case  in  which  any  of  the 
irrigating  fluid,  even  when  forcibly  injected  into  the  antrum, 
reached  the  frontal  sinus.  The  sinus  being  filled  with  air,  will 
not  allow  the  entrance  of  any  of  the  irrigating  fluid.  In  cases, 
on  the  other  hand,  in  which  an  external  opening  had  been  made 
into  the  frontal  sinus,  the  irrigating  fluid  could  be  readily 
forced  from  the  antrum  into  the  sinus.  These  investigations 
of  Menzel  would  seem  to  be  rather  conclusive  as  showing  that 
the  frontal  sinus  can  not  be  readily  infected  during  irrigations 
of  the  antrum. 

It  is  of  particular  importance  in  the  acute  cases  to  correct 
any  nasal  condition  interfering  with  proper  drainage  from  the 
antrum. 

Chronic  Maxillary  Sinusitis. — To  come  now  to  the  treatment 
of  chronic  maxillary  sinusitis,  which  as  a  rule  is  a  chronic  em- 
pyema, I  do  not  think  that  any  methods  of  treatment  except 
the  operative  ones  need  be  considered. 

Considering  first  the  operation  through  the  naso-antral  wall, 
it  may  be  said,  that  while  this  method  is  very  successful  in 
selected  cases,  in  the  writer's  experience  at  least,  it  is  not  always 
followed  by  the  best  results.  The  writer  has  operated  on  a 
few  cases  of  chronic  antral  empyema  by  this  method,  and  in 
all  but  one  case,  the  results  were  not  good,  the  discharge  did 
not  entirely  cease,  and  in  two  cases  the  radical  operation  through 
the  canine  fossa  had  to  be  performed  eventually.  In  each 
case,  a  large  opening  had  been  made  through  the  internal  wall 
after  resecting  a  little  more  than  the  anterior  portion  of  the 
inferior  turbinate,  and  the  degenerated  antral  membrane  and 
granulations  were  removed  as  thoroughly  as  possible  through 
the  nasal  opening.  Perhaps  the  writer's  technic  was  faulty  in 
some  way,  or  perhaps  the  opening  through  the  naso-antral 
wall  was  not  large  enough.  This  method  has  many  strong 
advocates  however,  such  as  G.  L.  Richards,  Freer,  Rethi,  Cur- 
tis, Myles  and  others.  It  is  perhaps  true  as  stated  by  Freer 
(The  Antrum  of  Highmore:  the  Removal  of  the  Greater  Part 
of  its  Inner  Wall  Through  the  Nostril  for  Empyema,  The  Lar- 
yngoscope, May,  1905),  that  many  of  the  operations  through 
the  naso-antral  wall  are  not  successful,  because  not  enough  of 
the  internal  wall  is  removed. 


CLEMENT  F.  THEISEX 


347 


Rethi  (Wiener  klinische  Wochenschrift,  No.  34,  1904)  recom- 
mends the  removal  of  the  anterior  two-thirds  of  the  inferior 
turbinate,  and  an  extensive  resection  of  the  nasal  wall  of  the 
antrum  both  in  the  inferior  and  middle  meatuses. 

Claoue  (Semaine  medicate,  October  15,  1902)  makes  a  large 
window  through  the  inferior  meatus. 

H.  H.  Curtis  (The  Laryngoscope,  October,  1903)  reports  an 
operation  in  which  after  the  anterior  third  of  the  inferior  tur- 
binate is  resected,  an  opening  is  made  through  the  lower  part 
of  the  inner  antral  wall  with  a  trephine  and  enlarged  with  a 
burr.    Case  reports  were  not  given  in  this  paper. 

Richards  (Journal  of  the  American  Medical  Association,  Sep- 
tember 16,  1905)  reports  good  results  with  this  method,  because 
he  states  "that  in  many  cases  the  antral  mucous  membrane 
is  not  particularly  degenerated."  A  permanent  opening  is 
usually  established  through  the  naso-antral  wall  only  in  the 
chronic  cases,  and  in  the  majority  of  these  the  membrane  is 
not  only  degenerated  but  greatly  thickened. 

Coakley's  investigations  prove  this  conclusively  (Observa- 
tions upon  the  Pathology  of  Chronic  Suppurative  Inflamma- 
tions of  the  Antrum  of  Highmore,  Transactions  of  the  American 
Laryngological  Association,  1902).  The  pathological  changes 
in  the  cases  examined  by  him,  showed  great  thickening  of  the 
mucous  membrane  in  every  case.  This  he  found  was  due  to 
an  increase  in  the  loose  connective  tissue  layer  beneath  the 
epithelium. 

I  do  not  think  that  the  operation  through  the  naso-antral  wall 
will  turn  out  to  be  permanently  successful  in  every  chronic  case 
where  this  thickening  and  degeneration  of  the  antral  mucous 
membrane  exists. 

Richards  also  states  however  that  if  the  condition  does  not 
improve  after  a  reasonable  length  of  time  with  this  method,  any 
nasal  operation  alone  will  not  be  sufficient,  and  nothing  less 
than  the  radical  operation  through  the  canine  fossa  will  bring 
about  a  cure.  The  rule  in  all  operative  work  upon  the  maxillary 
sinus,  just  as  in  the  case  of  the  frontal  sinus,  should  be  to  per- 
form the  operation  that  will  be  followed  by  an  obliteration  of 
the  sinus.  Such  an  operation  too,  should  be  performed,  that 
every  part  of  the  sinus  can  be  directly  inspected.  This  is  not 
easy  in  operations  through  the  nose.  We  all  know  how  difficult 
it  is  to  maintain  an  opening  through  the  naso-antral  wall,  even 


348 


TREATMENT  OF  MAXILLARY  SINUSITIS 


when  a  large  opening  is  made.  Granulations  will  develop  and 
the  opening  will  become  small  in  a  short  time.  In  selected 
cases  however,  this  operation  is  undoubtedly  sometimes  followed 
by  excellent  results,  for  which  we  have  the  testimony  of  the 
careful  observers  mentioned. 

Where  no  ethmoid  disease  exists,  and  where  the  nostril  does 
not  contain  numerous  polypi,  this  operation  may  be  tried  first. 
When  multiple  polypi  (a  common  symptom  of  chronic  sinusitis) 
exist  in  the  nose,  in  conjunction  with  a  chronic  purulent  dis- 
charge from  the  antrum,  the  antral  mucous  membrane  will  be 
found  greatly  thickened  and  degenerated  in  every  case,  in  fact 
in  many  cases  the  antrum  itself  will  be  found  filled  with  polypi 
and  granulations. 

In  such  cases,  where  we  have  almost  a  positive  assurance 
that  the  antrum  will  be  found  greatly  diseased,  it  seems  a 
better  plan  to  perform  the  radical  operation  in  the  first  place, 
rather  than  to  establish  an  opening  through  the  naso-antral 
wall  and  then  later  perhaps  being  compelled  to  perform  the 
radical  operation  anyway.  Nothing  but  the  radical  operation, 
the  Caldwell-Luc,  or  some  modification,  and  the  complete  removal 
of  the  antral  mucous  membrane  will  result  in  a  cure  in  many 
such  cases.  I  will  not  describe  the  technic  of  the  radical  opera- 
tion, as  it  is  so  familiar  to  everyone.  Just  as  much  of  the  anterior 
wall  as  possible  should  be  removed  and  all  of  the  mucous  mem- 
brane. The  writer  has  found  the  Luc  forceps  very  useful  for 
rapidly  removing  polypi  and  granulations  from  the  antral  cavity. 

It  is  almost  impossible  to  remove  all  of  the  degenerated 
membrane  by  any  except  the  radical  operation.  'The  Coakley 
lamps,  that  are  so  useful  in  frontal  sinus  work,  are  of  the  greatest 
service  for  inspecting  the  antrum  while  operating.  There  is 
no  positive  assurance,  in  cases  where  the  operation  through 
the  naso-antral  wall  has  been  performed,  and  the  opening  is 
finally  allowed  to  close,  that  the  sinus  may  not  again  become 
infected,  particularly  during  influenza  epidemics. 

In  conclusion  the  writer  would  briefly  report  the  two  following, 
rather  unusual,  cases  of  chronic  antral  disease. 

Mr.  J.  L.,  merchant,  aged  45  years,  has  been  under  the  writer's  care 
for  several  years  for  recurring  nasal  polypi.  During  the  past  four  years, 
polypi  have  been  frequently  removed  from  the  left  nostril.  Antral 
disease  was  diagnosed  when  he  first  came  under  observation,  but  he  was 
always  satisfied  with  the  relief  obtained  after  the  removal  of  the  polypi, 


CLEMENT  F.  THEISEN 


349 


and  persistently  refused  any  other  operative  work.  During  the  past 
year  the  discharge  of  pus  was  so  profuse,  the  polypi  recurring  about 
every  two  months,  and  he  suffered  so  much  from  pain  in  the  left  half  of 
the  head  and  in  the  eye,  that  he  consented  to  the  radical  operation. 
This  was  performed  in  the  usual  way,  and  the  left  antrum,  which  was 
very  large,  was  found  filled  with  pus,  and  a  mass  of  apparent  polypi  and 
soft  granulations.  There  was  very  free  bleeding  when  these  were  cleared 
out  with  Luc's  forceps.  The  mucous  membrane,  which  was  greatly 
degenerated  and  thickened  was  removed  with  curetts.  It  is  now  a  num- 
ber of  months  since  the  operation  has  been  performed,  and  there  is  no 
discharge  from  the  nose,  the  left  nostril  being  entirely  clean.  The  his- 
tological examination  of  the  mass  removed  from  the  antrum  is  interesting. 
It  is  as  follows: 

Bender  Hygienic  Laboratory, 

Albany,  N.  Y. 

The  specimen  removed  from  the  antrum  shows  a  very  rapidly  growing 
papillary  polyp,  with  infection,  degeneration  and  necrosis.  There  is  no 
definite  evidence  of  malignancy,  but  from  the  general  appearance  of  the 
tumor,  I  would  advise  careful  watch  for  recurrence. 

Very  truly  yours, 

R.  M.  Pearce, 

Director. 

This  examination  explains  the  rapid  recurrence  in  the  nostril 
after  each  removal  of  the  growths.  The  histological  examina- 
tion is  also  of  interest,  because  it  shows  perhaps  the  first  stage 
in  the  change  of  a  benign  to  a  malignant  growth.  The  earlier 
examinations  of  the  growths  removed  from  the  nose,  in  this 
case,  showed  that  they  were  the  ordinary  polypi.  The  last 
examination  of  the  growths  removed  from  the  nose,  also  showed 
however,  a  beginning  change  in  the  histological  structure. 

The  second  case  is  that  of  a  young  woman,  aged  36  years.  She  has 
had  a  purulent  discharge  from  the  right  nostril  for  years.  Transillumina- 
tion showed  a  shadow  under  the  right  eye,  and  a  dark  pupil.  On  exami- 
nation, numerous  polypi  were  found  in  the  middle  meatus  of  the  right 
nostril.  The  anterior  ends  of  both  inferior  and  middle  turbinates  were 
much  enlarged  and  oedematous. 

She  would  not  consent  to  the  radical  operation,  so  that  after  removing 
the  polypi,  the  anterior  end  of  the  middle  turbinate,  and  a  little  more 
than  the  anterior  third  of  the  inferior  turbinate,  an  opening  was  made 
through  the  inferior  meatus.  The  antrum  was  filled  with  soft  granula- 
tions and  there  was  a  free  discharge  of  pus.  The  patient's  general  con- 
dition was  so  poor,  that  the  pus  from  the  antrum  was  subjected  to  a 
microscopical  examination.  It  was  found  to  contain  tubercle  bacilli. 
None  were  found  in  the  sputum  however,  nor  could  any  general  tubercu- 
losis be  discovered.  Coakley,  in  the  paper  before  mentioned,  reports 
the  case  of  a  young  man,  aged  26  years,  with  double  antral  disease. 


EDITORIAL 


Microscopical  examination  of  the  scrapings  from  the  left  antrum,  showed 
the  presence  of  giant  cells  and  a  few  tubercle  bacilli.  Sputum  examina- 
tions in  this  case  were  also  negative. 

Before  closing  this  paper  the  writer  would  like  to  say  a  word 
about  the  use  of  "  Somnoform"  in  operations  upon  the  upper 
air  passages. 

It  is  an  admirable  and  safe  anesthetic,  and  can  be  used  to 
great  advantage  as  a  preliminary  step  in  the  administration  of 
ether.  It  is  used  in  a  special  "Somnoform"  inhaler.  It|is 
composed  of  chloride  of  ethyl,  sixty  per  cent.,  chloride  of  methyl, 
thirty-five  per  cent,  and  bromide  of  ethyl,  five  per  cent.  The 
patient  is  completely  under  the  influence  of  Somnoform  in  thirty 
or  forty  seconds,  and  then  the  administration  of  ether  can  be 
started  at  once.  It  does  not  produce  cyanosis  as  is  the  case 
with  the  ordinary  nitrous  oxide  gas.  It  certainly  shortens  the 
administration  of  a  general  anesthetic  very  much. 


EMtOf&d 

Tom  lit  the  fire  and  warmed  some  beef  soup.  George 
ate  some,  but  very  little;  however,  he  drank  a  great 
jugful  of  water,  then  dozed,  and  fell  into  a  fine  per- 
spiration. It  was  a  favorable  crisis,  and  from  that 
moment  youth  and  a  sound  constitution  began  to  pull 
him  through ;  moreover,  no  assassin  had  been  there  with 
his  lancet. 

It  is  Never  too  Late  to  Mend.  Chjlhles  Reade. 

The    thirty-third    annual    meeting    of  the 
Alumni  Day,     Alumni   Association   of   the   Albany  Medical 
1906.  College  will  convene  at  half  after  ten  o'clock 

in  the  morning  of  May  1,  1906.  The  Association 
has  prospered,  and  the  particular  features  of  the  meeting 
have  developed  from  year  to  year.  There  has  been  more  sys- 
tematic arrangement  of  class  reunions.  The  biographical 
histories  of  the  decennial  classes  have  been  more  exhaustively 
and  accurately  prepared,  and  the  decennial  classes  have  attended 
the  reunions  in  greater  number.    The  circular  recently  mailed 


EDITORIAL 


351 


to  even'  member  of  the  Association  urges  especially  the  attend- 
ance of  members  of  the  decennial  classes. 

The  classes  of  '56  and  '66  will  hold  their  reunion  meeting  in 
the  Chemical  Laboratory;  '86  in  the  Chemical  Lecture  Room; 
and  '96  in  Recitation  Room  A.  The  Association  for  the  first 
time  in  many  years  will  not  hold  its  general  meeting  in  what 
has  been  known  as  Alumni  Hall.  This  large  room  has  been 
given  over  during  the  year  to  the  Department  of  Physiological 
Chemistry,  and  is  now  equipped  and  used  as  a  laboratory. 

The  program  for  the  day  is  as  follows: 

9.30  a.  m.    Reception  in  Library. 

10.30  a.  if.  General  Alumni  Meeting:  Faculty  Address  of 
Welcome  by  Professor  Howard  Van  Rensselaer,  M.  D.;  Report 
of  Historian;  miscellaneous  business;  President's  address;  elec- 
tion of  officers. 

12.00  m.    Reunions  of  Decennial  Classes. 

3.00  p.  m.  Commencement  Exercises  at  Odd  Fellows'  Hall. 
Address  by  Hon.  Andrew  S.  Draper,  LL.D.,  New  York  State 
Commissioner  of  Education. 

The  Alumni  Dinner  will  be  held  at  the  Hotel  Ten  Eyck  at 
eight  o'clock.  Following  the  custom  of  recent  years  small 
tables  will  be  used,  and  the  banqueters  will  group  themselves 
for  the  promotion  of  the  utmost  cordiality.  The  price  of  the 
dinner  ticket  has  been  placed  at  three  dollars,  and  it  has  come 
to  be  understood  that  all  of  the  material  social  intellectual 
features  of  this  Alumni  Dinner  are  most  agreeably  worked  out. 

There  are  so  many  questions  in  medical  education,  in  medical 
practice,  and  in  medical  ethics  constantly  demanding  considera- 
tion, that  gatherings  of  this  kind  for  an  interchange  of  thought 
are  necessary,  not  only  for  the  general  welfare  of  the  profession, 
but  for  the  promotion  of  individual  interests.  The  Alumni 
of  the  Albany  Medical  College  have  been  active  and  loyal,  and 
it  is  expected  that  the  meeting  of  1906  will  reveal  characteristic 
energy. 


352 


LITTLE  BIOGRAPHIES 


Xtttle  BiOQrapbies 

V.  EUSTACHIUS. 

BARTELEMMEO   EUSTACHIUS   was   an  Italian 
anatomist,  born  in  the  early  part  of  the  sixteenth 
century.    The  exact  date  and  his  birthplace  are  not 
definitely  known.    He  was  one  of  the  great  anat- 
omists of  his  time,  second  only  in  fame  to  Vesalius. 

He  was  physician  to  the  Duke  of  Urbino  and  in  1562  became 
city  physician  of  Rome  and  a  year  later  professor  of  medicine 
in  the  College  Delia  Sapinza  at  Rome,  which  position  he  held 
until  his  death  in  1574. 

His  name  is  indelibly  associated  with  anatomical  science 
through  his  discovery  of  the  Eustachian  tube  and  the  rudi- 
mentary valve  of  the  heart  which  also  bears  his  name.  His 
attempts  to  shield  Galen's  reputation  from  the  attacks  of 
Vesalius  and  others  indicate  that  he  was  a  defender  of  the 
father  of  anatomy  rather  than  an  opponent,  as  were  most  of 
his  contemporaries. 

His  chief  discoveries  were  in  the  domain  of  comparative 
anatomy  and  embryology.  He  was  the  first  to  give  accurate 
description  of  the  thoracic  duct  and  was  probably  first  to 
notice  and  describe  the  "  Stapes  "  (one  of  the  chain  of  small 
bones  crossing  the  tympanic  cavity  of  the  ear). 

He  likewise  contributed  materially  to  the  diffusion  of  more 
accurate  knowledge  regarding  the  development  and  evolution 
of  the  teeth  and  the  structure  of  the  kidney. 

The  contemporaries  and  successors  of  Vesalius  aided  much 
in  placing  gross  anatomy  upon  a  secure  and  lasting  founda- 
tion. The  most  illustrious  among  these  was  Eustachius,  and 
he  is  regarded  as  one  of  the  founders  of  modern  anatomy. 

Eustachius  made  many  corrections  of  the  work  of  Vesalius 
and  was  an  original  investigator  of  great  force.  From  plates 
prepared  by  him,  but  not  published  until  the  eighteenth  cen- 
tury, it  appears  that  he  anticipated  many  discoveries  ordinarily 
ascribed  to  anatomists  of  later  periods. 

He,  with  Aristotle  and  Fallopius,  had  surmised  that  the 
organs  of  the  body  might  be  composed  of  simpler  elements. 

William  M.  Dwyer. 


SCIENTIFIC  REVIEW 


353 


Scientific  IRexnew 

The  Cerebro-Spinal  Fluid  in  Health  and  Disease. 

The    Diagnostic    and   Therapeutic    Value    of  Lumbar 

Puncture. 

It  is  only  within  the  last  fifteen  years  that  the  study  of  the 
cerebro-spinal  fluid  has  attracted  the  attention  of  the  medical 
profession  and  become  an  important  element  in  diagnosis.  The 
fluid  is  obtained  by  lumbar  puncture,  an  operation  devised  by 
Quincke  in  1891,  which  is  performed  as  follows:  The  patient 
lying  on  his  left  side  or  sitting  up  with  his  back  strongly  arched, 
a  needle  six  cm.  long  and  three-quarters  mm.  wide  is  introduced 
between  the  third  and  fourth,  fourth  and  fifth  or  even  between 
the  fifth  lumbar  vertebra  and  the  sacrum.  In  general  the 
point  where  a  line  drawn  at  the  level  of  the  iliac  crests  crosses 
the  middle  line  may  be  considered  a  suitable  landmark,  the  first 
enterspace  above  or  below  the  point  being  chosen  for  the  intro- 
duction of  the  needle.  The  field  of  operation  should  be  pre- 
viously sterilized  and  the  procedure  conducted  with  all  the 
aseptic  precautions  of  modern  surgical  technique. 

The  needle  may  be  introduced  in  the  middle  line  in  children 
and  one  cm.  to  the  outer  side  in  adults,  directed  inward  in  the 
latter  case  and  slightly  upward  in  both,  and  pushed  in  a  distance 
of  from  four  to  eight  cm.  as  the  case  may  be,  until  the  resistance 
is  overcome,"  when  the  cerebro-spinal  fluid  will  be  seen  to  flow 
out  drop  by  drop. 

Originally  a  mercury  manometer  was  attached  to  the  canula 
in  order  to  ascertain  the  varying  change  in  the  tension 
of  the  fluid  during  its  removal.  Normally  the  tension  varies 
between  seventy  and  150  mm.  and  it  was  recommended  never  to 
allow  it  to  sink  below  fifty  mm.  Athough  a  number  of  delicate 
instruments  have  been  devised  for  this  purpose,  the  long  ex- 
perience of  careful  clinicians  has  warranted  that  such  a  refine- 
ment be  abandoned.  The  results  are  inconstant  and  subject 
to  the  widest  variations.  The  tension  is  much  increased  in 
meningitis  and  cerebral  tumor;  being  often  250-300  mm.  and 
even  reaching  800  mm.  in  rare  cases.  (Recken).  Aspiration 
should  always  be  avoided. 

The  quantity  of  fluid  removed  varies  from  ten  to  forty  cc. 
but  much  larger  quantities  have  been  removed ;  usually  fifteen  to 
6 


354 


SCIENTIFIC  REVIEW 


twenty  cc.  will  suffice.  The  fluid  should  be  received  in  sterile  test- 
tubes  and  examined  physically,  chemically,  microscopically  and 
bacteriologically.  Although  the  amount  of  cerebro-spinal  fluid 
present  under  normal  and  pathologic  conditions  cannot  be 
determined  clinically,  completeness  of  description  requires  the 
consideration  of  this  point.  According  to  Codugno,  Magendie, 
Bichat,  etc.,  the  amount  normally  varies  between  seventy  and 
150  grams.  It  is  increased  in  the  various  forms  of  meningitis, 
acute  and  chronic.  In  mild  cases  of  hydrocephalus,  200-400 
gm.  are  usually  present,  and  it  is  not  rare  to  find  one-half  to  one 
liter  in  this  affection.  Extreme  cases  have  been  reported  in 
which  even  five  litres  were  found. 

Normally  the  cerebro-spinal  fluid  is  perfectly  clear,  but  patho- 
logically it  may  be  hemorrhagic;  this  hemorrhage  may  result 
from  the  local  traumatism  occasioned  by  the  puncture,  or  may 
be  due  to  an  organic  hemorrhage  within  the  central  nervous 
system.  In  a  general  way,  blood  which  comes  from  a  lesion 
of  the  central  organs,  does  not  coagulate  in  the  test  tube,  and,  if 
the  fluid  be  allowed  to  stand  a  few  hours  and  settle,  the  over- 
lying liquid  will  have  an  amber  coloration,  which,  according  to 
Mathieu,  will  persist  even  after  the  fluid  has  been  centrifugalized. 
In  this  connection  however,  it  must  be  borne  in  mind  that 
hemorrhage  may  occur  in  the  course  of  fibrinous  meningitis  and 
the  fluid  obtained  in  such  a  case  does  undergo  coagulation  owing 
to  the  meningeal  reaction. 

When  a  large  hemorrhage  has  ruptured  into  the  ventricles, 
almost  pure  blood  may  be  obtained.  Such  a  result  is  me- 
chanically impossible  in  epidural  haematoma;  but  in  this  latter 
condition,  Chauffard  and  Froin  have  observed  a  yellowish  fluid 
devoid  of  haemoglobin  and  red  blood  cells  and  the  color  of  which 
was  supposedly  due  to  a  blood-pigment  called  "luteine"  and 
described  by  H6nocque.  Blood  may  also  occur  in  subdural 
hematoma,  in  which  case  the  fluid  is  often  only  slightly  tinged. 
According  to  Moindrot,  more  or  less  pronounced  shades  of  yellow 
may  be  observed  independently  of  meningeal  and  cerebral 
hemorrhage,  in  cases  of  cerebral  tumor,  the  color  being  due  to  the 
presence  of  a  pigment  coincidently  elaborated. 

Apart  from  the  admixture  of  blood,  variations  in  the  color  of 
the  cerebro-spinal  fluid  occur  in  certain  diseases  the  fluid 
becomes  cloudy  in  many  forms  of  meningitis,  the  degree 
of     cloudiness     varying    considerably    in     different  cases. 


SCIENTIFIC  REVIEW 


355 


In  cerebro-spinial  meningitis,  the  fluid  is  often  only 
slightly  sero-purulent,  whereas  in  purulent  meningitis, 
or  where  an  abscess  has  ruptured  into  the  subarachnoidean 
space,  pure  creamy  pus  may  be  found.  In  tubercular  meningitis, 
in  serous  meningitis  and  also  in  hydrocephalus  and  cerebal 
tumor,  the  fluid  is  usually  perfectly  clear  and  colorless.  Whether 
cloudy  or  not,  the  fluid  rarely  undergoes  coagulation  in  even 
inflammatory  diseases  of  the  central  nervous  organs,  such  as: 
tumors  and  abcess,  and  when  coagulation  occurs,  it  indicates  an 
acute  inflammatory  process.  In  tubercular  meningitis  the 
coagula  are  delicate  and  spider-web  like;  in  purulent  men- 
ingitis they  are  much  denser  and  much  more  abundant. 

The  specific  gravity  of  the  cerebro-spinal  fluid  normally  varies 
between  1.005  an<^  1.007  an(^  may  reach  1.012  in  inflammatory 
diseases. 

The  reaction  is  always  alkaline  and  more  so  in  the  morning 
than  in  the  evening  according  to  Cavazzani. 

Cryoscopic  Analysis.  The  estimation  of  the  osmotic  tension  of 
the  cerebro-spinal  fluid  has  also  some  interest,  and  may  be  deter- 
mined by  cryoscopic  analysis.  Cryoscopy  shows  that  the  freezing 
point  of  blood  serum  is— o.  5  6°  C.  ,while  that  of  normal  cerebro-spinal 
fluid  is  between  — 0.720  C.  and  — 0.780  C,  thus  cerebro-spinal 
fluid  is  hypertonic  with  regard  to  blood  serum.  This  hyper- 
tonicity  is  inverted  in  cases  of  acute  meningitis  where  the  cryo- 
scopic point  of  the  fluid  varies  between  — 0.500  C.  and  — 0.5 6°  C. ; 
hence  cerebro-spinal  fluid  has  become  hypotonic  with  regard  to 
the  blood.  This  hypotonicity  confirms  the  diagnosis  of  an  acute 
meningitis  but  gives  no  clue  as  to  its  nature. 

The  chemical  composition  of  cerebro-spinal  fluid  is  tabulated 
as  follows  by  Gautier: 


Water   987.00 

Albumen   1.10 

Fat  :   0.09 

Cholesterin   0.21 

Alcoholic  and  aqueous  extract,  minus  salts  ) 

Sodium  lactate  j  2 -J  5 

Chlorides   6.14 

Earthy  phosphates   0.10 

Sulphates   0.20 

Ammonia    


356 


SCIENTIFIC  REVIEW 


The  chlorides  and  especially  the  chloride  of  sodium  (6-7  grams 
per  1000)  represent  the  predominating  inorganic  elements  of 
the  fluid  (Dircksen).  According  to  Geoghegan  however,  the 
percentage  of  potassium  salts  would  be  higher  than  that  of  the 
sodium  salts. 

It  has  been  known  for  a  long  time  that  the  cerebro-spinal 
fluid  contains  a  substance  capable  of  reducing  Fehling's  solution, 
but  most  authors  claimed  that  this  substance  neither  undergoes 
fermentation  nor  forms  an  osazen  when  treated  with  phenyl 
hydrazin.  Halliburton  maintained  that  this  substance  was 
pyrocatechin.  Cavazzani  found  in  the  cerebro-spinal  fluid  of 
man  and  animals  a  diastasic,  glycolytic  and  oxidyzing  ferment. 
Nawratzki,  who  experimented  mainly  on  cattle,  claims  that 
sugar  is  always  present.  Hofmann  found  in  eclampsia  a  sub- 
stance which  gave  the  Drechsel  reaction  for  carbonic  acid, 
reduced  copper  oxide,  but  which  gave  a  negative  result  when 
treated  with  Nylander's  solution  and  did  not  undergo  fermenta- 
tion. This  seemed  interesting  as  it  confirmed  the  views  of 
Ludwig  and  Sabor,  who  believed  that  eclampsia  is  due  to 
carbamic  acid  intoxication.  Pfaundler  and  Bernard  claim  that 
sugar  is  normally  present,  v.  Jaksch  denies  the  existence  of 
sugar,  but  mantains  that  a  product  closely  resembling  grape- 
sugar  ic  always  present.  He  calls  it  "  Isomaltose "  and  deter- 
mined by  means  of  Fehling's  method  that  its  normal  quantity 
varies  between  six  hundredths  and  eight  hundredths  per  cent. 

Blumenthal  denies  the  existence  of  pyrocatechin,  and  thinks 
that  ordinary  grape-sugar  is  more  likely  present  than  "Iso- 
maltose. " 

More  recently  the  interesting  studies  of  Gillard  and  Sicard 
have  thrown  much  light  on  this  long  controverted  question; 
both  authors  have  independently  arrived  at  almost  similar  con- 
clusions. According  to  Sicard,  the  cerebro-spinal  fluid  normally 
contains  glucose  in  the  proportion  of  .50  centigrammes  per  1000 
grams.  The  quantity  is  increased  in  diabetes  and  may  go  up  to  one 
gramme  or  more.  In  all  forms  of  acute  meningitis,  the  quantity 
of  glucose  is  diminished,  varying  between  0.10  and  0.25  per 
1000  gr.  The  author  insists  upon  the  importance  of  the  dim- 
inution in  differentiating  a  true  meningitis  from  the  meningeal 
syndrome  so  common  in  the  various  acute  infectious  diseases. 

Gillard  places  the  proportion  of  glucose  between  .40  and  .56 
centigrammes  per  1000  gr.  and  denies  the  existence  of  pyrocate- 


SCIENTIFIC  REVIEW  357 

chin.  Zambelli  states  that  the  amount  of  sugar  is  diminished 
in  tubercular  meningitis  and  that  it  disappears  entirely  in  puru- 
lent meningitis.  By  the  intraperitoneal  injection  of  adrenalin  in 
dogs,  Bierry  and  Laloa  have  determined  an  appreciable 
augmentation  in  the  quantity  of  sugar  in  both  the  blood  and 
cerebro-spinal  fluid.  Lichteim  found  by  means  of  the  phenyl- 
hydrazin  test,  that  glucose  was  present  in  all  of  the  cases  of 
cerebral  tumor  which  came  under  his  observation.  Quincke 
claims  that  the  presence  of  sugar  can  invariably  be  demonstrated, 
if  the  liquid  obtained  be  sufficient  in  amount  for  the  necessary 
tests.  Still,  Ftirbrenger  found  sugar  in  only  two  cases  of  diabetes 
associated  with  tuberculosis. 

Normally  the  cerebro-spinal  fluid  contains  a  trace  of  serum- 
globulin,  but  no  serum -albumen,  fibrin  or  fibrinogen.  Naw- 
ratzki,  in  his  report  on  the  albuminous  constituents  of  the  fluid, 
says  that  serum-albumen,  peptone  and  albumose  are  absent  and 
that  globulin  only  is  normally  present.  Comba  who  performed 
sixty -four  lumbar  punctures  in  children,  considers  that  the 
normal  quantity  of  albuminous  bodies  varies  between  0.008  per  cent 
and  0.04  per  cent.  There  is  a  great  increase  in  the  various  forms  of 
meningitis,  the  slighest  augmentation  occuring  in  the  metapneu- 
monic form.  v.  Jaksch  found  serum-albumen  in  all  cases  of  uraemia 
the  quantity  varying  between  0.03  per  cent  and  0.05.  per  cent. 
In  locomotor  ataxia,  general  paresis,  syphilitic  meningo-myelitis 
and  hemiplegia,  Widal  and  Sicard  have  always  detected  the 
presence  of  serum-albumen.  Pfaundler  and  others  have  shown 
that  the  greatest  amount  of  serum-albumen  occurs  in  acute 
meningitis,  especially  in  the  tubercular  type. 

A  faint  trace  exists  in  chronic  hydrocephalus,  serous  menin- 
gitis and  cerebral  tumor.  The  largest  amounts  have  been 
recorded  in  the  various  forms  of  acute  meningitis  and  especially 
in  tubercular  meningitis  (Pfaundler).  It  must  be  stated  that  the 
researches  of  Deniges  and  Sabrazes  have  not  confirmed  Pfaun- 
dler's  views  concerning  the  relative  quantity  of  albumen  in  the 
various  types  of  meningitis.  According  to  these  authors,  the 
proportion  varies  between  five  and  fifteen  per  1000  in  the 
acute  forms  and  only  reaches  one  to  two  and  eighteen  one- 
hundredths  in  the  tubercular  form. 

Until  very  recently,  it  was  considered  that  normally,  urea  was 
only  an  occasional  constituent  of  the  cerebro-spinal  fluid;  but 
Tonello  maintains  that  a  substance  capable  of  reducing  hypo- 


SCIENTIFIC  REVIEW 


bromate  of  sodium  is  invariably  present  and  Widal  and  Froin 
have  come  to  even  more  precise  conclusions.  According  to  these 
authors,  the  normal  fluid  contains  0.15  to  0.35  centigrammes  per 
litre  and  the  quantity  is  very  much  increased  in  Bright's  disease. 

They  report  two  cases  in  which  the  percentage  rose  to  2.94 
and  4.35  centigrammes  per  litre,  v.  Jaksch  has  also  insisted 
upon  the  increased  proportion  of  urea  in  cases  of  acute  uraemia. 

The  question  of  the  passage  of  biliary  acids  and  pigments  into 
the  cerebo-spinal  fluid  has  attracted  much  attention  of  late. 
Mongour  made  careful  analyses  in  six  cases  of  jaundice  and  says 
that  a  modification  of  color  is  rare  and  that  even  when  cholae- 
mia  and  choluria  are  intense,  the  biliary  pigments  and  acids  do 
not  exist  in  the  cerebro-spinal  fluid  in  sufficient  quantity  to  be 
appreciated  by  the  usual  tests.  To  explain  this  fact,  he  assumes 
that  either  the  bile  products  transuded  along  with  blood  serum 
are  transformed  in  the  subarachnoidean  cavity,  or  that  the 
cerebro-spinal  fluid  is  itself  not  a  transudate  but  a  true  secretion, 
probably  derived  from  the  choroid  plexuses. 

Shortly  after  these  facts  were  made  known,  the  interesting 
experiments  on  dogs  published  by  Ducrot  and  Gautrelet  con- 
firmed the  views  advanced  by  Mongour.  From  two  to  eight 
days  after  the  production  of  an  experimental  jaundice,  the 
external  carotid  artery  was  temporarily  ligated  and  three 
cubic  centimeters  of  a  saturated  solution  of  methyl-violet  were 
injected  into  the  internal  carotid;  this  substance  fixed  itself 
upon  the  choroid  plexuses  within  fifteen  minutes  and  inhibited 
their  action.  The  cerebro-spinal  fluid  was  then  no  longer 
colorless  as  it  was  one-half  hour  before  the  operation,  but  had 
become  distinctly  yellow  and  gave  a  positive  reaction  with 
Gmelin's  test.  Twenty-four  hours  later,  the  methyl-violet  had 
been  eliminated,  the  fluid  had  resumed  its  normal  appearance 
and  Gmelin's  test  was  negative.  It  thus  appears  that  the 
choroid  plexes  act  as  true  secreting  glands,  since  arrest  of  their 
function,  gives  the  cerebro-spinal  fluid  all  the  characters  of  a 
transudate. 

The  study  of  the  permeability  of  the  meninges  in  health  and 
disease  offers  considerable  interest  aside  from  the  consideration 
of  products  normally  present  in  the  system.  The  fluid  has  been 
carefully  tested  after  the  ingestion  of  subcutaneous  or  intra- 
venous injection  of  various  drugs. 

v.  Jaksch  has  never  detected  the  presence  of  salicylic  acid, 


SCIENTIFIC  REVIEW 


359 


the  salicylates,  the  iodides  and  the  silver  preparations  after 
their  administration  per  oram. 

Castaigne  claims  that  in  uraemia,  methylene  blue  and  iodide 
of  potassium  do  pass  into  the  cerebro-spinal  fluid,  if  injected 
subcutaneously. 

Widal,  Sicard  and  Monod  maintain  that  iodide  of  potassium 
does  not  pass  into  the  cerebro-spinal  fluid  of  normal  individuals 
nor  in  cases  of  cerebro-spinal  meningitis,  but  does  appear  in 
tubercular  meningitis.  These  facts  have  since  been  corroborated 
by  Griffon.  In  a  later  contribution  Sicard  claims  that  an  absolute 
impermeability  to  mercury  is  the  rule,  and  relates  that  in  two 
cases  of  tabes  and  one  of  general  paresis  despite  a  most  rigorous 
specific  treatment,  the  examination  of  the  fluid  remained  nega- 
tive. He  believes  that  this  impermeability  explains  the  frequent 
inefficiency  of  mercurial  treatment  in  cerebro-spinal  syphilis  and 
suggests  the  feasibility  of  the  subarachnoidean  injection  of  the 
soluble  salts,  extreme  care  being  taken. 

More  recently  Cruchet  reports  twenty -eight  cases  of  nervous 
affections  in  children,  in  which  iodide  of  potassium  taken  by 
mouth  was  never  detected  in  the  cerebro-spinal  fluid ;  eight  of  these 
cases  were  tubercular  meningitis  and  the  author  strongly  denies 
that  iodides  invariably  pass  into  the  fluid  in  this  affection. 

Jacob  and  Blumenthal,  and  Ransom  have  shown  that  when 
injected  subcutaneously  in  animals,  the  toxines  of  tetanus  do 
not  appear  in  the  fluid.  Milian  and  Legros  have  studied  the 
fluid  in  human  tetanus  and  have  never  been  able  to  reproduce 
the  disease  in  mice  by  the  inoculation  of  even  massive  quantities 
of  the  fluid  of  affected  patients.  Still,  Blumenthal  and  Stintzing 
each  report  a  case  of  tetanus  in  man  where  the  toxines  were 
found. 

But  if  substances  introduced  into  the  vascular  system  find 
their  way  only  with  difficulty  into  the  cerebro-spinal  fluid, 
the  reverse  is  not  true  and  it  has  been  clearly  demonstrated  by 
many  observers  that  both  drugs  and  bacterial  toxins  rapidly 
enter  the  general  circulation  if  injected  into  the  subarachnoidean 
cavity. 

Thus,  Lewandowsky  found  that  strychnine  poisoning  could  be 
determined  in  animals  by  using  one-tenth  of  the  dose  required 
when  the  drug  was  introduced  into  the  vascular  system  and 
that  the  symptoms  came  on  with  astonishing  rapidity.  He  also 
ascertained  that  a  few  centigrammes  of  sodium  ferrocyanide 


360 


SCIENTIFIC  REVIEW 


would  bring  about  marked  symptoms  of  intoxication,  whereas 
it  required  four — six  grammes  to  produce  the  same  phenomena 
when  the  drug  was  injected  into  the  jugular  vein.  The  presence 
of  the  ferro-cyanide  could  moreover  be  detected  in  the  urine, 
fifteen  to  thirty-five  minutes  after  its  introduction.  Jacob 
found  methylene  blue  in  the  urine  two  hours  after  it  had  been 
injected  into  the  subarachnoidean  space. 

Similarly,  Behring  who  experimented  on  chickens  succeeded 
in  producing  tetanus,  after  subcutaneous  and  intravenous 
injection  of  the  tetanic  toxines  had  remained  without  effect. 

Blumenthal  and  Jacob  determined  tetanus  in  animals  within 
ten  hours  and  found  both  the  toxines  and  antitoxin  of  tetanus 
in  the  blood  after  lumbar  injection  of  the  same. 

The  rapid  and  effective  anesthesia  secured  by  subarach- 
noidean administration  of  cocaine  and  stovaine  has  acquired 
considerable  inportance  in  surgery  within  the  last  few  years 
and  need  not  detain  us  here. 

It  seems  that  substances  introduced  in  this  way  come  in  direct 
contact  with  the  nerve  cells  of  the  brain  and  spinal  cord  by 
way  of  the  lymph  channels — a  free  communication  existing 
between  these  channels  and  the  subarachnoidean  cavity.  Ani- 
mals which  had  been  subjected  to  these  various  experiments 
have  been  sacrificed  and  according  to  Jacob,  Schwaebe,  Key, 
Retzeus  and  Quincke  the  perivascular  lymph  spaces  have  been 
found  rilled  with  methylene  blue  and  sodium  ferrocyanide  in 
combination  with  iron. 

Advantage  of  these  facts  has  been  taken  in  practical  medicine. 
In  the  treatment  of  hydrophobia  at  the  Pasteur  Institute,  the 
serum  has  been  administrated  by  sub-dural  injection  and  the 
same  method  has  been  adopted  by  Jacob  and  Blumenthal, 
Sicard,  von  Ley  den  and  Schultze,  Heubner,  Kraus  and  others 
for  the  introduction  of  anti-tetanic  serum.  Sicard  has  advocated 
that  in  tetanus,  massive  doses  of  the  serum  be  employed  and 
claims  to  have  had  very  good  results. 

Widal  and  Sicard  have  shown  that  agglutinin  never  passes 
into  the  cerebro-spinal  fluid.  Lewandowsky  has  never  found 
alexin  and  claims  that  the  fluid  has  no  haemolytic  power. 

Perhaps  the  most  interesting  question  relative  to  the  chemistry 
of  the  cerebro-spinal  fluid,  is  the  occurence,  under  particular 
circumstances,  of  choline. 

Mott  and  Halliburton  were  the  first  to  draw  attention  to  the 


SCIENTIFIC  REVIEW 


fact  that  choline  is  present  in  the  blood  and  in  the  cerebro- 
spinal fluid  whenever  a  more  or  less  active  destruction  of  nervous 
tissue  takes  place. 

Chemically,  choline  is  derived  from  lecithin  (or  rather  from 
protagon)  as  a  degenerative  product  and  is  thus  considered  to 
be  intimately  related  to  the  myelin  of  myelin  sheaths  of  nerve 
fibres. 

According  to  Gumprecht  choline  can  be  found  in  the  normal 
fluid,  but  this  assertion  is  actually  discredited — at  least,  it  is 
maintained  that  if  choline  really  exists  normally,  it  is  only 
present  as  a  faint  trace  which  can  practically  be  discarded  and 
which  compares  in  no  way  with  the  appreciable  quantity  occur- 
ing  under  certain  pathologic  conditions. 

Mott  and  Halliburton  have  found  choline  in  general  paresis 
and  in  cerebral  atrophy. 

More  recently  the  valuable  contributions  of  Donath,  Wilson, 
Coriali  Rosenfeld  and  others  have  thrown  much  light  on  this 
interesting  subject. 

Donath's  method  of  examination  is  usually  employed.  Ten  c.c. 
of  the  cerebo-spinal  fluid  are  placed  in  a  sterile  test  tube,  acid- 
ulated with  chlorhydric  acid  evaporated  to  dryness  and  exhausted 
by  means  of  absolute  alcohol.  Then  one  or  two  drops  of  a 
solution  of  platinum  chloride  in  absolute  alcohol  are  added  and 
a  double  chlorhydrate  of  platinum  and  choline  is  formed  i.  e. 
chloroplatinate  of  choline.  Sometimes  the  alkaline  chlorides 
are  also  precipitated  and  may  render  it  difficult  to  recognize 
the  choline  crystals, — to  avoid  this,  the  precipitate  is  dissolved 
in  1 5  per  cent  alcohol— this  weak  solution  dissolves  only  the  choline 
crystals;  the  solution  is  then  filtered  and  allowed  to  evaporate. 
The  choline  crystals  appear  as  plates,  rods,  straight  or  curved 
needles,  sometimes  they  are  so  disposed  as  to  form  tufts,  rosettes, 
— occasionally  prisms  or  dent  ate  d  forms  may  be  observed; 
they  are  distinctly  yellowish. 

At  first  Donath  gave  most  of  his  attention  to  the  study  of 
the  fluid  in  epilepsy;  he  showed  that  choline  was  invariably 
present  when  the  attacks  were  frequent  and  attributed  to  it 
an  important  role  in  the  production  of  convulsions.  He  also 
thinks  that  choline  is  responsible  for  the  epileptiform  seizures 
in  the  course  of  general  paresis.  Wilson  thinks  that  choline 
is  more  likely  the  effect  than  the  cause  of  the  attacks. 

Wilsen  made  careful  examination  of  the  cerebro-spinal  fluid 


362 


SCIENTIFIC  REVIEW 


in  thirty  cases  of  nervous  disease  in  Marie's  clinic,  and  made 
control  tests  in  various  other  affections,  rheumatism,  tubercu- 
losis, asthma,  etc. 

He  found  choline  in  cerebral  hemorrhage,  in  tubes  (in  ten  out 
of  twelve  cases)  idiopathic  epilepsy  Jacksonian  epilepsy ,  transverse 
myelitis,  cerebal  tumor,  haematomyelia,  cerebral  softening, 
syphilitic  hemiplegia  and  general  paresis. 

Wilson  insists  on  the  value  of  this  test  in  the  diagnosis  between 
hysteria  and  the  organic  diseases.  No  relationship  exists 
between  the  presence  of  choline  and  lymphocitosis — yet,  when 
a  lesion  is  purely  meningeal  (lymphocitosis)  choline  is  rarely 
found,  and  when  choline  is  present,  a  lymphocitosis  is  often 
absent. 

Donath  has  experimented  on  dogs,  rabbits  and  guinea  pigs 
and  has  shown  that  the  subdural  or  intracortical  injection  of 
the  chlorhydrate  of  choline  produces  violent  tonic  spasms 
which  are  sometimes  followed  by  paralysis. 

A  few  weeks  ago,  this  author  devised  a  new  method  for  the 
study  of  the  choline  crystals. 

The  method  is  based  on  the  proof  of  the  double  refraction  of 
chloroplatinate  of  choline  and  obviates  all  possibilities  of  misin- 
terpretation. 

By  a  long  and  minute  technique,  the  various  bodies  which 
may  be  found  in  the  cerebro-spinal  fluid  (protein,  bilirubin,  fat, 
glucose,  urea,  cholesterin,  lactic  acid,  iron,  earthy  phosphate, 
etc.),  some  of  which  possess  double  refraction,  are  eliminated 
and  the  final  precipitate  contains  only  chloroplatinate  of  potas- 
sium, ammonium  and  choline. 

With  the  exception  of  choline,  the  substances  present  belong 
to  the  regular  system  of  crystallization.  By  means  of  the  po- 
laryzing  microscope,  there  can  be  no  difficulty  in  recognizing 
the  choline  crystals. 

Donath  has  studied  the  fluid  of  27  patients  by  this  method 
and  gives  the  following  table. 

Seven  cases  of  general  paresis — 6  cases  positive. 

Three  cases  chronic  myelitis,  all  positive. 

Six  cases  idiopathic  epilepsy — 4  cases  positive. 

One  case  hystero-epilepsy — positive. 

Three  cases  tubercular  meningitis — all  negative. 

Four  cases  tabes — all  negative. 

One  case  syphilitic  headache — positive. 


SCIENTIFIC  REVIEW 


363 


One  case  spinal  spasmodic  paralysis — negative. 
One  case  neurastheina. — negative 

As  might  be  expected,  attempts  have  been  made  to  determine 
.  the  exact  nature  of  cerebro-spinal  fluid  from  its  chemical  compo- 
sition and  from  the  peculiarities  of  its  behavior  under  pathologic 
conditions  of  the  system. 

Can  it  be  considered  a  transudate?  The  proportion  of  its  al- 
buminous constituents  is  much  lower  than  in  blood,  0.2% 
against  7%  it  is  also  lower  than  that  of  lymph  4-5%-  Lew- 
andowsky  says  that  that  alone  does  not  suffice  to  exclude 
transudative  character  of  fluid,  as  in  the  ascites  of  cachexia,  the 
albumen  proportion  may  sink  to  0.03%.  On  the  other  hand, 
cerbro-spinal  fluid  contains  normally  no  serum-albumen  and  the 
important  fact  that  agglutinin  and  alexin  have  never  been  found, 
justify  the  assertion  that  it  is  not  a  transudate.  Lewandow- 
sky  thinks  that  the  fluid  is  a  specific  product  of  the  brain. 
Spina  who  is  of  the  same  opinion,  claims  that  it  is  derived  from 
the  brain  substance  or  from  its  capillaries,  but  not  from  the 
choroid  plexes.  According  to  Blumenthal,  the  cerbro-spinal 
fluid  must  be  considered  as  being  a  lymphatic  secretion.  Still, 
the  experiments  of  Mongour,  and  of  Ducrot  and  Gautrelet 
would  lead  one  to  regard  the  fluid  as  a  specific  secretion  of  the 
choroid  plexes. 

Certain  authors  have  maintained  that  a  true  circulation  of  the 
cerebro-spinal  fluid  exists  and  that  it  differs  in  no  way  from  that 
of  lymph.  The  studies  of  Cathelin  are  especially  worthy  of 
consideration.  According  to  the  author,  the  fluid  is  derived 
from  the  blood  and  returns  to  it  through  the  lymphatic  system. 
The  course  which  the  circulation  follows  may  be  thus  sum- 
marized (1)  the  afferent  bloodvessels  of  the  choroid  plexes 
(secreting  glands)  (2)  the  arachnoidean  cavity  which  acts  as  a 
reservoir  but  not  as  an  excretory  canal;  (3)  the  perivascular 
sheaths,  which  are  not  truly  lymphatic,  but  simply  connecting 
channels  through  which  the  cerebro-spinal  fluid  reaches;  (4) 
the  paravertebral  lymphatics  and  their  glands,  whence  the  greatly 
modified  fluid  returns  to  the  cistern  of  Pecquet  and  the  thoracic 
duct  and  finally  enters  the  general  circulation  along  with  lymph 
through  the  left  subclavian  vein.  The  circulation  of  the  fluid  is 
dependent  upon  a  number  of  factors;  its  own  constant  tension, 
the  arterial  pulsations  of  the  subarachnoidean  vessels,  the  res- 
piratory movements,  the  varying  attitudes  of  the  body,  etc. 


364 


PUBLIC  HEALTH 


Cathelin  insists  that  the  circulation  of  the  fluid  is  not  based  on 
mere  theory  but  is  the  logic  outcome  of  well-established  exper- 
mental  facts.  Thus,  it  has  been  shown  that  the  choroid  plexes 
are  the  true  secreting  glands  of  the  fluid,  that  the  fluid  enters  the 
various  lymphatic  glands  of  the  system  and  finally  we  know  that 
abundant  quantitities  of  the  fluid  are  expelled  whenever  the 
subarachnoidean  cavity  is  interested  in  traumatic  affections  of 
the  head.  Cathelin  considers  that  the  circulation  of  the  cerebro- 
spinal fluid  is  one  of  the  best  established  facts  of  modern  physi- 
ology La  Salle  Archambault. 

(To  be  continued.) 


public  fcealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 


Department  of 

Health- 

-City  of 

Albany, 

N.  Y. 

Abstract  of 

Vital  Statistics, 

March,  i 

906 

Deaths. 

1902 

1903 

1904 

i9°5 

1906 

18 

21 

25 

18 

Typhoid  Fever  

1 

1 

3 

2 

2 

0 

0 

Measles  

0 

0 

1 

0 

6 

0 

1 

Diphtheria  and  Croup  

2 

0 

1 

1 

6 

0 

4 

3 

1 

3 

1 

1 

17 

14 

16 

13 

4 

6 

8 

6 

8 

1 1 

10 

9 

13 

Bright 's  Disease  

20 

27 

21 

13 

6 

3 

7 

x3 

6 

1 2 

5 

6 

4 

7 

20 

29 

24 

10 

70  years  and  over  

39 

53 

32 

28 

Total  deaths  

175 

212 

161 

152 

Death  rate  

20.59 

24-95 

18.  21 

17.89 

Death  rate  less  Non-residents  12.24 

19. 18 

2365 

16.74 

17.30 

PUBLIC  HEALTH 


365 


Deaths  in  Institutions 

1902  1903         1904  1906  1906 


Non- 

Non- 

Non. 

Resi- 

Resi- 

Resi- 

resi- 

Resi- 

resi- 

Resi- 

resi- 

Resi- reii- 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

den 

IO 

0 

I  0 

5 

17 

0 

7 

Q 
O 

7 

3 

Albany  Orphan  Asylum. . . . 

O 

0 

2 

1 

0 

0 

0 

O 

1 

0 

i~\  1    •  1  1  j      XT  *  j  1 

O 

3 

I 

1 

2. 

1 

0 

O 

1 

0 

4 

2 

4 

2 

7 

0 

0 

O 

4 

2 

0 

0 

2 

0 

4 

1 

0 

O 

0 

0 

1 

0 

I 

0 

0 

0 

0 

O 

0 

0 

2 

0 

0 

0 

1 

0 

0 

O 

1 

0 

Homeopathic  Hospital  

0 

0 

3 

0 

3 

I 

3 

O 

0 

0 

Hospital  for  Incurables 

1 

0 

1 

0 

1 

0 

0 

O 

0 

0 

I 

0 

0 

0 

0 

O 

0 

O 

0 

0 

Little  Sisters  of  the  Poor. . . 

1 

0 

2 

0 

4 

1 

4 

O 

2 

0 

Penitentiary  

1 

1 

0 

0 

0 

0 

0 

O 

0 

0 

4 

2 

2 

1 

0 

0 

1 

O 

0 

0 

1 

0 

0 

0 

1 

0 

0 

2 

0 

0 

St.  Peter's  Hospital  

6 

2 

5 

I 

6 

I 

7 

2 

4 

0 

2 

0 

Births   73 

Marriages   31 

Still  and  Premature  Births   6 

Plumbing  Inspections 
In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were 
286  inspections  made  of  which  149  were  of  old  buildings  and  137  were 
of  new  buildings.  There  were  52  iron  drains  laid,  11  connections  with 
street  sewers,  22  tile  drains,  1  cellar  drain,  6  urinals,  5  latrines,  134 
cesspools,  131  wash  basins,  97  sinks,  93  bath  tubs,  73  wash  trays,  1 
butler's  pantry  sink,  1  trap  hopper  in  yard,  176  tank  closets,  2  slop 
hoppers,  2  stable  wash  stands.  There  were  73  permits  issued,  of  which 
fifty-three  were  for  plumbing  and  17  were  for  building  purposes.  There 
were  19  plans  submitted,  of  which  53  were  of  old  buildings  and  17  were 
for  new  buildngs.  There  were  8  houses  tested  on  complaint,  3  with 
blue,  red  and  5  with  peppermint.  There  were  12  water  tests  made. 
There  were  21  houses  examined  on  complaint  and  50  re-examined. 
Twelve  complaints  were  found  valid  and  9  without  cause. 

Bureau  of  Contagious  Diseases 
Cases  Reported 


1902 

1903 

1904 

i9°5 

1906 

Typhoid  Fever  

5 

5 

12 

4 

3 

Scarlet  Fever  

1 1 

13 

29 

7 

18 

Diphtheria  and  Croup  

8 

1 1 

13 

2 

IO 

Chicken  pox  

8 

1 1 

6 

IO 

5 

1 1 

22 

32 

454 

3 

4 

4 

0 

3 

1 

3  66 


SOCIETY  PROCEEDINGS 


Contagious  Diseases  in  Relation  to  Public  Schools. 


Reported 


S.  F. 


Deaths 

D.        S.  F 


Public  School  No.  i . , 
Public  School  No.  2 . , 
Public  School  No.  5. . 
Public  School  No.  6.. 
Public  School  No.  11 
Public  School  No.  22, 
Public  School  No.  24, 


High  School   1 

New  York  State  Normal  College  

Cathedral  School  

Number  of  days  quarantine  for  diphtheria: 

Longest,  35;  shortest,  9;  average,  17^. 
Number  of  days  quarantine  for  scariet  fever: 

Longest,  56;  shortest,  13;  average,  3or3T. 
Fumigations — Houses,  30;  rooms,  70. 

Cases  of  diphtheria  reported  10 

Cases  in  which  antitoxin  was  used   8 

Cases  in  which  antitoxin  was  not  used   2 

Deaths  after  use  of  antitoxin   1 


Society  proceefcinfls 

Medical  Society  of  the  County  of  Albany. 

A  regular  meeting  of  the  Medical  Society  of  the  county  of  Albany  was 
held  in  the  Albany  Medical  College  March  14,  1906,  at  8:30  p.  m. 

The  meeting  was  called  to  order  by  the  President.  There  were  present 
Doctors  Ball,  Baldauf,  Bedell,  Beilby,  Cook,  Cox,  Craig,  Curtis,  Gutmann, 
Happel,  Holding,  Laird,  Lempe,  Moore,  C.  H.,  MacFarlane,  Moston, 
Neuman,  Papen,  Sampson,  Traver,  Winne,  L.  B.,  Winne,  C.  K.,  Jr., 
Wiltse. 

The  Secretary  being  absent  Dr.  Bedell  was  appointed  Secretary  pro  tern. 

Dr.  Lempe  moved  that  the  minutes  of  the  preceding  meeting  be  ac- 
cepted as  printed  in  the  Annals. 

Dr.  Curtis  as  Chairman  of  the  Committee  on  the  Revision  of  By-Laws 
stated  that  the  committee  had  been  unable  to  meet.  Dr.  Lempe  made 
a  motion  that  the  committee  on  the  Revision  of  the  By-Laws  be  given 
until  April  to  report.  Carried. 

Dr.  MacFarlane  offered  the  following  resolution:  That  the  Secretary 
of  this  Society  be  authorized  to  ascertain  the  attitude  of  the  pharmacists 
of  this  county  in  regard  to  Senate  bill  No.  258  and  Assembly  bill  No.  458 
and  report  the  results  obtained  at  the  annual  meeting.  Carried. 


SOCIETY  PROCEEDINGS 


Dr.  Holding  offered  the  following  resolution: 

Resolved,  That  the  members  of  the  Albany  County  Medical  Society  Ex- 
press their  appreciation  of  the  manner  in  which  the  Anti-Narcotic  League, 
Collier's  Weekly  and  the  Ladtes'  Home  Journal  have  condemned  the  sale 
of  propriety  remedies  under  false  pretenses  and  that  a  copy  of  this  resolu- 
tion be  forwarded  to  the  above  mentioned  League  and  periodicals  by  the 
Legislative  Committee. 

Dr.  Ball  offered  the  following  resolution: 

Resolved,  That  the  Censors  report  at  the  annual  meeting  whether  or  not 
Homeopaths  are  eligible  to  membership  in  this  Society. 

Dr.  Holding  then  read  his  paper  on  "Coxa  Vara  in  Contradistinction  to 
Hip  Joint  Disease  and  Congenital  Dislocation  of  the  Hip. 

Dr.  Laird  then  read  his  paper  on  "A  Review  of  Some  of  the  Recent 
Literature  Regarding  the  Widal  Reaction." 

Dr.  Curtis  expressed  his  appreciation  of  Dr.  Laird's  paper,  especially 
the  practical  manner  in  which  the  doctor  had  demonstrated  the  value  and 
applicability  of  the  test. 

Dr.  Neuman  spoke  of  his  work  with  the  Widal,  when  he  had  succeeded 
in  getting  typical  reaction  with  normal  blood  and  had  failed  to  get  it  in  a 
case  of  typhoid  with  a  1-20  dilution  after  Johnson  had  said  1-30  was 
strong  enough.  At  that  time  some  observers,  including  himself,  thought 
this  was  not  so,  and  he  was  glad  that  Dr.  Laird  had  said  that  this  reaction 
occurs  without  typhoid  fever.  Among  the  cases  brought  to  his  mind  in 
which  the  test  was  of  practical  value  was  one  occurring  in  the  Albany 
Hospital:  a  patient  with  continued  fever  showed  no  other  symptom  of 
typhoid,  no  enlarged  spleen  or  liver;  clinically  it  was  diagnosed  as  typhoid, 
the  Widal  was  positive,  at  the  end  of  the  second  week  the  patient  died, 
but  on  autopsy  intestinal  lesions  were  not  found,  but  cultures  showed  the 
presence  of  the  typhoid  bacillus.  Another  case  was  one  of  gall  stones 
with  obstructive  jaundice  without  fever.  He  made  a  Widal  and  dis- 
covered the  bacillus.  Another  case  six  years  after  having  typhoid  fever: 
the  patient  had  severe  pains  without  jaundice;  positive  Widal,  stones  in 
the  cystic  duct.  In  all  cases  1-40  or  1-60  dilution.  He  was  especially 
interested  in  the  charts  and  thought  that  with  a  fair  dilution  we  could 
feel  sure  in  all  but  two  to  five  per  cent  of  the  cases.  He  considered  the 
method  should  be  used  in  all  cases. 

Dr.  WiNNE  wished  to  express  thanks  in  behalf  of  the  laboratory  men, 
and  said  while  he  had  had  much  experience  and  seen  many  patients, 
Iverson's  work  had  not  been  done  at  that  time  and  many  perplexing 
things  and  differences  in  opinion  arose  in  this  city  and  in  Johns  Hopkins. 
He  spoke  of  a  case  of  locating  infection  regarding  which  Dr.  Stanton 
spoke  to  him.  The  case  was  one  in  the  Philadelphia  Hospital  where  the 
blood  was  sent  to  the  laboratory  and  positive  Widal  was  reported.  The 
clinicians  were  amused.  Nevertheless  an  operation  was  performed  and 
an  abscess  cavity  was  found  from  which  pure  cultures  of  the  typhoid 
bacillus  were  obtained.  He  agreed  with  Dr.  Neuman  regarding  their 
presence  in  jaundice  and  said  that  he  himself  had  found  viable  bacilli  in 
the  centre  of  gall  stones. 


368 


MEDICAL  NEWS 


Dr.  Sampson  spoke  of  a  case  having  pain  in  the  lower  abdomen  and 
fever  greater  than  the  pain  with  a  mass  about  the  ovary  and  it  was  a 
question  whether  or  not  this  condition  was  present  with  typhoid  fever. 
Widal  positive.  On  operation  pelvic  abscess  and  pyosalpinx  were  found. 
Cultures  which  were  sterile  later  on  showed  positive  Widal,  while  there 
were  no  signs  of  typhoid  in  previous  history. 

Dr.  Curtis  asked  regarding  the  temperature  curve. 

Dr.  Sampson  said  there  was  no  typhoid. 

Dr.  Wiltsk  then  asked  regarding  the  technic. 

Dr.  Sampson  said  that  glass  slides  and  glass  tubing  had  been  used. 

Dr.  Laird,  in  closing  the  discussion,  said  there  was  no  difference  between 
the  clinical  methods  and  that  he  did  not  consider  this  a  distinguishing 
pathognomonic  symptom,  but  nevertheless  where  conditions  shows  posi- 
tive Widal  we  must  consider  it  as  a  prominent  symptom. 

Dr.  Curtis  made  a  motion  to  adjourn,  which  was  carried. 

Arthur  J.  Bedell, 

Secretary  Pro  Tern. 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick.  —  Statistics  for 
March,  1906. — Number  of  new  cases,  120;  classified  as  follows:  district 
cases  reported  by  the  health  physicians,  6;  charity  cases  reported  by  other 
physicians,  70;  patients  of  limited  means,  44;  old  cases  still  under  treat - 
m  nt,  53  ;  total  number  of  patients  under  nursing  care  during  the  month, 
173- 

Classification  of  diseases  {new  cases):  Medical,  31;  surgical,  6;  gynae- 
cological, 1 ;  obstetrical  work  of  the  Guild,  27  mothers  and  28  infants  under 
professional  care;  dental,  7;  eye  and  ear,  1 ;  nose  and  throat,  1 ;  removed 
to  hospital,  4;  deaths,  4. 

Special  Obstetrical  Department. — Number  of  obstetricians  in  charge  of 
cases,  4;  attending  obstetricians,  2;  medical  students  in  attendance,  8; 
Guild  nurses,  7;  patients,  9;  number  of  visits  by  head  obstetricians,  1; 
by  attending  obstetricians,  8;  by  the  medical  students,  61;  by  the  Guild 
nurses,  102. 

Visits  of  the  Guild  nurses  (all  departments) :  Number  of  visits  with 
nursing  care,  1,241;  for  professional  supervision  of  convalescents,  176; 
total  number  of  visits,  1,417.  Five  graduate  nurses  and  6  assistants  nurses 
were  on  duty.  Cases  were  reported  to  the  Guild  by  3  of  the  health 
physicians  and  by  37  other  physicians  and  by  3  dentists. 

New  York  State  Journal  of  Medicine. — The  Annals  has  received 
the  Centennial  number  of  the  New  York  State  Journal  of  Medicine,  cele- 
brating the  one  hundredth  anniversary  of  the  Medical  Society  of  the  State 
of  New  York. 


IN  MEMORIAM 


369 


Purdue  University. — In  May,  1905,  the  various  Medical  Colleges  of 
Indiana  were  brought  together  under  the  general  management  of  Purdue 
University.  These  included  the  Medical  College  of  Indiana,  Central  Col- 
lege of  Physicians  and  Surgeons  and  the  Fort  Wayne  School  of  Medicine. 

Personal. — Dr.  Michael  J.  Thornton  (A.  M.  C.  '01)  has  been  ap- 
pointed expert  alienist  for  the  U.  S.  Government  to  examine  immigrants 
entering  New  York  harbor. 

Dr.  W,  G.  Rommel  (A.  M.  C.  1905)  has  started  practice  at  Grapevine, 
Greene  county,  N.  Y. 

Dr.  Willis  E.  Merriman,  Jr.,  (A.  M.  C.  1902)  is  in  the  hospital  at 
Spuyten  Duyvil,  as  resident  physician. 


Deaths. — Dr.  George  F.  Dearborn  (A.  M.  C.  '57)  died  at  his  home, 
Rockaway,  N.  J.,  March  26,  1906,  aged  71,  after  a  short  illness  from 
pneumonia.    He  was  a  surgeon  in  the  Civil  War. 

Dr.  Fordyce  H.  Benedict  (A.  M.  C.  '68)  died  at  his  home,  Weedsport, 
N.  Y.,  aged  61,  from  pneumonia.  He  was  a  member  of  the  Cayuga 
County  Medical  Society,  and  a  surgeon  in  the  Civil  War. 

Dr.  Frederick  A.  Smart  (A.  M.  C.  '99)  died  at  Cobleskill,  N.  Y.,  April 
14,  1906. 


Selwyn  A.  Russell,  M.  D. 

The  following  memorial  resolution  is  published  by  request  of  the  Pough- 
keepsie  Trust  Company: 

By  the  death  of  Dr.  Selwyn  A.  Russell,  which  occurred  at  his  home  in 
Poughkeepsie,  after  an  acute  illness  of  three  days  in  which  his  physi- 
cians alternated  between  hope  and  fear,  the  world  has  lost  a  man  who, 
by  reason  of  rare  mental  ablity,  Christian  character  and  refined  per- 
sonality, was  beloved  and  respected  by  all  who  knew  him. 

After  graduating  from  the  Albany  Medical  College  and  studying  in 
Vienna,  Doctor  Russell  spent  some  time  in  travel.  He  was  one  of  the 
intellectual  men  of  Poughkeepsie  and  his  wide  and  intelligent  view  of 
the  affairs  of  the  world  marked  him  as  a  conversationalist  of  unusual 
interest. 

That  those  who  knew  him  best  felt  that  the  world  was  better  through 
his  unselfish  and  spotless  life,  seems  but  a  fitting  tribute  to  his  beautiful 
character. 


7 


370 


IN  MEMORIAM 


William  M.  White,  M.  D. 

Dr.  William  Maxwell  White  of  Amsterdam  died  December  29,  1905, 
at  the  home  of  his  mother,  Mrs.  Catharine  J.  White,  No.  102  West  Green 
street,  that  city.  Dr.  White  was  in  his  fiftieth  year,  having  been  born 
in  Amsterdam  March  28,  1856.  He  received  his  early  education  in  the 
Amsterdam  academy  and  was  graduated  from  Union  college  at  Schenec- 
tady in  1881.  In  1886  he  was  graduated  from  the  Albany  Medical  college 
with  high  honors,  being  the  valedictorian  of  his  class.  He  then  located 
in  Amsterdam  and  succeeded  to  the  practice  of  his  father,  the  late  Dr. 
Joseph  N.  White.  Dr.  White  continued  in  active  practice  until  about 
a  year  ago,  when  his  health  began  to  fail  as  the  result  of  overwork  and 
he  was  afflicted  with  neurasthenia.  In  efforts  to  regain  his  health  he 
visited  various  places.  He  had  been  suffering  from  a  cold  for  several 
days  and  this  suddenly  developed  into  pneumonia,  which  speedily  resulted 
in  his  death. 

Dr.  White  was  one  of  the  most  prominent  professional  men  of  Amster- 
dam and  was  also  active  in  charitable  and  religious  work.  At  one  time 
he  was  president  of  the  Amsterdam  Y.  M.  C.  A.,  and  he  was  chairman 
of  the  relief  committee  which  had  charge  of  furnishing  food  and  clothing 
to  the  unemployed  and  needy  during  the  winter  of  1903-4.  He  was  also 
chairman  of  the  relief  committee  which  sent  about  $4,000  to  the  Johns- 
town, Pa.,  flood  sufferers.  He  was  a  member  of  the  Amsterdam  Medical 
Society,  one  of  the  staff  of  the  Amsterdam  City  Hospital,  took  an  active 
part  in  the  Training  School  for  Nurses,  was  Health  Officer  of  the  city 
of  Amsterdam  for  several  terms,  physician  to  the  Children's  Home  for 
many  years,  served  a->  an  officer  of  the  Homeopathic  Society  of  Mont- 
gomery and  Fulton  counties  and  was  also  identified  with  various  Amster- 
dam organizations.  Dr.  White  never  married.  Besides  his  mother,  he 
is  survived  by  two  sisters,  the  Misses  Sarah  E.  and  Lucy  M.  White 
of  Amsterdam,  and  one  brother,  Attorney  Edward  P.  White,  formerly 
of  Amsterdam,  but  now  of  Buffalo. 

The  Amsterdam  Medical  Society  attended  the  funeral  in  a  body,  sent 
a  floral-piece  containing  its  initials  and  adopted  resolutions  of  respect. 
The  bearers  were  Doctors  Hicks,  Stoner,  Johnson  and  Bronk  of  Amster- 
dam, Garnsey  and  Eisenbury  of  Gloversville,  Walrad  of  Johnstown  and 
L.  Faust  of  Schenectady. 


Frederick  Adams  Smart,  M.  D. 

Dr.  Frederick  A.  Smart  died  at  his  home  in  Cobleskill,  N.  Y.,  Satur- 
day, April  14,  1906.  Dr.  Smart  was  born  in  Troy  about  twenty-nine 
years  ago,  and  graduated  from  the  Albany  Medical  College  with  the 
class  of  1899.  He  first  located  at  Carlisle,  N.  Y.,  and  then  at  Nassau, 
N.  Y.,  going  to  Cobleskill  in  1903.  On  the  26th  day  of  June,  1902, 
he  married  Miss  Lois  Wilcox,  a  prominent  lawyer.  His  wife  and  one 
child  survive  him. 


CURRENT  MEDICAL  LITERATURE 


371 


Current  /iBefcical  ^Literature 

REVIEWS  AND  NOTICES  OF  BOOKS 

Saunders'  Question  Compends.  Essentials  of  Materia  Medica,  Therapeu- 
tics, and  Prescription  Writing.  By  Henry  Morris,  M.  D.,  College 
of  Physicians,  Philadelphia.  Seventh  Edition,  Thoroughly  Revised. 
By  W.  A.  Bastedo,  Ph.  G.,  M.  D.,  Instructor  in  Materia  Medica 
and  Pharmacology  at  the  Columbia  University  (College  of  Physi- 
cians and  Surgeons),  New  York  City.  i2mo,  300  pages.  Philadel- 
phia and  London:  W.  B.  Saunders  &  Company,  1905.  Cloth,  $1.00 
net. 

Dose-Book  and  Manual  of  Prescription-Writing:  with  a  List  of  the 
Official  Drugs  and  Preparations,  and  the  more  important  Newer 
Remedies.  By  E.  Q.  Thornton,  M.  D.,  Assistant  Professor  of 
Materia  Medica,  Jefferson  Medical  College,  Philadelphia.  Third 
Edition,  Revised  and  Enlarged.  i2mo,  392  pages,  illustrated. 
Philadelphia  and  London:  W.  B.  Saunders  &  Company,  1905. 
Bound  in  flexible  leather,  $2.00  net. 

Materia  Medica  and  Pharmacy.  By  Reynold  Webb  Wilcox,  M.  A.,  M.  D., 
LL.  D.,  Professor  of  Medicine  at  the  New  York  Post-Graduate 
Medical  School,  Etc.,  Etc.  Sixth  Edition,  Based  on  the  Fifth  Edi- 
tion of  White  and  Wilcox's  "  Materia  Medica  and  Therapeutics." 
Philadelphia:   P.  Blakiston's  Son  &  Company. 

Pharmacology  and  Therapeutics.  By  the  same  author  and  publishes  as 
Materia  Medica  and  Pharmacy. 

A  Text-Book  on  Modern  Materia  Medica  and  Therapeutics.  By  A.  A. 
Stevens,  A.  M ,  M.  D.,  Lecturer  on  Physical  Diagnosis,  University 
of  Pennsylvania ;  Professor  of  Pathology,  Woman's  Medical  College 
of  Philadelphia.  Fourth  Edition,  Revised.  Octavo  of  670  pages. 
Philadelphia  and  London :  W.  B.  Saunders  &  Company,  1905. 
Cloth,  $3.50  net. 

A  Text-Book  of  Materia  Medica,  Therapeutics  and  Pharmacology.  By 
George  F.  Butler,  Ph.  G.,  M.  D.  Associate  Professor  of  Therapeu- 
tics in  the  College  of  Physicians  and  Surgeons,  Chicago;  Professor 
of  Medicine  and  Therapeutics,  Dearborn  Medical  College,  Chicago. 
Fifth  Edition,  Thoroughly  Revised  and  Rewritten  and  Adapted  to 
the  Eighth  Edition  (1905)  of  the  U.  S.  Pharmacopoeia.  By  Smith 
Ely  Jeliffe,  M.  D.,  Ph.  D.,  Professor  of  Pharmacognosy  and  In- 
structor in  Materia  Medica  and  Therapeutics  in  Columbia  Uni- 
versity (College  of  Physicians  and  Surgeons),  New  York.  Phila- 
delphia and  London :    W.  B.  Saunders  Company. 

The  several  books  above  mentioned  are  all  of  them  new  editions  of 
standard  works  and  all  of  these  new  editions  have  been  brought 
into  being  by  reason  of  the  eighth  decennial  revision  of  the  United  States 
Pharmacopoeia,  they  can  all  very  properly  be  reviewed  together. 

"Essentials  of  Materia  Medica  and  Therapeutics"  by  Dr.  Morris  is 
neither  better  nor  worse  than  previous  editions  and  what  information 


372 


CURRENT  MEDICAL  LITERATURE 


it  contain?  is  both  correct  and  conforms  to  the  new  pharmacopoeia.  We 
can  say  of  this  edition  what  we  said  of  the  previous  (the  6th)  one, 
"  It  is  however  like  all  books  of  its  class,  of  no  use  to  the  student  who 
studies  for  the  sake  of  knowledge  and  not  merely  for  a  license  to 
practice." 

Dr.  Thornton's  "  Dose-Book "  occupies  a  distinct  place  of  its  own  in 
that  it  gives  in  a  concise  and  exact  form  a  really  remarkable  amount  of 
information,  information  of  a  character  which  would  make  it  of  value  to 
the  practitioner  as  well  as  the  student.  There  are  tables  which  show  the 
change  in  strength  of  the  more  important  preparations  of  the  new  pharma- 
copoeia, the  equivalents  of  the  apothecaries'  weights  and  measures  in 
the  metric  system,  and  the  solubilities  of  drugs  as  well  as  several  others. 
The  instructions  in  prescription  writing  are  unusually  good. 

"  Materia  Medica  and  Pharmacy,"  and  "  Pharmacy  and  Therapeutics," 
both  by  Wilcox  are  really  two  volumes  of  the  same  book.  The  first 
mentioned  gives  a  resume  of  various  pharmaceutical  processes,  kinds  of 
preparations  and  dosage  together  with  a  description  in  detail  of  remedies. 
The  second  volume  is  largely  given  over  to  the  application  of  thera- 
peutic agents.  Both  works  conform  with  great  exactness  to  the  new 
pharmacopoeia,  both  are  written  with  clearness  and  in  the  second,  much 
new  matter  has  been  added.  These  two  books  will  both  retain  the 
popularity  which  was  won  by  White  and  Wilcox'  "  Materia  Medica  and 
Therapeutics." 

By  far  the  most  valuable  work  published  to-day  for  the  medical  student 
is  "  Modern  Materia  Medica  and  Therapeutics "  by  Dr.  Stevens.  Each 
rapidly  succeeding  edition  testifies  not  only  as  to  the  author's  learning, 
and  his  ability  in  concise  expression,  but  to  the  fact  that  his  endeavors 
are  thoroughly  appreciated.  There  is  hardly  anything  which  a  student 
should  know  that  is  not  to  be  found  between  the  covers  of  this  book  and 
in  addition,  expressed  with  such  clearness  and  in  such  condensed  form 
that  in  reviewing  it,  it  would  be  unfair  to  speak  of  any  one  feature  as 
being  better  than  another.  The  author  still  clings  to  his  former  method 
of  classification  of  drugs  "  according  to  their  pharmacological  action," 
instead  of  taking  up  each  drug  separately  and  by  itself,  so  that  when 
one  is  studying  a  drug  like  nux  vomica,  for  instance,  he  finds  it  considered 
under  four  different  heads,  and  as  to  location  in  the  book,  in  places 
widely  separated  from  each  other. 

When  all  is  said  and  done,  when  the  smoke  of  battle  is  over  and  the 
undergraduate  student  gives  place  to  the  practicing  student  and  he  wants 
a  really  admirable  work  on  Materia  Medica  and  its  kindred  branches, 
he  will  make  no  mistake  if  he  selects  Dr.  Butler's  "  Text-Book  of  Materia 
Medica,  Therapeutics  and  Pharmacology."  This  book  is  much  too  large 
for  the  medical  student,  but  for  the  practitioner,  no  better  book  is  pub- 
lished. Especially  to  be  commended  is  the  great  length  with  which  the 
author  treats  the  physiological  action  of  each  drug  and  the  manner  in 
which  he  then  applies  the  information  thus  given  to  the  drug's  therapeutic 
action. 

There  is  one  serious  criticism  to  be  made  however,  one  which  makes 
it  impossible  to  recommend  the  book  for  the  undergraduate's  use,  that 


CURRENT  MEDICAL  LITERATURE 


373 


is  its  many  mistakes  as  to  the  names  of  preparations,  omission  of  official 
preparations  and  mistakes  in  dosage. 

For  example,  the  dose,  (U.  S.  P.)  of  Liquor  Arseni  et  Hydrargyri 
Iodidi  is  given  as  i.oo  Cc  instead  of  o.io  C.  c,  the  dose  of  Sodii  Aresnas 
as  5-10  grain  instead  of  1-10  grain;  among  the  list  of  preparations  of 
mercury,  no  mention  is  made  of  the  oleate,  and  Ferri  Hydroxidmn  cum 
Magnesia  is  given  instead  of  Ferri  Hydroxidum  cum  Oxida;  but  worse 
than  all,  the  reader  is  told  (as  he  is  indeed  in  many  other  materia  medicas) 
that  Liquor  Sodii  Arsenatis  is  Pearson's  Solution  while  every  one  who 
pretends  to  accuracy  in  this  branch  of  medicine  knows  that  the  former 
contains  one  per  cent,  of  the  salt  and  the  latter  is  not  official  in  the 
U.  S.  P.,  but  is  the  Liquor  arsenicale  de  Pearson  of  the  French  Codex  and 
is  but  one-tenth  per  cent,  in  strength. 

SPENCER  L.  DAWKS. 


A  Compend  of  Medical  Chemistry,  Inorganic  and  Organic,  including  Urine 
Analysis.  By  Henry  Leffmann,  M.  D.,  Professor  of  Chemistry  in 
the  Woman's  Medical  College  of  Pennsylvania.  Fifth  Edition, 
Revised.    P.  Blakiston's  Son  &  Company,  1905.  Philadelphia. 

This  quiz  compend  appears  in  its  new  edition  somewhat  revised  but 
upon  the  whole  in  substantially  the  same  form  as  in  the  previous  issue. 

The  author  still  adheres  to  the  somewhat  empirical  and  unreal  classifi- 
cation of  the  subject  into  the  inorganic  and  organic  divisions. 

There  can  be  no  doubt  that  there  is  collected  and  presented  in  a 
clear  and  concise  manner  within  the  small  space  of  200  pages  a  great 
amount  of  chemical  material  which  will  be  of  considerable  value  to  the 
medical  student  who  wishes  to  "  cram  up  "  for  an  examination. 

In  considering  the  importance  of  the  various  topics  discussed,  as  judged 
from  the  space  devoted  to  them,  one  cannot  fail  but  be  impressed  with 
the  view  that  for  the  student  of  medicine  the  inorganic  branch  has  re- 
ceived undue  attention  over  the  other  divisions  of  the  subject.  One-half 
of  the  book  is  taken  up  with  this,  while  the  chemistry  of  the  carbon  com- 
pounds with  their  immediate  and  important  connection  with  physiological 
chemistry  and  hence  directly  to  medical  science  is  relegated  to  the  other 
half. 

It  is  a  pity  that  the  subject  of  blood  finds  no  place  in  the  book.  The 
chemistry  of  the  circulating  medium,  the  methods  for  the  determination 
of  the  hemoglobin  per  cent.,  the  specific  gravity,  the  coagulation  time  or 
the  counting  of  the  corpuscles  is  certainly  as  much  if  not  more  the  subject 
of  clinical  interest,  as  the  consideration  of  the  fat  or  total  proteid  content 
of  milk. 

The  important  topic  of  physical  chemistry  as  applied  in  numerous  ways 
(cryoscopy,  osmotic  pressure,  ionic  action,  etc.,)  to  the  various  processes 
of  the  animal  body  has  remained  untouched. 

Upon  the  whole  it  must  be  said  that  the  book  is  lacking  in  that  part 
of  the  subject  which,  at  present,  is  exciting  the  most  attention  in  the 
medical  schools  and  sciences,  namely,  chemistry  applied  to  the  living 
organism — call  it  biological,  physiological,  medical  or  what  one  will. 

h.  c.  j. 


374 


CURRENT  MEDICAL  LITERATURE 


American  Edition  of  Nothnagel's  Practice.  Malaria,  Influenza,  and 
Dengue.  By  Dr.  J.  Mannaberg,  of  Vienna,  and  Dr.  0. 
Leichtenstern,  of  Cologne.  Entire  volume  edited,  with 
additions,  by  Ronald  Ross,  F.  R.  C.  S.,  F.  R.  S.,  Professor  of 
Tropical  Medicine,  University  of  Liverpool;  J.  W.  W.  Stephens, 
M.  D.,  D.  P.  H.,  Walter  Myers  Lecturer  in  Tropical  Medicine, 
University  of  Liverpool;  and  Albert  S.  Grunbaum,  F.  R.  C.  P., 
Professor  of  Experimental  Medicine,  University  of  Liverpool. 
Octavo  volume  of  769  pages,  fully  illustrated,  including  eight  full- 
page  plates.  Philadelphia  and  London :  W.  B.  Saunders  &  Com- 
pany, 1905.    Cloth,  $5.00  net;  Half  Morocco,  $6.00  net. 

This  excellent  volume  from  Nothnagel's  series,  is  mostly  taken  up  by 
Mannaberg's  monograph  upon  malaria.  This  is  so  well  known,  at  least 
among  students  of  tropical  medicine,  that  extended  comment  upon  it  is 
unnecessary.  Almost  the  only  important  changes  made  in  the  original 
articles  are  those  necessitated  by  the  demonstration  of  the  role  of  the 
mosquito  in  the  transmission  of  malaria,  and  the  consequent  alterations 
in  the  theories  previously  held  in  regard  to  this  matter  and  to  the  proper 
prophylaxis  against  infection.  A  few  changes  and  additions  of  minor 
importance,  but  all  tending  to  a  better  presentation  of  the  subject,  have 
been  made  elsewhere. 

The  most  important  addition  is  a  comprehensive  section  by  Dr.  Stephens 
upon  "  Malaria  in  its  Relation  to  the  Mosquito."  He  discusses  in  a 
detailed  manner  the  anatomy,  life  history,  distribution  and  classification 
of  mosquitoes,  especially  the  subfamily  Anophelina  which  is  the  only 
one  which  takes  part  in  the  dissemination  of  this  disease.  The  mosquito- 
malaria  cycle  is  discussed  in  detail,  and  also  the  habits  of  Anophelinae 
and  their  relation  to  malarial  endemicity.  For  a  thorough  exposition  of 
the  so-called  "Mosquito  Theory"  (of  malaria)  we  would  refer  anyone 
to  this  section  of  the  volume. 

The  question  of  pernicious  malarial  fever  is  considered  at  length,  but 
we  would  suggest  that  it  would  be  better  were  less  stress  laid  upon  the 
different  types  of  pernicious  fever.  They  are  considered  almost  as  separate 
diseases,  though  the  common  etiology,  rather  than  as  one  disease  in 
which  different  single  symptoms  or  groups  of  symptoms  are  predominant. 
Would  not  the  general  arrangement  be  better  were  the  pathology  of 
malaria  considered  before,  rather  than  after,  the  sections  devoted  to 
symptomatology? 

The  section  upon  diagnosis  contains  some  remarks  which  we  cannot 
do  better  than  repeat  here  in  toto : 

"From  these  few  illustrations  (etc.,  etc.),  it  is  evident  how  little  regard 
is  bestowed  on  the  rule  that  a  fever  which  resists  quinine  for  a  long 
time  is  not  malaria.  The  only  absolute  diagnostic  characteristic  of  malaria 
is  the  occurrence  of  malarial  parasites  in  the  blood.  The  results  of 
expert  investigations  teach  that  the  parasites  may  be  found  in  almost 
every  case.  The  demonstration  of  the  parasite  is  therefore  not  only  of 
theoretical  interest  but  of  considerable  practical  value.    It  possesses  at 


CURRENT  MEDICAL  LITERATURE 


375 


least  as  much  significance  in  malarial  as  Koch's  bacillus  in  tuberculosis. 
The  examination  of  the  blood  has  accordingly  become  indispensable  and 
it  is  to  be  earnestly  desired  that  the  method  obtain  the  widest  prevalence, 
not  only  among  physicians  practicing  in  malarial  regions,  but  elsewhere. 
*  *  *  *  *  jt  is  a  weu  known  fact  that  the  physicians  practicing 
in  regions  free  from  malaria  are  helpless  in  regard  to  intermittent  fevers, 
the  causes  of  which  are  not  evident,  and  that,  they  too  willingly  jump 
at  the  diagnosis  of  malaria  when  a  blood  examination  would  solve  the 
question." 

The  discussion  upon  malaria  is  followed  by  a  long  list  of  references 
(twenty-three  pages)  which  contains  all  the  important  work  done  upon 
the  subject. 

The  latter  part  of  this  volume  contains  Leichtenstern's  monographs 
upon  Influenza  and  Dengue.  Of  this  the  greater  portion  is  occupied  by 
the  work  upon  influenza.  Though  originally  published  in  1898,  but  little 
has  been  added  to  our  knowledge  of  the  subject  since  then  and  his 
description  of  the  disease  is  so  complete  and  so  accurate  that  it  will  long 
remain  a  classic.  The  text  is  followed  by  a  very  extensive  collection 
of  references  to  the  literature  on  the  general  and  special  aspects  of 
influenza. 

It  seems  like  the  ircny  of  fate  that  the  author  should  have  succumbed 
to  an  attack  of  pneumonia,  the  result  of  a  previous  attack  of  influenza, 
shortly  after  the  publication  of  his  treatise. 

The  section  upon  Dengue  is  brief,  but  complete.  It  was  written,  how- 
ever, before  the  role  of  the  mosquito  in  the  transmission  of  tropical 
diseases  was  discovered,  and,  as  a  consequence,  some  of  the  remarks 
upon  etiology  are  not  quite  in  accord  with  present  ideas. 

C.  K.  w.,  JR. 


American  Edition  of  Nothnagel's  Practice.  Diseases  of  the  Kidney, 
Diseases  of  the  Spleen,  and  Hemorrhagic  Diseases.  By  Drs. 
H.  Senator  and  M.  Litten,  of  Berlin.  Edited  with  addi- 
tions, by  James  B.  Herrick,  M.  D.,  Professor  of  Medicine  in  Rush 
Medical  College,  Chicago.  Octavo  of  816  pages,  illustrated.  Phila- 
delphia and  London:  W.  B.  Saunders  &  Company,  1905.  Cloth, 
$5.00  net;  Half  Morocco,  $6.00  net. 

When,  among  the  many  books  of  only  passing  value  which  constantly 
issue  from  the  press,  the  reviewer  finds  one  of  such  decided  merit  as 
this  volume  in  Nothnagel's  series,  a  distinct  sense  of  pleasure  and  satis- 
faction is  at  once  felt.  Though  all  parts  of  the  work  are  not  equally 
satisfactory  and  up  to  date,  as  a  whole  it  is  very  valuable  and  we  are 
sure  will  be  considered  as  an  authority  in  English  upon  the  subjects  of 
which  it  deals  as  it  already  is  in  German. 

Senator's  monograph  upon  the  diseases  of  the  kidney  comprises  by  far 
the  largest  part  of  the  volume.  This  is  divided  into  a  General  and  a 
Special  section.    The  first,  after  a  short  historical  review  of  the  develop- 


376 


CURRENT  MEDICAL  LITERATURE 


mcnt  of  our  knowledge  of  renal  affections,  considers  in  detail  various 
abnormal  urinary  conditions,  such  as  albuminuria,  chyluria,  haematuria, 
phosphaturia,  etc.,  of  which  naturally  the  consideration  of  albuminuria 
takes  by  far  the  largest  amount  of  space.  This  discussion  of  urinary 
states  is  followed  by  that  upon  Dropsy,  Uraemia  and  the  Vascular  Changes 
which  take  place  in  disease  of  the  kidney. 

Following  this  consideration  of  general  subjects  so  closely  allied  to, 
and  in  fact  part  of,  abnormal  renal  conditions,  there  is  in  the  special 
section  a  full  discussion  of  pathological  kidney  conditions  per  se.  These 
are  considered  in  the  following  order :  Malformations,  Displacements, 
Neuralgia  (Renal  Colic)  Circulatory  disturbances,  Hypertrophy  and  Atro- 
phy, Non-suppurative  inflammations  (Bright's  disease),  Suppurative  in- 
flammations, Amyloid  and  Fatty  degenerations,  Inflammatory  affections 
involving  other  renal  structures  than  the  parenchyma  (pyelitis,  pyelo- 
nephritis, hydronephrosis,  etc.),  Cystic  kidneys,  Neoplasms,  Renal  Con- 
cretions, Animal  and  Vegetable  parasites,  Peri-nephritis  and  Fara-nephri- 
tis,  Ancmalies  of  renal  vessels. 

The  discussion  of  the  various  topics  is  full,  at  all  times  fair,  and  full 
references  to  the  literature  are  given,  both  as  footnotes  and  collectively 
at  the  beginning  of  each  section.  The  Editor  has  found  little  to  add  or 
criticize  but  has  inserted  some  paragraphs  bringing  the  subject  matter 
fully  up  to  date  and  giving  points  of  special  value  to  the  general  practi- 
tioner, such  as  in  diagnosis  and  treatment. 

Some  plates  have  been  added  which  well  illustrate  points  in  the 
pathology  of  nephritis,  and  two  from  Rieder's  well  known  atlas  illustrate 
types  of  renal  casts. 

The  part  of  the  volume  dealing  with  the  diseases  of  the  spleen  is  from 
the  pen  of  Litten.  This  section  is  not  as  good  as  that  upon  the  kidney. 
It  is  not  as  up  to  date  and  consequently  many  of  the  ideas  here  expressed 
are  not  in  exact  accord  with  the  opinions  now  held  in  regard  to  the  same 
subjects;  particularly  is  this  the  case  in  connection  with  the  discussion  of 
physiology  of  the  spleen,  leukaemia,  malaria,  and  the  changes  in  the  bone 
marrow,  lymphatic  apparatus  and  blood  which  take  place  after  splenectomy. 
One  statement  in  particular  we  must  take  exception  to :  that  "  the  spleen 
and  bone  marrow  convert  leucocytes  (that  are  probably  reformed  in  the 
lymph  glands)  into  red  blood  corpuscles." 

In  this  part  of  the  book  many  whole  sections  have  been  added  by  the 
Editor,  notably  those  upon  Splenic  Anaemia,  Chronic  Cyanosis  with  Poly- 
cythaemia  and  Enlarged  Spleen,  and  Chronic  Icterus  with  Splenomegaly. 
Many  additions  have  been  made  by  the  Editor  in  the  sections  upon  Leuk- 
aemia and  Malaria. 

The  last  portion  of  the  volume  is  also  from  the  pen  of  Litten,  and  is 
given  over  to  a  discussion  of  the  so-called  haemorrhagic  diseases.  The 
author  considers  the  haemorrhagic  diathesis  under  three  headings :  Scurvy, 
Haemophilia,  and  Morbus  Maculosus  Werlhofii  (Purpura  haemorrhagica). 
To  these  the  editor  has  added  a  section  upon  Infantile  Scurvy.  The 
author  calls  attention  to  the  fact  that  our  real  knowledge  of  these  con- 
ditions does  not  permit  so  sharp  a  distinction;  the  differences  are  in 
part  arbitrary,  and  not  based  on  strict  etiological  or  pathologico-anatomi- 


CURRENT  MEDICAL  LITERATURE 


377 


cal  data.  Though  he  has  not  brought  much  order  out  of  the  previous 
chaos  yet  his  work  has  perhaps  cleared  up  some  points  and  certainly 
deserves  careful  study.  c.  k.  vv.  jr. 


A  Text-Book  of  Medical  Chemistry  and  Toxiology.  By  James  W. 
Holland,  M.  D.,  Professor  of  Medical  Chemistry  and  Toxicology, 
and  Dean,  Jefferson  Medical  College,  Philadelphia.  Octavo  volume 
of  600  pages,  fully  illustrated,  including  8  plates  in  colors.  Phila- 
delphia and  London :  W.  B.  Saunders  &  Company,  1905.  Cloth, 
$3.00  net. 

The  press  work  of  this  book  is  excellent  both  as  regards  the  typography 
and  the  many  rather  well  executed  colored  plates  which  are  diffusely 
spread  through  the  volume. 

That  part  devoted  to  the  inorganic  division  is  especially  complete. 
Metrology,  heat,  light,  magnetism  and  electricity  are  discussed  with  detail 
sufficient  to  supply  the  physical  knowledge  necessary  to  the  further  com- 
prehension of  the  subject.  Gibb's  phase  rule  receives  attention  to  the 
extent  of  two  pages. 

In  the  consideration  of  the  various  elements,  their  occurrence,  prepara- 
tion and  properties — these  in  some  cases  being  taken  up  from  the  physical, 
chemical  and  medical  standpoint — are  followed  by  the  incompatibilities 
of  the  compounds,  the  pharmacopoeial  preparations  with  their  doses  and 
finally  by  a  statement  from  the  toxicological  standpoint.  This  latter 
includes  the  symptoms,  fatal  dose,  fatal  period,  treatment  and  post- 
mortem appearance  of  the  tissues  and  organs.  To  the  mind  of  the  re- 
viewer it  is  questionable  whether  the  introduction  of  pharmacopoeial  pre- 
parations, doses  and  toxicological  discussions  are  not  absolutely  out  of  place 
in  a  chemistry,  even  one  expected  to  fall  into  the  hands  of  medical 
students.  The  modern  schools  provide  special  chairs  in  materia  medica, 
therapeutics,  pharmacology  and  even  in  some  cases  pharmacy.  In  a 
thorough  presentation  of  these  subjects,  all  the  necessary  detail  which 
was  in  the  past  given  under  the  name  of  toxicology,  finds  consideration. 
Toxicology  as  a  special  subject  is  a  relic  of  the  times  when  all  that 
was  known  about  chemistry  could  be  narrated  in  a  small  volume.  It  is 
evident  that  the  pharmacologist  will  not  recommend  to  his  students  a 
book  on  chemistry  from  which  to  obtain  physiological  or  pathological 
action  or  doses,  nor  will  the  therapeutist  be  satisfied  with  the  discussion 
of  the  symptoms  or  treatment  as  given  in  a  chemistry.  The  special 
subjects  are  too  large  to  allow  of  such  concentration.  The  physical  side 
of  the  subject  in  connection  with  the  various  elements  is  admirably  pre- 
sented. The  importance  of  the  ions  in  reactions,  precipitation,  electrolytic 
conductivity,  physiological  action  and  as  indicators  receives  careful  and 
well  directed  attention.  The  "  organic  "  compounds  are  defined  as  "  those 
whose  carbon  is  combustible."  This  then  excludes  the  carbon  compounds 
such  as  carbonates  and  oxalates.  These  together  with  the  cyanides  are 
placed  under  the  inorganic  subdivision;  but  just  why  the  deviations  of 
hypothetical  carbonic  acid,  the  cyanides  and  oxalates  are  not  taken  up 


378 


CURRENT  MEDICAL  LITERATURE 


under  carbon,  as  one  would  expect,  is  not  clear  to  the  writer.  The 
value  of  the  organic  division  becomes  greatly  enhanced  by  the  many 
structural  formulae  found  in  the  text.  This  is  always  of  inestimable 
value  both  in  teaching  and  in  studying  the  subject.  It  is  rather  unfortu- 
nate, however,  that  substances  of  such  intimate  importance  to  medicine 
as  the  lecithins,  cystein  and  asparatic  acid  receive  such  slight  notice 
and  the  names  of  succinic  and  glutamic  acids,  allantoin,  pyrollidin  and  serin 
do  not  appear  in  the  index  and  hence  it  is  to  be  presumed  are  wanting 
in  the  text.  The  chapter  on  ptomaines  and  toxins  is  concise  and  well- 
chosen.  The  book  concludes  with  a  discussion  of  physiological  and  clinical 
chemistry  through  which  some  few  detailed  experiments  are  interspersed. 
There  appear  short  resumes  of  salivary,  gastric  and  pancreatic  digestion 
with  colored  plates  to  indicate  tests  which  depend  upon  color-changes. 
Topfer's  method  is  given  in  detail.  The  bile,  intestinal  juice,  and  blood 
receives  limited  attention,  but  milk  with  methods  of  analysis,  preservation, 
etc.,  is  complete  from  the  clinical  or  commercial  standpoint.  The  more 
important  physiological  and  pathological  constituents  of  the  urine  are 
covered  and  the  usual  clinical  methods  for  their  determination  given. 
The  method  for  chlorides  is  bad  and  gives  inaccurate  results  in  patho- 
logical conditions.  It  is  doubtful  whether  Ruhemann's  volumetric  uric 
acid  determination  has  found  sufficient  use  or  received  enough  verification 
to  warrant  its  recommendation  for  general  employment  unless  only  approxi- 
mate values  are  required. 

No  gross  errors  have  come  to  notice  and  it  may  be  said  that  the  book 
can  well  be  made  to  serve  as  a  text-book  for  general  chemistry  but  must 
be  largely  supplemented  in  the  physiological  chemical  branches. 

h.  c.  j. 


A  Treatise  on  Diseases  of  the  Skin.  For  the  use  of  advanced  Students 
and  Practitioners.  By  Henry  W.  Stelwagon,  M.  D.,  Ph.  D.,  Pro- 
fessor of  Dermatology,  Jefferson  Medical  College,  Philadelphia; 
and  Clinical  Professor  of  Dermatology,  Woman's  Medical  College, 
Philadelphia.  Fourth  Edition,  Revised.  Handsome  octavo  of  1135 
pages,  with  258  text-illustrations,  and  32  full-page  lithographic  and 
half-tone  plates.  Philadelphia  and  London:  W.  B.  Saunders  & 
Company,  1905.    Cloth,  $6.00  net ;  Sheep  or  Half  Morocco,  $7.00  net. 

This  book,  already  In  its  fourth  edition,  is  an  exceedingly  attractive  and 
useful  work.  The  present  edition  contains  considerable  new  matter  in 
the  form  of  a  brief  but  clear  description  of  the  therapeutic  uses  of  Electro- 
lysis, the  Rontgen  and  Einsen  rays  and  the  high  frequency  current.  Many 
new  plates  have  been  added,  most  of  them  from  the  author's  own  cases. 

The  bibliographical  references  are  placed  as  footnotes  on  the  pages  and 
while  not  intended  to  be  complete,  they  contain  the  most  important  com- 
munications relating  to  each  disease.  The  book  is  to  be  recommended 
particularly  to  physicians  and  to  students  who  have  access  to  large  clinics. 
In  small  clinics  the  student  we  believe,  would  profit  more  from  a  small 
atlas.  h.  w.  c. 


CURRENT  MEDICAL  LITERATURE 


379 


NEUROLOGY 
Edited  by  Henry  Hun,  M.  D. 

Anatomical  Findings  %n  Two  cases  of  Korsakoff1  s  Symptom-Complex 

F.  Robertson  Sims.    The  Journal  of  Nervous  and  Mental  Diseases. 

The  author's  first  case  was  one  of  acute  alcoholic  multiple  neuritis  in 
a  woman  of  forty-eight  years,  accompanied  by  delirium,  hallucinosis  and 
romancing.  Later  came  convulsions  with  twitchings  of  various  muscular 
groups  which  was  followed  by  spasticity  of  one  extremity  and  flaccidity 
of  the  extremities  of  the  opposite  side.  There  was  some  paralysis  of 
the  facial  muscles.  Death  occurred  after  five  weeks  and  was  preceded 
by  a  rapid  rise  in  pulse  and  temperature.  The  autopsy  showed  slight 
arteriosclerosis,  hypostatic  pneumonia,  fatty  infiltration  of  the  liver,  acute 
degeneration  of  many  of  the  peripheral  nerves,  axonal  reaction  in  cells  of 
the  anterior  horns,  Clark's  columns  and  many  cranial  nerve  nuclei.  Degen- 
erations in  the  posterior  column,  direct  cerebellar  tracts  and  the  root 
bundles  were  also  present.  There  was  a  moderate  "  acute  alteration  "  of 
the  cortical  cells. 

The  second  case  was  one  of  acute  alcoholic  confusion  following  chronic 
neuritis.  There  was  marked  amnesia  for  recent  events,  irritability, 
increased  emotional  reaction,  imperfect  orientation  and  mild  delirium. 
Later  he  developed  difficulty  in  speaking  and  swallowing.  He  died  from 
vagus  paralysis  and  failure  of  respiration. 

The  autopsy  showed  general  arteriosclerosis  involving  the  aorta  and 
coronaries.  There  was  an  acute  bronchitis,  fatty  degeneration  of  the 
heart,  liver  and  kidneys,  and  acute  degeneration  in  the  peripheral  nerves 
of  the  lower  extremities  and  also  in  the  vagi.  Axonal  reaction  occurred 
in  the  cells  of  the  anterior  column,  in  Clarke's  column,  many  cranial 
nuclei  and  the  Betz  cells  of  the  cortex. 

There  were  vascular  changes  in  the  cord  and  cortex  with  numerous 
microscopical  hemorrhages  throughout  the  cerebrum,  also  acute  degenera- 
tion of  the  cortical  radiations  and  of  both  motor  and  sensory  systems  of 
the  cord,  as  well  as  degenerations  of  the  cord  not  easily  reconcilable  with 
the  systemic  changes. 


A  Case  of  Myaesthenia  Gratis  with  Autopsy. 

Charles  W.  Burr.    The  Journal  of  Mental  and  Nervous  Disease,  March, 
1905,  page  172. 

The  author's  case  is  as  follows  :  A  robust  man,  thirty  years  old,  whose 
family  and  previous  personal  history  was  unimportant.  A  physician  was 
called,  November  14,  1900.  He  had  had  a  headache  for  two  months  and 
had  noticed  that  his  eyelids  began  to  droop,  especially  at  night,  and  that 
the  muscles  of  his  jaw,  shoulders  and  arms  were  becoming  weak.  He  also 
had  blurring  of  vision,  and  vertigo.  • 

The  examination:  The  gait  was  normal,  any  movement  of  arms  or 
hands  caused  great  tire.   Sensation  normal,  no  disturbance  of  the  reflexes. 


3«o 


CURRENT   MEDICAL  LITERATURE 


Diplopia  was  present,  speech  slow,  voice  weak,  talking  caused  great  tire. 
Swallowing  difficult.  He  grew  steadily  worse  and  the  legs  became  involved. 
Then  double  ptosis  when  at  rest.  There  was  no  ataxia.  Reflexes  were 
never  exaggerated.  There  was  no  wasting  of  muscles  in  the  face,  tongue 
or  extremities.  Faradic  response  was  slower  than  normal.  Had  complete 
control  of  bladder  and  rectum.  Swallowing  became  more  and  more  diffi- 
cult. Difficulty  in  breathing  began  four  days  before  death.  He  died 
November  27,  190c.  Eye  symptoms:  contraction  of  visual  fields  and 
partial  reversal  of  the  red  and  blue  fields. 

Autopsy:  The  thymus  gland  was  prominent.  It  weighed  twenty-two 
grains  and  contained  an  encapsulated  chronic  abscess.  The  microscopical 
examination  of  the  cranial  nerves  and  spinal  cord  was  negative.  The 
only  changes  found  in  the  brain  were  small  hemorrhagic  areas  in  the 
region  of  the  aqueduct  of  Sylvius.  These  were  recent,  without  other 
evidence  of  inflammatory  reaction.  The  muscles  showed  a  lymphoid  infil- 
tration. 


Acute  Dilatation  of  the  Heart.    (Zur  Frage  der  acuten  Herzdilatatioti.) 
Kress.    Neurologisches  Ccntralblatt,  Jahr.  24,  Nr.  19,  1905. 

Two  cases  were  observed  in  young  men  between  twenty  and  thirty  years 
of  age.  Both  were  well  nourished  and  temperate,  and  both  had  an 
hereditary  neurasthenic  taint. 

The  first  patient  was  a  student  of  fair  ability,  who  lacked  energy  and 
concentration.  He  was  taken  from  his  studies  after  paroxysmal  attacks 
of  praecordial  anguish,  partly  unpleasant  and  partly  painful,  for  which  he 
consulted  a  physician  who  diagnosed  dilatation  of  the  heart,  whereas, 
later,  another  physician,  who  saw  him  in  an  interval,  declared  the  heart 
to  be  unaffected.  Kress  placed  the  patient  under  observation  and  describes 
an  attack  as  follows :  spasmodic  crying  and  sobbing,  undefined  general 
feeling  of  anxiety,  stabbing  pains  in  praecordia,  restlessness,  pronounced 
mental  excitability  and  irritability;  pulse  120  to  130,  irregular;  and  lateral 
enlargement  of  area  of  heart  dullness,  of  about  three  centimetres  to  the 
left  and  two  and  a  half  to  the  right.  After  half  an  hour's  duration  the 
attack  subsided,  and  an  hour  later  the  area  of  cardiac  dullness  was 
reduced  to  its  normal  limit.  The  patient  recovered  under  treatment  for 
neurasthenia. 

The  second  patient  was  a  cattle  drover,  who  was  congenitally  neuras- 
thenic. His  attacks  lasted  from  several  hours  to  two  days,  and  consisted 
of  severe  general  unrest  and  irritability,  pains  in  the  praecordia,  vague 
apprehension,  and  disturbance  of  sleep  with  unpleasant  dreams  and  tor- 
menting ideas.  The  area  of  cardiac  dullness  extended  three  centimetres 
to  the  right  and  one  and  a  half  centimetres  to  the  left  of  the  normal  limit. 
On  the  evening  of  the  day  when  this  was  determined  a  second  examination 
revealed  normal  conditions.  Over  one  hundred  such  attacks  were 
observed. 

There  were  thus  two  patients,  degenerate  neurasthenics,  who  exhibited 
in  sharply  defined  attacks,  a  correlation  between  a  transitory  change  in 
the  heart  boundaries  and  a  paroxysmal  symptom-complex  of  nervous 


CURRENT  MEDICAL  LITERATURE 


38l 


origin.  Kress  believes  that  this  may  be  explained  as  an  emotional  state  in 
which  the  innervation  of  the  heart  participates,  and  that  it  is  analogous 
with  the  vaso-motor  disturbances  common  to  emotional  variations. 


Contributions  to  the  Pathogenesis  of  Chorea  and  Acute  Infectious  Pro- 
cesses in  the  Central  Nervous  System.  (Beitrage  zur  Pathogenese 
dcr  Chorea  und  der  akuten  infekiiosen  Prozesse  des  Zentralnerven- 
systems.) 

Cramer  and  Tobben.  Monatsschrifi  fiir  Psychiatrie  und  Neurologie, 
Band  XVIII,  Heft  6,  December,  1905. 

Two  cases  are  reported  by  the  authors,  in  the  course  of  which  there 
were  some  articular  pains  and  swellings,  and  the  choreic  movements  were 
quite  characteristic.  The  first  patient  recovered.  The  symptoms  of  the 
second  case  were  much  more  active,  and  the  case  terminated  fatally,  ten 
days  after  admission  to  the  hospital.  The  author  obtained  cultures  from 
the  blood  during  life.  In  the  first  staphylococci  were  isolated  without 
difficulty.  In  the  second  case  the  first  attempt  resulted  negatively.  A 
few  days  later  other  cultures  were  taken,  which  revealed  after  a  long 
period  of  incubation  a  film  which  did  not  liquefy  gelatin,  made  a  ribbon- 
like strip  upon  agar  agar,  upon  blood  serum  left  a  similar  soft  film,  and 
upon  gelatin  plate  left  small  transparent  colonies  with  a  fine  nucleus  and 
a  slightly  swollen  border.  Preparations  made  from  these  cultures  showed 
cocci  reacting  to  Gram,  and  assuming  the  form  of  chains  which  consisted 
of  from  six  to  ten  points,  and  were  raised  either  in  a  confused  mass  or 
into  neatly  arranged  bundles. 

At  the  autopsy  in  the  second  patient  certain  definite  characteristic 
changes  were  found,  such  as  distension  of  the  blood  vessels,  perivascular 
hemorrhages  and  increased  proliferation  of  the  interstitial  nuclei.  Strep- 
tococci were  cultivated  from  the  blood,  small  sections  of  the  brain,  cerebro- 
spinal and  peritoneal  fluids  and  from  the  diseased  cardiac  valve.  These 
cultures  were  injected  subcutaneously  in  guinea  pigs,  which  died  after 
fourteen  days  of  slight  fever  and  perceptible  emaciation.  One  guinea 
pig  revealed  post  mortem  embolic  abscesses  in  the  left  kidney,  necrosis 
of  the  cardiac  muscle,  and  in  another  there  was  found  a  fresh  erosion  of 
the  aortic  arch.  In  the  other  animals  the  post  mortem  results  were 
negative. 

The  authors  recall  the  literature  upon  this  subject,  but  find  that  all 
previous  investigations  into  the  infectious  character  of  chorea  have  been 
dependent  upon  post  mortem  findings  only.  It  has  been  ascertained  that 
chorea  is  associated  not  only  with  articular  rheumatism,  but  also  with 
ether  infectious  diseases,  as  measles,  scarlet  fever,  diphtheria,  influenza, 
angina  and  the  puerperal  period.  It  is  also  believed  that  polyarthritis  is 
not  due  to  the  specific  poison,  but  is  only  a  part  of  pyemia  which  may  be 
due  to  different  microbes.  It  is  consequently  to  be  assumed  that  a  specific 
organism  as  the  cause  of  chorea  is  not  to  be  sought,  but  that  there  may  be 
different  organisms  which  find  their  way  into  the  body  through  different 
channels. 


382 


CURRENT  MEDICAL  LITERATURE 


The  authors  further  draw  attention  to  the  prominence  of  mental  symp- 
toms in  chorea,  and  believe  that  there  is  an  analogy  between  acute 
delirium  and  Landry's  paralysis,  polioencephalitis,  acute  delirium  and 
chorea.  The  susceptibility  of  the  motor  structures  to  these  infectious 
processes  has  already  been  pointed  out  by  several  authors. 


A  Case  of  Motor  Aphasia  without  Agraphia. 
Byron  Bramwell.    The  Lancet,  October  7,  1905. 

The  great  point  of  interest  in  the  following  case  is  the  fact  that  there 
was  complete  motor  aphasia  without  agraphia ;  any  defect  in  writing 
which  was  present  in  the  early  stages  of  the  case  was  clearly  a  defect  of 
manipulation,  a  defect  properly  so  called.  The  aphasia  was  purely  motor. 
For  a  fortnight  after  the  occurrence  of  the  lesion  the  patient  did  not 
utter  a  spoken  word,  although  she  tried  to  do  so.  It  was  only  after  she 
was  taught  to  repeat  vocal  sounds,  that  she  began  to  speak 
at  all,  and  it  was  not  for  some  days  after  that  she  was  able  to  repeat 
the  most  elementary  speech  sounds.  On  February  3d,  when  she  could 
only  repeat  some  of  the  letters  of  the  alphabet,  she  wrote  a  well- 
written  letter.  Bramwell  states  that  he  knows  of  no  case  in  which  such 
complete  motor  vocal  aphasia  was  associated  with  such  perfect  writing 
ability.  Some  authorities  believe  that  the  nervous  impulses  concerned  in 
the  production  of  written  speech  pass  through  the  motor  vocal  speech 
center  (Broca's)  in  order  to  reach  the  graphic  or  writing  center.  Bramwell 
on  the  contrary  has  urged  for  the  past  few  years  against  this  view  and 
has  taught  that  under  normal  conditions  the  nervous  impulses  for  written 
speech  pass  from  the  visual  speech  center  to  the  graphic  speech  center 
directly  and  not  through  Broca's  center.  If  in  this  case  the  motor  aphasia 
was  due  to  a  lesion  of  the  motor  speech  center,  this  view  would  of  course 
be  absolutely  proved.  But  without  an  autopsy  it  is  impossible  to  state 
whether  the  aphasia  was  cortical  or  sub-cortical. 

The  patient,  a  married  weman  aged  twenty-seven  years,  was  suddenly 
seized  with  head  symptoms  during  an  attack  of  influenza.  She  suddenly 
felt  giddy,  her  hands  numb,  and  fell  backward  striking  the  back  of  her  head. 
On  rising  from  the  flooi  she  fell  torward  and  bruised  her  forehead  she  then 
managed  to  crawl  into  bed.  Her  husband  returning  from  work  found 
her  in  what  he  thought  to  be  an  unconscious  condition,  unable  to  speak 
and  with  rigidity  of  the  limbs.  The  right  arm  was  paralyzed.  Bramwell's 
examination  disclosed  a  right  sided  facial  paralysis  The  hearing  was  good 
and  she  seemed  to  understand  what  was  said  to  her.  She  could  recognize 
time  and  could  write  the  first  two  letters  of  her  name.  On  admission  to 
the  hospital  four  days  afterwards  it  was  found  that  all  movements  in 
the  extremities  were  performed  in  a  normal  manner.  There  was  no  optic 
paralysis.  The  optic  discs  were  normal.  The  patellar  reflexes  were  lively 
and  there  was  slight  ankle  clonus  on  the  right  side.  The  plantar  reflexes 
showed  an  extensor  response  on  the  right  side.  There  was  some  anaes- 
thesia and  analgesia  on  the  right  side  of  the  face.    Vision  was  normal. 


CURRENT   MEDICAL  LITERATURE 


383 


There  was  no  hemianopsia.  Hearing  was  impaired  in  the  right  ear.  Taste 
was  impaired  on  the  right  side  of  the  tongue.  Smell  was  abolished  in 
the  right  nostril. 

Speech  function:  She  was  right  handed.  She  understood  everything  that 
was  said  to  her.  She  was  totally  unable  to  speak.  She  could  read  quite 
well  and  there  was  no  hemianopsia.  She  had  difficulty  in  holding  the 
pen,  but  could  write  quite  well  apart  from  this  manipulatory  defect.  She 
wrote  her  name  and  a  short  sentence  from  dictation.  She  correctly 
indicated  on  her  ringer  the  number  of  syllables  in  the  following  words, 
"  papa,"  "  mamma,"  "  Constantinople."  She  was  quick  at  understanding 
signs.  Her  intellectual  faculties  appeared  normal.  The  sole  defect  was 
a  complete  motor  aphasia  without  agraphia.  She  was  unable  to  repeat 
vocal  speech ;  but  when  the  words  "  papa "  and  "  mamma "  were  slowly 
articulated  and  her  attention  was  directed  to  the  lips  of  the  speaker  she 
managed  to  copy  the  movement  and  to  whisper  the  words  in  an  imperfect 
way.  During  the  presence  of  this  complete  motor  aphasia  the  patient 
wrote  to  Dr.  Bramwell  several  well  formed  and  constructed  letters.  She 
ultimately  made  an  almost  complete  recovery.  When  discharged  she 
could  repeat  all  the  letters  of  the  alphabet  and  numbers  and  was  able  to 
name  all  common  objects  shown  her.  There  was  still  slight  paralysis  of 
the  right  side  of  the  face. 


PAEDIATRICS 

Edited  by  Henry  L.  K.  Shaw,  M.  D. 

Later  Results  with  the  Moser  Polyvalent  Scarlet  Fever  Serum.  (Meine 
neuren  Erfahrungen  uber  das  Moser'sche  polyvalente  Scharlach- 
Serum.) 

Bokay.  "  Jahrbuch  fiir  Kinderheilkunde,  September,  1905. 

Two  years  ago  the  author  published  the  results  he  obtained  by  the  use 
of  the  Moser  serum  in  ten  severe  cases  of  scarlet  fever.  At  that  time  he 
expressed  himself  as  convinced  that  this  serum  had  a  decided  beneficial 
effect  in  severe  cases  which  was  not  apparent  after  the  use  of  other  anti- 
streptococcic sera  he  had  used  as  control.  In  the  present  article  he 
critically  reviews  the  literature  on  this  subject.  Kolly  and  some  col- 
leagues in  Moscow  have  succeeded  in  producing  some  polyvalent  serum 
and  have  reported  very  satisfactory  results  in  thirty-nine  severe  cases. 
Mendelsohn,  an  assistant  of  Baginsky,  has  recently  written  an  article 
strongly  advocating  the  use  of  this  serum  as  a  result  of  his  clinical  ex- 
perience with  four  cases.  Heubner  and  Ganghofer  on  the  other  hand  are 
sceptical  over  the  benefits  claimed  to  have  been  attained  by  the  use  of  the 
Moser  serum. 

Bokay  gives  the  full  clinical  history  and  temperature  charts  from  seven 
severe  cases  in  which  the  serum  was  employed.  These  were  chosen  for 
injection  on  account  of  the  severity  of  the  disease,  especially  on  the  part 
of  the  nervous  system.    All  the  cases  made  a  complete  recovery. 

In  a  summary  of  these  cases  the  author  first  emphasizes  the  marked 


3«4 


CURRENT  MEDICAL  LITERATURE 


improvement  in  the  general  condition  observed  in  twentyTfour  hours  after 
the  injection.  The  eruption  faded  more  quickly  than  in  the  uninjected 
cases.  The  average  fall  of  temperature  within  twenty-four  hours  after 
the  injection  was  two  and  one-tenth  degrees  centigrade.  There  was  a 
corresponding  lowering  of  the  pulse  rate  and  improvement  in  the  pulse 
wave.  The  tonsillar  involvement  was  not  so  great  and  soon  disappeared. 
In  two  eases  there  was  a  transient  albuminura,  but  no  severe  kidney 
involvement  in  any  case.  A  secondary  serum  rash  appeared  in  all  the 
cases,  but  it  was  not  severe. 

The  author  concludes  that  his  latter  results  make  him  even  more 
enthusiastic  over  the  specific  antitoxic  action  of  this  serum  and  cor- 
roborates the  claims  of  Moser  and  Escherich  as  to  the  distinct  value  of 
the  polyvalent  serum  in  severe  cases  of  scarlet  fever. 


Serumthcrapy  in  Scarlet  Fever.    (Ziir  Serumtherapie  des  Scharlachs.) 
Zuppinger.    Wiener  klinische  Wochenschrift,  No.  44,  1905. 

The  author  has  treated  the  most  severe  cases  of  scarlet  fever  in  the 
Rudolf  Children's  Hospital  in  Vienna  with  the  Moser  serum.  Twenty- 
eight  cases  in  all  were  so  treated,  and  of  these  five  terminated  fatally. 
No  beneficial  effect  was  noted  after  the  use  of  Marmorek's  serum  in 
several  control  cases.  The  earlier  the  administration  of  the  serum  the 
better  is  the  prognosis.  Of  five  cases  injected  the  first  day  of  the  disease 
all  recovered;  on  the  second  day  seven  were  injected  and  all  recovered; 
on  the  third  day  eight  were  injected  and  one  died;  on  the  fourth  day 
three  were  injected  and  one  died;  on  the  fifth  day  one  was  injected  and 
recovered;  on  the  sixth  day  four  were  injected  and  three  died.  From 
the  rapid  disappearance  of  the  severe  toxic  symptoms  the  author  agrees 
with  Escherich  and  Moser  that  the  serum  contains  a  specific  antitoxin. 

The  following  case  illustrates  the  effect  of  the  serum.  On  June  22, 
1905,  a  five-year-old  girl  was  admitted  with  a  very  severe  attack  of 
scarlet  fever.  The  face  and  lips  were  cyanotic  and  the  eruption  a  dark 
red  color.  There  was  a  severe  conjunctivitis.  Temperature,  41 0  C,  feeble 
pulse,  rapid  and  irregular  respiration.  The  liver,  spleen,  and  inguinal 
glands  were  enlarged.  The  child  was  unconscious  and  very  restless. 
There  were  involuntary  twitchings,  vomiting,  and  frequent,  offensive 
stools.  This  was  the  second  day  of  the  disease  and  the  child  was  given 
300  cubic  centimeters  of  the  Moser  serum.  Within  twenty-four  hours  the 
temperature  had  fallen  3.40  C.  without  collapse  and  the  child  was  con- 
scious and  sitting  up  in  bed  playing.  This  child  made  a  complete  re- 
covery, but  for  two  weeks  the  pulse  was  weak  and  irregular.  Without 
the  serum  the  author  believes  it  would  have  been  impossible  to  save  this 
child.  The  same  improvement  was  noted  in  the  other  cases.  A  secondary 
serum  examthem  occurred  in  fifty-three  per  cent,  of  the  cases,  but  it  was 
not  intense. 

The  author  believes  that  the  Moser  serum  given  in  large  doses  early 
is  the  most  potent  specific  against  scarlet  fever  and  that  it  alone  can 
save  life  in  the  most  severe  cases.    He  pleads  for  its  wider  use. 


Vol.  xxvii 


JUNE,  1906 


No  6. 


ALBANY 

MEDICAL  ANNALS 


©rtafnal  Communications 

THE  ADAMS-STOKES  DISEASE 

WITH  THE  REPORT  OF  THREE  CASES 

An  Address  delivered  at  the  Centennial  Anniversary  of  the  Washington 
County  Medical  Society,  held  at  Sandy  Hill,  N.  Y.,  Tuesday,  October 
3rd,  1905. 

By  HERMON  C.  GORDINIER,  M.  D., 

Troy,  N.  Y. 

The  Adams-Stokes  disease,  also  called  by  Gibson  recurrent 
bradycardia,  is  a  symptom-complex  usually  associated  with 
arterio-sclerosis  and  myocardial  changes,  characterized  by  true 
or  false  bradycardia  of  a  permanent  or  temporary  character, 
and  allorrhythmia.  Vertigo  and  syncopal  attacks  with  or 
without  epileptiform  convulsions  or  pseudo-apoplectiform  sei- 
zures, unaccompanied  by  paralysis,  together  with  dyspnoea, 
Cheyne-Stokes  breathing  and  vaso-motor  instability,  are  among 
the  more  common  nervous  manifestations  of  the  disease. 

This  remarkable  condition  was  first  described  by  Robert 
Adams  of  Dublin,  in  1827.  His  patient  was  a  man  aged  sixty- 
eight  years,  who  had  in  seven  years  at  least,  twenty  apoplectic 
attacks,  each  of  which  was  preceded  for  a  few  days  by  hebetude 
and  loss  of  memory.  The  pulse  was  permanently  slow,  and  at 
the  time  of  the  attacks  became  slower.  No  paralysis  ever 
occurred.  Death  followed  an  attack.  At  the  post  mortem, 
the  heart  was  found  to  be  fatty.*  Stokes,  in  1846,  described 
this  condition  more  fully,  and  laid  particular  stress  on  the 

*  According  to  Professor  Osier,  Joseph  Erlanger,  of  the  Johns  Hopkins  Physiological 
Laboratory,  divides  heart  block  into  partial  and  complete : 

A.  Partial:  (i)  Occassional  ventricular  silence;  (2)  regularly  recurring  ventricular 
silence,  either  one  ventricular  beat  missed  in  7,  6,  5,  4,  etc.,  auricular  beats,  or  a  2,  1,  3,  1 
4,  1,  rhythm,  or  either  of  these  alternating. 

B.  Complete  heart  block.    Auricular  and  ventricular  rhythms  perfect  but  independent. 

C.  Paroxysmal  bradycardia  {Stokes-Adams  disease),  affecting  ventricular  rate  alone. 


386 


ADAMS-STOKES  DISEASE 


syncopal  attacks,  their  repetition,  the  absence  of  paralysis  and 
the  good  effect  of  a  stimulating  rather  than  a  depleting  plan 
of  treatment.  Stokes  suggested  for  these  attacks  the  name  of 
false  or  pseudo-apoplexy.  His  first  case  is  very  interesting. 
It  was  a  man  aged  sixty  years;  he  was  suddenly  seized  with  a 
fainting  fit  which  recurred  several  times  each  day.  For  three 
years  before  his  admission  to  the  hospital  he  had  had  about 
fifty  seizures.  A  fit  of  indigestion  or  any  sudden  exertion 
would  suffice  to  bring  on  an  attack.  He  never  had  convul- 
sions or  paralysis.  He  was  absolutely  unconscious  during  the 
attack  for  from  four  to  five  minutes,  his  pulse  was  twenty- 
eight  per  minute,  and  the  arteries  were  in  a  condition  of  per- 
manent distention;  the  temporal  arteries  ramifying  under  the 
scalp  just  as  they  are  seen  in  well-injected  subjects.  The 
threatenings  of  the  attacks  he  could  recognize,  and  would 
often  ward  off  an  attack  by  turning  on  his  hands  and  knees 
and  keeping  the  head  low. 

Huchard,  in  1893,  directed  the  profession's  attention  anew 
to  this  interesting  group  of  symptoms  and  called  this  condition 
"The  Stokes- Adams  Syndrome,"  in  honor  of  the  two  distin- 
guished Dublin  physicians  who  first  reported  cases  of  it.  Ac- 
cording to  Huchard  this  symptom  group  occurs  almost  exclu- 
sively in  individuals  of  an  advanced  age,  and  is  due  to  an  arterio- 
sclerosis of  the  cardio-bulbar  type. 

Etiology.  It  is  much  disputed  whether  the  bradycardia 
associated  with  the  Adams-Stokes  syndrome  is  due  to  a  veri- 
table heart  block,  the  result  of  myocardial  changes  in  the 
auriculo-ventricular  bundle  of  His,  or,  as  suggested  by  Huchard, 
to  a  bulbar  arterio-sclerosis,  with  changes  in  the  vagi  centers 
and  a  consequent  vagus  inhibition.  The  positive  centrifugal 
pulsations  of  the  jugular  veins  exceeding  in  frequency  the  apex 
beat  observed  by  His,  in  his  remarkable  case  of  this  disease, 
supports  the  theory  of  heart  block,  as  the  centrifugal  pulsations 
of  the  jugulars  appear  to  him  to  be  due  to  an  allorrhythmia 
or  auriculo-ventricular  asynchronism.  His  patient  had  a  pulse 
ranging  between  eighteen  and  thirty-two,  exactly  synchronous 
with  the  apex  beat,  the  jugular  pulse  rate  ranging  between 
96  to  104  and  being  isochronous  with  a  low,  humming 
murmur  heard  to  the  right  and  left  of  the  sternum  in  the  second 
and  third  intercostal  spaces.  One  of  Stokes'  cases  presented 
the  same  phenomenon  though  less  marked. 


HERMOX  C.  GORDIXIER 


387 


The  fainting  attacks  together  with  the  epileptiform  and 
apoplectiform  seizures  are  doubtless  induced  by  sudden  tran- 
sient changes  in  the  cerebral  circulation,  doubtless  anaemic 
in  character  and  due  to  a  temporary  or  periodic  slowing  of  the 
blood  current  and  consequent  diminished  circulation.  The 
attacks  are  usually  preceded  for  a  brief  period  of  time  (a  few 
seconds)  by  complete  cessation  of  the  pulse  and  heart  beats. 
On  the  heart  resuming  its  beat,  the  face  flushes  and  conscious- 
ness returns  with  a  wild  stare,  a  distinct  grunt,  foaming  at  the 
mouth,  and  considerable  convulsive  movements  of  the  muscles 
of  the  mouth  and  face.  Balfour  states  that  the  initial  seizures 
seems  to  be  essentially  syncopal  in  character  while  the  suc- 
ceeding phenomena  are  evidently  due  to  the  unusually  large 
blood  wave  with  which  the  tissues  are  suddenly  flushed  on 
what  may  be  termed  the  return  of  life. 

Grasset,  Ranzier  and  Savill  are  of  the  opinion  that  the  ver- 
tigo, epileptiform  and  syncopal  attacks  are  due  to  an  arterio- 
sclerosis of  the  medulla,  while  Jaquet,  on  the  other  hand,  be- 
lieves that  the  phenomena  of  Adams-Stokes  disease  depends 
upon  a  cramp-like  constriction  of  the  vessels  of  the  brain. 

Hoffman,  whose  patient  was  a  woman  of  twenty-three  years 
of  age,  without  clinical  signs  of  cardiac  or  other  organic  disease, 
but  with  a  severe  anaemia,  ascribes  the  symptoms  to  an  inter- 
ference with  the  ability  of  the  cardiac  muscle  fibres  to  respond 
to  the  stimuli  or  to  conduct  the  impulses  to  contraction  from 
the  auricle  to  the  ventricle.  In  other  words,  there  is  a  block 
in  the  fibres  which  carry  the  impulse  to  contraction  from  the 
auricles  to  the  ventricles.  A.  Belski,  from  a  careful  study  of 
the  phenomena  of  three  cases  of  this  disease,  and  from  a  study 
of  all  the  cases  in  the  literature,  comes  to  the  same  conclusion. 

To  Dr.  Gaskell  belongs  the  credit  (1881)  of  first  showing  (in 
the  tortoise)  that  the  automatic  rhythm  of  the  heart  originates 
in  the  muscular  tissue  itself  and  he  explains  the  fact  that  the 
contractions  originate  in  the  sinus  by  the  peculiar  structure  of 
the  cardiac  muscle  in  this  part  of  the  heart;  while  he  states 
that  the  sequence  of  the  contraction  of  the  ventricles  to  the 
auricles  is  not  due  to  separate  stimuli  of  nerve  fibres  from  the 
sinus  to  the  ventricle,  not,  in  short,  to  any  nervous  mechanism, 
but  to  the  fact  that  the  wave  of  contraction  passes  directly 
from  the  muscle  fibres  of  the  auricle  to  the  muscle  fibres  of  the 
ventricle,  through  the  muscular  fibres  of  the  aauriclo-ventriculr 


388 


ADAMS-STOKES  DISEASE 


groove.  The  pause,  or  more  correctly,  the  alteration  of  rate 
in  the  progress  of  the  contraction  wave  which  takes  place 
between  the  contraction  of  the  auricle  and  ventricle,  is,  he 
says,  due  to  an  alteration  in  the  conducting  power,  which 
naturally  exists  at  the  auriculo-ventricular  ring  (natural  heart 
block).  He  has  also  found  that  by  stimulating  the  aortic  bulb 
contractions  occurred  which  ran  from  ventricle  to  auricle;  that 
is  in  reverse  direction  to  normal.  This  seems  strongly  sugges- 
tive that  the  impulse  originates  in  the  muscle  fibres  independent  - 
dently  of  any  nervous  mechanism. 

Dr.  Erlanger,  of  the  Johns  Hopkins  school,  has  succeeded  for 
the  first  time  in  this  country,  in  producing  a  veritable  heart 
block  in  mammals.  His  experimental  work  started  with  the 
study  of  a  case  of  Adams-Stokes  disease  in  the  Johns  Hopkins 
Hospital.  It  was  found  by  careful  pulse  tracings  that  the 
auricle  and  ventricle  in  this  patient  beat  with  different  rhythms. 
The  administration  of  atropine  had  the  usual  effect  on  the  au- 
ricular beat,  but  the  ventricular  beat  did  not  change.  The 
accelerators  were,  however,  shown  to  influence  both  auricle  and 
ventricle.  He  accomplished  heart  block  in  dogs  by  inserting  a 
specially  devised  needle  hook-clamp  between  the  auricle  and 
ventricle  and  compressing  with  it.  the  auriclo-ventricular  bundle 
of  His.* 

The  study  of  the  case  and  further  experimental  work  on  dogs 
showed  conclusively  that  every  case  of  Adams-Stokes  disease 
(the  rhythm  in  the  neck  vessels  differing  from  the  rhythm  at 
the  heart,  being  one  of  the  features  described  by  Stokes)  was 
in  reality  an  instance  of  heart  block.  And  a  study  of  all  the 
cases  in  literature  which  have  been  well  observed  and  by  ade- 
quate methods  confirms  this  idea.  All  the  symptoms  Erlanger 
states  can  be  explained  by  a  lesion  of  the  auriculo-ventricular 
bundle  of  His,  and  there  seems  to  be  neither  need  nor  warrant 
for  calling  in  the  cardiac  nerve  centers  to  explain  the  condition.! 

♦William  His,  Jr.,  first  described  this  bundle  in  the  mammalian  heart  in  the  form  of  a 
slight  fasciculus  of  muscle  fibres  extending  from  the  right  side  of  the  interauricular  septum 
to  the  interventricular  septum.  It  is  about  eighteen  millimeters  long,  two  and  five- 
tenths  millimeters  broad,  one  and  five-tenths  millimeters  thick.  His  found  that  division 
of  this  bundle  in  the  septum,  in  rabbits,  caused  a  complete  heart  block.  Krehl  and  Rom- 
berg have  destroyed  all  connection  between  the  auricles  and  ventricles  save  that  by  the 
auriculo-ventricular  bundle  and  as  a  result  of  these  experiments  they  conclude  that  the 
impulse  which  normally  causes  the  ventricles  to  contract  passes  through  the  auriculo-ven- 
tricular bundle  of  His. 

tDr.  Erlanger  has  collected  thirteen  cases  of  Stokes-Adams  disease  from  the  literature 
in  all  of  which  the  condition  of  heart  block  was  verified  by  careful  tracings. 


HERMON  C.  GORDINIER 


389 


Considerable  evidence  verified  by  careful  postmortem  findings 
exists  to  show  that  the  bradycardia  associated  with  this  disease 
may  be  due  to  vagus  inhibition  the  result  of  disease  of  the  vagi 
center  or  to  changes  in  the  vagi  nerves  of  a  parenchymous 
nature.  Luce,  in  1902,  found  at  the  autopsy  of  his  case  in  ad- 
dition to  a  primary  sarcoma  of  the  heart,  acute  parenchymatous 
neuritis  of  the  vagi  nerves,  with  in  many  places  total  destruc- 
tion of  the  axones.  In  this  connection  I  have  introduced  an 
abstract  of  the  very  interesting  case  of  Holberton,  copied  from 
Balfour's  work  on  the  senile  heart,  1898.  His  case  was  doubt- 
less one  of  Adams-Stokes  disease  occasioned  by  traumatism  to 
the  cervical  spine  with  consequent  changes  in  the  medulla. 
Retardation  of  the  pulse  occurred  two  years  after  the  injury. 
His  patient's  age  was  sixty-four  years.  He  was  thrown  on 
his  head  while  hunting,  in  1834.  At  first  he  was  stiff  and  sore 
with  great  pain  in  the  neck,  about  the  cuneiform  process  and 
the  condyles  of  os  occipitis.  The  pain  continued  about  six 
weeks.  At  the  end  of  a  year  he  was  well,  but  had  difficulty 
in  moving  his  head.  In  1837  he  had  a  fainting  fit,  with  a  pulse 
of  but  twenty  per  minute.  His  usual  pulse  was  thirty,  but 
often  after  a  fit  it  fell  to  twenty,  fifteen  or  eight  per  minute. 
His  syncopal  attacks  always  ended  in  epileptiform  seizures. 
His  last  fatal  attack  occurred  in  April,  1840.  After  his  death 
his  heart  was  found  to  be  enlarged,  the  walls  of  the  left  ven- 
tricle were  rather  thin,  the  valves  healthy  and  the  auriculo- 
ventricular  openings  dilated.  The  coronary  arteries  were  not 
sclerosed.  The  inflammatory  action  which  had  followed  the 
injury  to  the  first  and  second  vertebra,  had  narrowed  the  fora- 
men magnum  and  the  upper  part  of  the  spinal  canal,  com- 
pressing and  increasing  the  density  of  the  medulla  oblongata 
and  upper  part  of  the  cord. 

Surgeons  have  long  recognized  that  dislocation  or  fracture  of 
the  cervical  vertebrae  is  often  accompanied  by  a  very  slow 
pulse.  Gault  found  the  pulse  reduced  as  low  as  twenty  per 
minute  in  a  case  of  injury  to  the  seventh  cervical  vertebra. 
Charcot  states  that  retardation  of  the  pulse  is  one  of  the  most 
interesting  and  least  noticed  facts  of  the  symptomatology  of 
cervical  spinal  lesions.  Jonathan  Hutchinson  states  that  unless 
the  injury  to  the  spine  is  in  the  cervical  region,  no  influence 
on  the  heart's  action  is  observed.  The  probable  explanation 
lies  in  the  relation  of  the  spinal  accessory  nerves  to  this  region. 


39Q 


ADAMS-STOKES  DISEASE 


They  take  their  origin  from  a  group  of  cells  at  the  base  of  the 
ventral  and  lateral  horns  of  the  cervical  cord  and  passing  brain- 
ward  through  the  foramen  magnum,  then  course  peripherally 
through  the  foramen  lacerium  posterior,  the  bulbar  portion  of 
this  nerve  joins  the  vagus  and  contains  the  inhibitory  fibres 
which  pass  on  with  that  nerve  to  the  heart.*  Tripier  held 
that  the  disease  was  a  genuine  epilepsy,  a  view  to  which  few 
at  the  present  time  would  subscribe.  Syphilis  has  been  ascribed 
as  an  etiological  factor  in  a  few  cases.  The  case  recently  ex- 
perimented upon  by  Erlanger  became  quite  well  on  antisyphi- 
litic  treatment  which  was  suggested  by  Professor  Osier.  Dr. 
Erlanger  suggests  that  owing  to  the  close  relation  which  the 
mesial  leaflet  of  the  tricuspid  valve  bears  to  the  auriculo-ven- 
tricular  bundle  of  His,  that  disease  of  this  leaflet  may  inter- 
pose a  block  to  the  passage  of  normal  impulses  from  auricle  to 
ventricle.  He  advises  that  the  condition  of  this  leaflet  should 
be  carefully  determined  in  all  cases  of  Adams-Stokes  disease 
that  come  to  autopsy. 

Pathology.  The  morbid  anatomy  of  this  interesting  syn- 
drome remains  to  be  written.  Few  careful  autopsies  have 
been  made  and  in  only  one  or  two  instances  has  a  searching 
microscopic  study  been  made,  particularly  of  the  heart  and 
nervous  system.  Stokes  believed  that  the  symptoms  were 
referable  to  fatty  changes  in  the  heart  muscle.  At  the  present 
time,  Quain  still  associates  the  bradycardia  with  fatty  heart, 
though  he  says  a  rapid  pulse  is  also  indicative  of  the  same 
pathological  changes.  In  some  instances  no  change  in  the  myo- 
cardium has  been  observed,  while  in  others  chronic  fibroid 
myocarditis  has  been  found  associated  or  not  with  hypertrophic 
dilation  of  the  heart  chambers,  particularly  the  ventricles.  In 
Dr.  Edes  series,  twenty-six  cases  presented  sclerotic  and  myo- 
cardial changes.  The  coronary  arteries  are  often  sclerosed  or 
the  seat  of  calcareous  deposit.  There  is  usually  well  marked 
arterio-sclerosis ;  valvular  defects  are  not  common  though  rela- 
tive insufficiency  of  the  auriculo-ventricular  orifices  often  occurs 
from  dilatation  due  to  myocardial  changes.  In  a  case  of  Sendler, 
1902,  one  coronary  artery  was  incompletely  occluded  by  the 
pressure  of  a  primary  fibroma  of  the  heart.    In  the  case  of 

♦Edinger  observed  pronounced  slowing  of  the  pulse  on  defecation  due  to  the  existence 
of  a  varix  in  the  ventral  portion  of  the  accessorius  nucleus.  Subsequently,  as  the  varix 
grew  the  retardation  of  the  pulse  became  greater  until  the  heart  ceased  to  beat  altogether 
when  the  varix  ruptured.    Berliner  klinische  Wochenschrift,  i8q8. 


HERMON  C.  GORDINIER 


391 


Halbertons,  above  alluded  to,  it  is  said  that  parenchymatous 
changes  were  found  in  both  vagi,  and  superior  cervical  gangliae. 
Lepine's  case  showed  compression  of  the  pons  and  medulla. 
The  late  Dr.  Prentiss,  who  recorded  one  of  the  first  and  most 
remarkable  cases  in  this  country,  found  at  autopsy  the  heart 
enlarged,  but  no  changes  in  the  aorta  or  coronary  arteries. 
Sections  of  the  medulla  showed  congestion  of  the  vessels,  but 
no  other  changes.  There  was  extensive  general  arterio-sclerosis. 
His  patient  was  a  male  aged  fifty-three  years,  with  extensive 
arterio-sclerosis,  he  had  had  for  two  years  a  pulse  ranging 
from  eleven  to  forty.  During  this  time  he  was  subject  to  faint- 
ing spells.  Death  was  sudden,  preceded  for  several  days  by 
delirium.  In  the  case  of  Luce,  mention  of  which  was  made 
by  the  author  under  etiology,  a  primary  sarcoma  of  the  heart 
muscle  was  found  associated  with  changes  in  both  vagi  nerves. 
It  is  interesting  to  note  that  in  Jaquets'  case  a  most  careful 
post  mortem  examination  was  made,  but  no  lesion  was  found. 
It  will  be  interesting  in  this  connection  to  mention  that  in  a 
typical  case  of  Dr.  Edes,  a  most  careful  post  mortem  by  Dr. 
Councilman  disclosed  nothing  abnormal. 

Osier  divides  this  condition  into  three  distinct  types. 

(1.)  Post  febrile  type  following  especially  typhoid  fever, 
pneumonia,  diphtheria,  influenza  and  other  infectious  diseases. 
The  prognosis  of  this  type  seems  more  hopeful  although  he  states 
that  the  first  attack  may  prove  fatal. 

(2.)  The  most  common,  an  arterio-sclerotic  type,  with  marked 
vascular  and  myocardial  changes. 

(3.)  The  neurotic  type,  due  to  gross  changes  in  the  brain, 
bulb,  or  spinal  cord. 

It  is  very  probable  that  most  if  not  all  cases  presenting  the 
Adams-Stokes  Syndrome  are  due  to  a  definite  heart  block  the 
result  of  changes  of  a  sclerotic  nature  partially  or  completely 
destroying  the  auriculo-ventricular  bundle  of  His. 

In  confirmation  of  this  statement  three  cases  of  veritable 
heart  block  have  been  reported  very  recently ;  the  first  by  Dr.  A. 
Miiller,  in  which  sclerotic  changes  in  the  auricles  had  completely 
destroyed  this  bundle ;  the  second,  Stengel's,  a  typical  case  of 
Adams-Stokes  disease  with  autopsy,  in  which  a  lesion,  sclerotic 
patch,was  found  on  the  anterior  mitral  leaflet  which  had  extended 
to  the  endocardium  exactly  over  the  bundle  of  His,  where  this 
muscular  fasciculus  passes  from  the  ventricle  to  auricle,  and 


392 


ADAMS-STOKES  DISEASE 


the  third  (Schmoll's)  observation  upon  a  typical  case  of  heart 
block,  the  autopsy  showing  formation  in  and  around  of  His  just 
below  the  membranous  septum. 

Symptomatology.  The  symptoms  of  this  strange  and  interest- 
ing condition  while  very  definite  are  but  few. 

There  is  a  bradycardia  which  is  permanent  or  transient 
together  with  vertigo,  faint ness,  epileptiform  or  apoplectiform 
seizures  and  changes  in  respiration  of  the  Cheyne-Stokes  type. 
The  bradycardia  is  most  often  permanent,  although  it  may 
only  occur  for  a  short  time  including  the  seizures,  and  then 
rapidly  or  gradually  disappear.  The  pulse  rate  may  range 
from  fifty  to  twenty  or  less,  a  pulse  of  five  having  been  recorded. 
The  pulse  is  usually  full;  with  difficulty  compressed,  and  at 
times  intermittent.  The  tension  is  most  always  plus.  The 
arteries  are  generally  sclerosed,  the  temporals  being  prominent, 
and  arcus  senilis  is  quite  common.  The  bradycardia  while 
usually  true,  i.  e.,  accompanied  by  the  same  number  of  heart 
beats  as  the  pulse  rate  may  be  false,  i.  e.,  accompanied  by  a 
greater  number  of  heart  beats  than  the  pulse  rate.  This  false 
bradycardia  is  due,  as  is  well  known,  to  hemisy stole,  numbers 
of  the  ventricular  contractions  being  too  weak  to  be  recognized 
at  the  wrist.  Balfour  records  the  case  of  a  lady  with  false  brady- 
cardia, who  was  suddenly  seized  while  shoping  with  an  epilepti- 
form fit.  These  seizures  would  recur  on  the  slightest  exertion, 
and  when  Balfour  saw  her  she  was  unable  to  rise  from  the 
recumbent  position  without  bringing  on  an  attack.  Her  pulse 
was  slow,  only  20  per  minute,  while  her  heart  was  beating 
at  the  rate  of  60,  only  every  third  beat  was  strong  enough  to 
reach  the  periphery. 

The  heart  may  be  normal,  or  enlarged,  the  apex  being  dis- 
placed outward  and  downward.  The  heart  sounds  may  be 
normal,  feeble  or  accentuated,  especially  the  aortic  second 
sound,  or  they  may  be  partially  or  completely  replaced  by 
endocardial  murmurs.  A  soft  blowing  murmur  over  the  body 
of  the  heart  has  often  been  observed.  The  syncopal  attacks 
and  seizures  vary  very  much  in  regard  to  their  frequency. 
His  has  recorded  153  attacks  in  twenty-four  hours,  and  in  a 
very  interesting  case  recently  reported  by  Quinan  four  or  five 
attacks  were  recorded  hourly. 

In  other  cases  the  attacks  are  much  less  frequent,  occurring 
at  intervals  which  are  very  variable.    The  patient  usually  feels 


HERMON  C.  GORDIXIER 


393 


well  during  the  interval  between  the  seizures.  The  spells  may 
or  may  not  be  preceded  by  prodromata  such  as  mental  hebetude, 
vertigo,  vaso-motor  instability  such  as  sudden  palor  or  flushing 
of  the  face,  cold  extremities,  slight  cyanosis,  etc.  The  attack 
is  always  sudden.  It  may  only  be  syncopal  or  may  be  accom- 
panied by  epileptiform  or  apoplectiform  seizures.  One  can 
diagnose  the  approaching  attack  by  the  sudden  slowing  of  the 
pulse  below  that  in  the  interval.  During  the  actual  attack 
according  to  most  observers  it  is  absent  from  the  wrist,  and  the 
heart  sounds  may  not  be  audible  on  auscultation. 

There  is,  in  other  words,  a  complete  cessation  of  the  heart 
beats  and  pulse,  as  Professor  Osier  well  expresses  it,  a  complete 
count  out.  He  says  to  wait  thirty-five  seconds  with  watch  in 
hand  without  a  heart  beat  seems  like  the  final  count  out.  In 
Quinan's  case  the  pulse  waves  became  less  frequent,  dropping 
from  forty  to  twenty -six  or  less,  with  slight  arrythmia,  then 
faded  out  entirely,  and  the  heart  ceased  to  beat.  The  absolute 
heart  rest  in  this  case  occurred  some  time  before  the  convulsive 
phase. 

A  phenomenon  connected  with  this  syndrome  of  much  interest, 
first  observed  and  described  by  Stokes,  though  elaborated  and 
brought  definitely  to  our  attention  through  the  clinical  studies 
of  His,  is  a  positive  centrifugal  pulsation  of  the  juglar  vein 
exceeding  in  frequency  the  apex  beat.  This  indicates  that  the 
beats  of  the  auricles  and  ventricles  are  of  different  rythms,  a 
distinct  heart  block,  an  allorrythmia  or  auriculo-ventricular 
asynchronism. 

Case  i,  October  5,  1905.  Mrs.  C.  C,  aet.  forty-nine  years,  house- 
wife, consulted  me  in  reference  to  numerous  dizzy,  faint  and  convulsive 
attacks,  the  first  of  which  occurred  two  years  ago. 

Family  history.  Father  and  mother  both  dead  of  paralysis;  one 
sister  dead  of  typhoid  fever,  and  another  from  an  injury  to  the  spine. 

Personal  history.  Had  during  childhood,  scarlet  fever,  pertussis, 
measles,  acute  articular  rheumatism  and  pleuresy.  Menstruation  estab- 
lished at  fifteen  years  of  age.  Always  regular  and  has  presented  nothing 
unusual.  Had  five  living  children  and  two  miscarriages.  Lost  one 
child  at  fourteen  years  of  age  of  diabetes  mellitus.  Has  had  dyspnoea 
and  rapid  heart  action  for  many  years. 

Present  condition.  Two  years  ago  developed  suddenly  a  dizzy  spell 
which  lasted  fifteen  minutes.  Her  present  illness  began  in  June,  1905, 
with  pain  at  the  base  of  the  skull  which  extended  through  both  eyes, 
this  continued  several  days  and  then  suddenly  ceased  an  interval  of 
three  weeks  existing  before  the  pain  recurred,  and  then  there  occurred 


394 


AUAMS-STOKES  DISEASE 


occasional  convulsive  seizures  with  complete  loss  of  consciousness. 
During  these  attacks  there  was  a  wild  stare,  the  eyes  were  rotated  upward 
and  outward  and  fixed.  The  face  was  cyanotic  or  ashen.  The  loss  of 
consciousness  lasted  about  a  minute  or  more  and  on  its  return  she  seemed 
dazed,  was  very  pale  and  extremely  nervous.  She  has  had  thus  far  more 
than  a  dozen  convulsive  seizures,  together  with  a  great  many  dizzy 
and  faint  attacks.  Her  husband,  a  very  intelligent  man,  has  noted, 
during  these  attacks,  that  the  pulse  becomes  much  slower  and  then  is 
almost  lost  at  the  wrist. 

Physical  examination.  Slightly  built,  short  in  stature,  flabby  muscu- 
lature, no  oedema,  slight  cyanosis  of  the  lips;  face  and  mucous  mem- 
branes pale,  tongue  protruded  in  the  median  line.  All  cranial  nerves 
intact.  Optic  discs  normal,  motion  and  sensation  normal.  Reflexes 
intact,  memory  good.  Her  facial  expression  is  indicative  of  much 
suffering.  Lungs  exhibit  a  slight  degree  of  emphysema.  The  throat  is 
normal. 

Heart  and  arteries.  The  heart's  apex  is  in  the  sixth  interspace  two 
centimeters  outside  of  the  left  mammillary  line.  No  thrill.  A  slight 
presystolic  murmur  is  present,  preceded  by  a  distinct,  but  very  soft, 
diastolic  one,  both  having  their  points  of  maximum  intensity  to  the 
right  of  the  apex,  between  it  and  the  left  border  of  the  sternum  where 
they  are  strictly  localized.  At  the  aortic  interspace  a  rough  systolic 
murmur  was  heard,  well  conducted  into  the  carotids.  The  first  sound 
at  the  apex  ceases  with  a  sudden  slap.  The  pulmonic  second  sound  is 
accentuated.  The  aortic  second  sound  not  heard,  no  double  tone  in  the 
femorals.  Positive  centrifugal  pulsation  of  the  right  jugular  vein  was 
observed.  The  pulse  rate  wras  thirty-six  per  minute,  regular,  rather 
firm,  but  small.  The  vessel  wall  while  easily  palpated,  did  not  appear 
much  thickened.  The  arterial  tension  taken  with  Gaertner's  new  tono- 
meter, was  1 80  millimeters  of  mercury.  The  urine  was  acid.  S.  G.,  1016, 
contained  no  albumin,  sugar,  blood  or  casts.  Haemoglobin  seventy-five 
per  cent,  Tallquist.  No  blood  count  was  made.  A  diagnosis  of  a  double 
mitral  lesion  and  aortic  stenosis  was  made,  accompanied  with  the  Adams- 
Stokes  Syndrome.  The  treatment  consisted  of  nitroglycerin,  iodide  of 
of  potash  and  strychnine. 

October  13,  1905.  Patient  has  had  several  dizzy  spells  each  day  and 
more  than  twenty  yesterday.  On  October  1 1  she  had  a  general  con- 
vulsion with  loss  of  consciousness.  The  pulse  has  ranged  from  thirty- 
four  to  thirty-eight  per  minute,  it  is  quite  regular.  The  artery  seems 
firm  and  well  filled.  The  jugular  pulsations  were  100  per  minute.  The 
bradycardia  is  a  true  one.  October  30,  patient  seems  improved;  is  less 
nervous,  has  no  pain  in  head,  has  had  no  convulsions  but  many  dizzy 
spells.    Pulse  forty-four,  heart  beats  forty-four  times  per  minute. 

November  3,  1905.  Several  dizzy  spells,  no  convulsions.  Patient 
sitting  up,  appetite  good,  pulse  thirty-six,  regular.  Positive  centrifugal 
jugular  pulsations.    Tension  170  millimeter  mercury. 

November  20.  Pulse  forty-two,  regular  jugular  pulsations  eighty-two, 
cardiac  murmurs  less  distinct,  no  convulsions,  bradycardia  true. 

December  20.    Patient  much  improved,  only  a  few  dizzy  spells  each 


HERMON  C.  GORDIXIER 


395 


day,  able  to  sit  up  out  of  bed.  Pulse  forty-eight.  No  convulsions  since 
October  n,  1905. 

I  never  happened  to  see  this  patient  either  in  a  severe  faint 
attack  or  in  a  convulsive  seizure,  though  often  summoned, 
when  I  have  arrived  the  attacks  were  over. 

Case  2. — M.  A.  L.,  aged  72  years,  married.  Her  family  history  is 
not  important.  She  is  the  mother  of  six  children,  five  of  which  are 
living  and  well.  She  has  never  before  been  ill  and  has  enjoyed  a  very 
active  life.  Her  present  trouble  began  about  eight  years  ago  when 
she  noticed  dyspnoea  on  slight  exertion  and  she  was  easily  fatigued. 
In  February,  1897,  after  a  hearty  meal  she  had  a  fainting  attack  which 
passed  off  in  a  few  minutes.  A  physician  was  called  and  she  was  then 
told  that  her  pulse  was  40  per  minute.  In  May,  1903,  she  had  another 
fainting  attack  while  walking  over  a  railroad  track.  She  had  no  warn- 
ing but  fell  and  immediately  became  unconscious  for  several  minutes. 
A  physician  was  again  called  and  noted  the  slow  pulse.  These  attacks 
became  more  frequent  and  more  severe.  On  several  occasions  she  was 
cut  about  the  head  and  face. 

On  May  3,  1904,  she  had  an  attack  and  it  was  said  that  she  was  un- 
conscious for  one  and  one-half  hours. 

I  saw  her  for  the  first  time  May  6,  1904.  She  had  had  a  severe  seizure 
that  afternoon  and  was  then  suffering  from  an  attack  of  oedema  of  the 
lungs. 

On  examination,  the  following  conditions  were  found.  The  patient 
was  sitting  propped  up  in  bed.  Dyspnoea  was  well  marked  and  she 
was  quite  cyanotic.  The  apex  beat  was  in  the  fifth  intercostal  space 
about  one-half  inch  outside  of  the  nipple  line.  At  the  apex  a  systolic 
murmur  was  heard  which  was  conducted  toward  the  axilla.  The  second 
pulmonic  sound  was  accentuated.  There  was  also  a  systolic  murmur 
heard  over  the  aortic  interspace  and  conducted  to  the  vessels  of  the  neck. 
The  pulse  was  slow  and  sometimes  intermittent.  The  radial  and  tem- 
poral arteries  were  very  much  thickened.  Urine  negative.  Examina- 
tion of  the  lungs  showed  emphysema,  and  pulmonary  oedema  at  the 
bases  of  both  lungs.  She  was  very  nervous  and  demanded  constant 
attention. 

Her  condition  became  somewhat  better  but  at  times  she  would  feel 
dizzy  and  become  short  of  breath.  On  May  12,  she  had  a  severe  attack 
and  the  nurse  made  the  following  observations :  ''Patient  suddenly 
raised  her  hands  to  her  head  and  sank  deeper  in  bed.  The  respirations 
became  rapid  and  she  became  cyanotic.  The  radial  pulse  was  not 
perceptible  but  a  cardiac  impulse  was  felt  beating  102  times  per  minute. 
Hypodermics  of  nitroglycerin  were  given  and  the  pulse  became  percept- 
ible at  the  wrist  at  first  thirty-six  per  minute.  Unconsciousness  lasted 
about  10  minutes."  June  1,  although  she  had  had  several  slight  attacks, 
she  was  quite  comfortable  and  her  general  condition  seemed  much  better. 
On  the  morning  of  June  2,  she  suddenly  raised  her  hands  to  her  head, 
became  very  cyanotic,  respirations  became  very  rapid  and  ceased  five 
minutes  after  attack  began.    Autopsy  not  allowed. 


396 


ADAMS-STOKES  DISEASE 


Case  3. — I  am  indebted  to  Dr.  Gow  of  Schuylerville  for  the  oppor- 
tunity of  examining  the  following  typical  case  of  Adams-Stokes  disease: 

The  patient,  J.  E.  B.,  age  sixty-one  years,  farmer,  consulted  me  April 
11,  1904,  complaining  of  dizzy  attacks,  dyspnoea  on  exertion  and  con- 
vulsive seizures. 

Family  history. — Father  died  of  typhoid  fever;  Mother,  of  phthisis 
pulmonalis;  two  brothers  died  in  childhood,  cause  unknown.  One 
sister  dead  of  malarial  fever.    Personal  history,  unimportant. 

The  present  trouble  began  about  one  year  ago  with  dyspnoea  on  exer- 
tion and  in  January,  1905,  he  became  very  faint  and  would  have  fallen 
to  the  ground  save  that  he  was  caught  by  a  bystander.  Since  then  he 
has  had  three  attacks  in  all  of  which  he  has  fallen  to  the  ground  uncon- 
scious. In  one  of  the  attacks  the  unconsciousness  lasted  three  minutes. 
In  the  last  attack,  which  occurred  while  he  was  standing  in  front  of  a 
window  in  a  drug  store  at  Stillwater,  he  plunged  directly  through  the 
window  while  in  convulsion  and  was  badly  cut  about  the  face  and  scalp. 

Physical  examination.  Strongly  built,  large  frame,  dusky  face, 
venules  of  face  prominent,  tongue  protruded  in  the  median  line. 

Heart  and  arteries. — The  apex  is  in  the  nipple  line.  The  first  sound 
is  prolonged  and  booming.  The  aortic  second  sound  is  accentuated. 
At  soft,  systolic  murmur  exists  in  carotids.  The  cardiac  dulness  is 
almost  effaced  by  a  vesiculotympanitic  note.  The  pulse  is  28  per 
minute  and  quite  regular.  The  arterial  .wall  is  thickened;  the  radial 
and  temporal  arteries  are  tortuous  and  the  radials  are  almost  incompre- 
hensible. The  arterial  tension  is  plus  215  mm.  Hg,  mercury  Riva 
Rocei  instrument. 

Dr.  Gow  states  that  his  pulse  rate  varies  between  20  and  30  per  min- 
ute. He  has  never  observed  him  during  an  attack.  The  jugular  pulse 
rate  was  76  per  minute.  Cranial  nerves  were  intact.  The  sensorium 
was  free.  The  reflexes  were  intact  and  normal.  Station  was  good,  and 
the  gait  was  normal.  The  liver  dullness  was  almost  effaced  by  a  vesiculo- 
tympanitic note.  The  lungs  show  a  marked  degree  of  emphysema. 
The  urine  was  entirely  negative. 

It  was  perfectly  evident  that  this  patient  presented  the  symptom 
complex  so  characteristic  of  Adams- Stokes  disease  together  with  marked 
general  arterio-sclerosis.  He  was  accordingly  advised  to  take  potassium 
iodide  with  nitroglycerine  and  to  rest  for  several  weeks. 

Three  weeks  afterward  he  had  a  severe  convulsive  seisure  which  ter- 
minated fatally.    No  post  mortem  examination  could  be  obtained. 


REFERENCES. 


Adams,  R.  Dublin  Hospital  Reports,  1827,  Vol.  iv.,  p.  396. 

Balfour,  G.  W.        The  Senile  Heart,  London,  1894,  pp.  91-114. 

Babcock.  Diseases  of  the  Heart  and  Arterial  System,  p.  627. 

Belaski,  A.  Ein  Beitrag  zur  Kenntnis  der  Adams-Stokes'schen  Krankheit. 

Zeitschrift  fur  klinische  Medicin,  Band  57,  p.  529. 
Erlanger  I.  Journal  of  Experimental  Medicine,  Vol.  vii,  No.  6,  p.  676,  and^Vol. 

viii,  No.  1,  p.  8. 
Edinger.  Berliner  klinische  Wochenschrift,  1898. 


H ERA! ON  C.  GORDIXIER 


397 


Gibson,  Diseases  of  the  Heart  and  Aorta,  p.  808. 

Gaskell.  Journal  of  Physiology,  Vol.  iv.,  pp.  72-73. 

Huchard.  Traite  Clinique  des  Maladies  du  Coeur,  Paris,  1899.    p.  395. 

Hoffman  A.  Pathologie  und  Therapie  der  Herz  Neurosen  und  der  functionellen 

Kreislaufs  Storungen,  1901.    p.  271. 
His,  Jr.  Zeitschift  fur  Physiologie,  1895,  ix.,  469,  and  Deutsche  Archiv  fur 

klinische  Medicin,  1899,  lxiv.,  p.  316. 
Jacquet.  Ueber  die  Stokes-Adamschen  Krankheit.    Zeitschrift  fur  klinische 

Medicin,  1900,  Bd.  xii.,  p.  358. 
Muller,  A.  Zeitschrift  fur  klinische  Medicin,  1905,  B.  56,  p.  520. 

Osler,  W.  Slow  pulse  and  Syncopal  Attacks,  Lancet,  February  27,  1881. 

Osler,  W.  On  the  So-called  Stokes-Adams  Disease,  Lancet,  August  22,  1903 

p.  516. 

Osler.  Practice  of  Medicine,  Sixth  Edition,  p.  834. 

Prentis.  Quoted  by  Osier,  Angina  Pectoris  and  Allied  States,  p.  73. 

Stokes.  Observation  on  Some  Cases  of  Slow  Pulse,  Dublin  Quarterly  Journal, 

1846,  p.  73- 

Stengel,  A.  Fatal  Case  of  Stokes-Adams  Disease,  American  Journal  of  the  Medical 

Sciences,  December,  1905,  p.  1083. 
Schmoll,  E.  Journal  of  the  American  Medical  Association,  February  3,  1906,  p. 

361. 

Quinan,  C.  -  The  Adams-Stokes  Symptom-Complex  with  Report  of  a  Case, 

American  Journal  of  the  Medical  Sciences,  September,  1904,  p.  403  . 


AUTOPSY  OF  MR.  ADAMS'  CASE. 


The  most  remarkable  example  which  I  have  yet  seen  of  the  degeneration  of  the  heart 
into  fat,  is  preserved  in  the  Richmond  School  of  Anatomy.  It  is  the  heart  of  a  man  whose 
case  is  described  by  Mr.  Adams  in  the  Dublin  Hospital  reports.  He  was  68  years  of  age 
of  a  full  habit  of  body  and  subject  for  many  months  preceding  his  death  to  attacks  of  an 
apoplectic  nature;  before  each  of  which  he  was  heavy  and  lethargic  with  loss  of  memory, 
he  would  then  fall  down  in  a  state  of  complete  insensibility;  when  they  attacked  him  his 
pulse  which  generally  ranged  at  30  in  a  minute,  would  become  even  slower  than  usual,  his 
breathing  became  stertorous;  he  died  in  one  of  these  attacks. 

Upon  examination  of  the  body  the  condition  of  the  heart  particulaly  attracted  attention. 

The  right  auricle  was  much  dilated.  The  right  ventricle  presented  externally  no  appear- 
ance of  muscular  fibres,  it  seemed  composed  of  fat  of  a  deep  yellow  color  throughout  its 
whole  substance.  The  reticulated  lining  of  the  ventricle  which  here  and  there  allowed  the 
fat  to  appear  between  its  fibres,  alone  presented  any  appearance  of  the  muscular  structure. 
The  left  ventricle  was  very  thin  and  its  whole  surface  was  covered  with  a  layer  of  fat. 
Beneath  this  the  muscular  structure  was  not  a  line  in  thickness;  it  had  degenerated  from 
its  natural  state,  was  soft  and  easily  torn  and  a  section  of  it  exhibited  more  the  appearance 
of  a  liver  than  a  heart. 


398 


ALBANY  MEDICAL  COLLEGE  IX  WAR  TIME 


ALBANY  MEDICAL  COLLEGE  IN  WAR  TIME. 

Annual   Address   before   the  New  England  Alumni  Association  of  the 
Albany  Medical  College,  at  Hartford,  Conn.,  December  6,  IQ05. 

By  T.  D.  CROTHERS,  M.  D., 

Supt.  Walnut  Lodge  Hospital,  Hartford,  Conn. 

In  preparing  a  history  of  the  class  of  1865,  I  found  some 
old  documents  and  letters,  together  with  memorandum  of  con- 
versations with  Dr.  Devol  and  others,  which  at  this  time  may 
have  some  historic  interest.  I  speak  of  Dr.  Charles  Devol,  for 
the  reason  that  he  was  quite  a  remarkable  man  in  many  ways, 
and  was  well  known  by  nearly  all  the  students  of  these  times. 
He  was  a  Methodist  minister,  for  nearly  half  a  life  time,  then 
became  a  physician,  and  practiced  medicine  in  Albany  for  the 
remainder  of  his  life,  dying  somewhere  in  the  eighties.  Dr. 
Devol  was  a  frequent  visitor  at  the  college,  attending  lectures, 
and  a  great  admirer  of  Dr.  March.  He  was  invited  occasionally 
to  deliver  lectures  on  Homeopathy,  which  was  always  the  occa- 
sion of  the  most  boisterous  applause  and  hilarity.  He  had  the 
utmost  contempt  for  this  branch  of  practice,  and  described  his 
opinions  in  wild,  lurid  rhetoric,  and  startling  expletives,  so  that 
his  appearance  as  a  lecturer  was  an  Opera  Bouffe  of  the 
session. 

At  the  beginning  of  the  civil  war,  the  Albany  Medical  Col- 
lege was,  perhaps,  about  the  same  as  many  of  the  other  inland 
colleges,  except  that  in  surgery  it  was  recognized  as  particularly 
strong.  There  were  schools  at  Qeneva,  Castleton,  Pittsfield 
p.nd  other  places  farther  west,  and  they  were  all  practically  local 
colleges.  The  Albany  school  being  nearer  to  New  York,  and 
having  a  rather  noted  faculty,  was  considered  better.  In  New 
York,  Philadelphia  and  Boston,  the  classes  were  larger,  and  most 
of  the  teachers  had  received  training  abroad,  and  adopted  the 
foreign  customs  of  having  little  to  do  with  students  outside  the 
lecture  room,  paying  little  attention  to  their  progress,  only  re- 
quiring that  they  pass  the  stated  examinations.  The  only  pre- 
liminary for  admission  to  lectures  was  a  physician's  certificate, 
that  the  applicant  had  registered  in  his  office,  and  received  what- 
ever instruction  he  may  have  given  him. 

The  examinations  at  the  close  of  the  term  were  formal  and 
technical  in  the  large  schools,  ana1  the  student  with  a  good 


T.  D.  CROTHERS 


399 


memory  was  sure  to  pass,  while  the  much  stronger  man,  but 
of  less  available  memory,  was  turned  down.  At  the  close  of 
each  session,  quite  a  number  of  students  felt  the  injustice  of 
failure,  comparing  themselves  with  others  who  succeeded  from 
the  accident  of  memory,  and  concluded  that  it  was  favoritism 
and  prejudice  and  consequently,  took  the  next  course  of  lec- 
tures at  some  inland  college.  Many  students  of  this  class  came 
to  Albany,  and  graduated  with  honors,  and  became  distinguished 
physicians,  later  realizing  that  the  failure  to  pass  one  college 
was  a  blessing  in  disguise,  as  it  made  them  stronger  students  for 
the  future.  Union  College,  at  Schenectady,  for  many  years  was 
called  "A  Botany  Bay,"  where  expelled  and  faulty  students  of 
other  colleges,  could  repair  their  losses,  and  receive  diplomas. 
The  president  of  this  college.  Rev.  Dr.  Nott,  had  a  remarkable 
personal  magnetism  and  faculty  of  influencing  and  controlling 
refractory  students.  Men  from  other  colleges,  who  had  failed, 
came  here  and  developed  into  strong  characters.  The  Albany 
Medical  College  had  something  of  a  similar  reputation.  No 
doubt  Dr.  Marsh,  who  was  a  warm  personal  friend  of  Dr.  Nott, 
unconsciously  copied  many  of  the  means  and  methods  used  in 
the  development  of  the  student,  hence  from  the  early  days  of  the 
college,  each  medical  student  was  personally  known  to  the 
teacher,  together  with  his  history,  general  conduct  and  character. 
His  appearance  in  the  lecture  room,  and  individualism,  of 
strength  and  weakness,  was  the  subject  of  inquiry  and  observa- 
tion, and  was  considered  in  the  final  examinations,  and  fore- 
casts for  the  future. 

While  the  class  of  graduates  in  the  fifties,  and  up  to  a  recent 
period  may  have  lacked  in  general  training  and  culture,  compared 
with  those  of  some  of  the  sea  board  schools,  they  were,  as  a  rule, 
superior  in  personality  and  practical  grasp  of  the  facts  which 
were  to  be  utilized  in  after  life.  To  Dr.  March's  emphatic 
personality  was  added  that  of  Dr.  MacXaughton,  who  was  a 
Scotchman  of  very  high  ideals,  and  of  equally  strong  individ- 
ualism. Others  of  the  faculty  were  characteristic  teachers,  and 
the  student  could  not  help  but  feel  the  influence  of  these  men 
beyond  their  formal  lectures.  The  class  of  '61  began  to  feel  the 
coming  storm  of  war,  and  the  demand  for  medical  service,  both 
in  and  out  of  the  army,  was  realized  by  thoughtful  men.  En- 
thusiastic war  physicians  all  over  the  country  gave  up  their  prac- 
tice for  army  service,  and  left  vacancies. 
4 


400  ALBANY  MEDICAL  COLLEGE  IN  WAR  TIME 

In  1862,  the  quietness  of  medical  work  all  over  the  Northern 
States,  was  greatly  disturbed.  The  doctors  had  gone  to  the 
front,  and  empirics  and  quacks  were  occupying  their  places.  The 
class  of  that  year  was  large,  and  composed  of  men  anxious  to  get 
a  diploma  to  go  into  the  army  or  occupy  vacant  places  at  home. 
The  class  of  1863  brought  a  number  of  war  veterans,  soldiers, 
hospital  stewards,  nurses  and  men  who  had  taken  one  course  of 
lectures,  before  the  war  broke  out;  wounded  men  and  those 
who  had  attended  lectures  in  Washington  during  their  army 
service,  and  many  who  had  taken  a  course  in  the  eclectic  or 
homeopathic  colleges,  and  who  realized  that  a  diploma  to  be  of 
value  must  be  from  a  reputable  college. 

The  same  class  flocked  to  the  seaboard  colleges,  but  a  large 
proportion  appeared  at  Albany,  probably  because  the  fees  and 
other  expenses  were  lower  than  in  New  York.  They  were  prob- 
ably what  was  called  "  speculative  students,"  but  who  now  were 
attracted  by  the  possibilities  of  "  short  cuts  "  into  the  profession, 
with  all  its  honors  and  emoluments. 

Young  men  in  various  parts  of  the  country  caught  the  con- 
tagion of  becoming  physicians,  serving  in  the  army,  or  attaining 
prominence  at  home.  Curiously  enough,  quite  a  large  propor- 
tion of  the  graduates  during  these  war  times  dropped  out  of  the 
profession,  after  the  close  of  the  war,  and  became  business  men. 

The  class  of  1864  was  very  much  of  the  same  character,  only 
there  were  more  hospital  stewards,  more  army  veterans,  and 
more  students  who  had  taken  one  or  two  courses  at  other  colleges, 
and  presumably  had  failed  to  pass  the  examinations.  The  classes 
of  '65,  '66  and  '67  contained  large  numbers  of  men  with  army 
experience,  and  others  who  were  anxious  to  secure  diplomas  for 
various  reasons. 

After  that  the  number  dropped  down  and  the  veterans  dis- 
appeared, and  a  class  of  students  followed  who  appeared  to 
have  better  preliminary  training.  During  these  years  the  col- 
lege was  prosperous,  surgery  was  the  popular  and  leading  topic 
of  instruction.  Dr.  March  was  at  the  very  acme  of  his  profes- 
sional life,  his  lectures  and  clinics  were  crowded  by  anxious 
students,  who  followed  his  instructions  with  great  eagerness. 
His  lectures  were  largely  an  amplification  of  Druit's  surgery, 
one  of  the  great  authorities  of  that  day,  and  were  very  practical, 
intense,  personal  presentations  of  subjects  that  had  a  wide  influ- 
ence on  the  character  and  culture  of  his  hearers. 


T.  D.  CROTHERS 


40I 


Dr.  Mac  Naughton,  who  taught  practice,  was  not  so  popular 
among  his  students.  He  followed  Cullen,  a  great  Edinburgh 
authority  of  that  day,  and  gave  prominence  to  calomel,  bleeding 
and  other  measures  which  at  that  time  were  condemned  by  some 
modern  authorities. 

His  descriptions  of  disease  were  listened  to  wTith  great  attention 
but  his  means  of  treatment  created  considerable  displeasure, 
manifest  in  boisterous  conduct,  and  noisy  demonstrations.  He 
was  more  feared  than  any  other  teacher  because  of  his  strenuous 
ethical  notions,  and  the  understood  sentiment  that  he  had  de- 
clared his  determination  to  "  black  ball "  any  students,  and  pre- 
vent them  from  securing  a  diploma,  who  intended  to  engage  in 
other  than  the  regular  practice. 

In  this  the  faculty  seemed  to  be  in  accord,  but  Dr.  Mac  Naugh- 
ton was  particularly  outspoken.  The  sudden  withdrawal  of  a 
large  number  of  prominent  physicians  from  private  practice  into 
the  army,  furnished  an  exceptional  opportunity  for  irregulars  of 
every  class  to  rush  in  and  occupy  their  vacant  places.  After  a 
little  experience  they  found  it  necessary  to  have  a  diploma,  and 
sought  some  colleges  where  the  final  examinations  were  not  very 
severe. 

Both  Dr.  Mac  Naughton  and  Dr.  March  were  implacable  ene- 
mies of  students  with  this  intention,  and  many  of  these  men  who 
failed  in  Albany  succeeded  in  other  schools  whose  lecture  courses 
were  held,  in  the  spring.  This  wave  of  empiricism  died  out 
soon  after  the  close  of  the  war,  and  these  half  trained  irregulars 
finally  disappeared  in  a  large  degree.  It  was  one  of  the  jokes 
among  the  faculty  as  the  graduation  approached,  that  so  many 
of  their  "  black  balled  "  students  would  go  to  this  or  that  neigh- 
boring college  for  diplomas,  depending  on  the  amount  of  money 
they  had  and  their  desire  to  get  through  quickly. 

The  idea  prevailed  in  the  colleges  of  New  York  and  Philadel- 
phia that  Albany  was  one  of  the  hardest  inland  colleges  from 
which  to  secure  a  diploma.  In  a  letter  of  advice  given  to  a 
young  man,  who  wanted  to  get  through  quickly  (noted  in  the 
published  correspondence  of  Dr.  Laurance),  a  warning  was  given 
to  "  keep  away  from  Albany,  as  they  were  a  lot  of  old  fossil  pro- 
fessors, without  sympathy  or  liberality  for  any  one  who  did  not 
come  up  to  their  standard." 

While  most  of  the  colleges  were  more  or  less  weak  in  their 
standards,  it  was  pleasant  to  note  that  the  Albany  faculty  were 


402  ALBANY  MEDICAL  COLLEGE  IN  WAR  TIME 

considered  a  good  deal  above  the  average  of  that  time  in  the 
requirements  for  a  diploma. 

Many  of  the  students  of  that  war  period  had  suffered  both 
from  disease  and  injury  in  the  army  and  in  prison,  and  were  re- 
garded with  great  sympathy  and  encouraged  in  their  studies, 
and  were  no  doubt  given  preferences  in  the  final  graduation. 

Dr.  Mac  Naughton's  reputation  for  severity  held  in  check 
many  who  had  quackish  intentions,  but  it  was  a  curious  fact 
that  by  some  means  unknown  every  student  who  expected  to 
practice  in  any  other  school  of  medicine  was  known  to  the  fac- 
ulty. A  story  is  told  of  a  young  man  whose  parents  were  very 
strenuous  advocates  of  the  homeopathic  school,  and  who  passed 
a  very  brilliant  examination  and  was  a  man  of  more  than  usual 
genius,  but  the  faculty  decided  to  keep  him  out  for  this  reason. 
He  was  finally  called  in  and  questioned  as  to  his  intentions.  He 
frankly  stated  that  he  had  intended  to  go  into  this  school  of  prac- 
tice, but  on  reflection  he  found  he  could  secure  a  place  in  the 
army,  and  therefore  would  take  up  that  branch  of  medical  serv- 
ice. Dr.  Mac  Xaughton  remarked,  "  We  must  pass  him,  and  if 
an  experience  in  the  army  does  not  change  him  he  is  hopeless." 
The  story  is  that  he  continued  in  the  army  until  death,  and  was  a 
very  active,  useful  man. 

Among  the  other  professors  of  that  period  was  Dr.  Barker, 
who  was  not  only  a  brilliant  man  and  very  famous  in  after  life, 
but  a  great  ethical  teacher.  He  insisted  that  students  should 
observe  the  proprieties  of  gentlemen,  and  if  anyone  in  his  de- 
partment failed  in  this,  he  received  no  favors,  no  matter  what 
his  other  qualifications  were.  Dr.  March  was  also  very  em- 
phatic in  condemning  rudeness  and  boisterous  manners.  Dr. 
Armsby  was  less  pronounced,  but  had  a  silent  way  of  expressing 
his  disgust  for  bad  manners.  During  all  these  war  times  it  was 
an  unwritten  law  that  the  rude  and  bad  mannered  students  would 
not  be  certain  of  securing  a  diploma,  no  matter  how  brilliant 
their  examinations  might  be. 

Dr.  March  insisted  that  each  student  should  have  a  general 
knowledge  of  the  theory  and  practice  of  surgery,  and  also  with 
Dr.  Barker,  that  he  should  be  a  gentleman  in  his  manners.  Dr. 
Mac  Naughton  wanted  to  know  that  he  would  not  be  a  quack,  or 
practice  in  other  schools  of  medicine.  Other  professors  had 
equally  strenuous  views  as  to  the  qualifications  that  a  diploma 
should  represent,  so  that  notwithstanding  the  rush  and  excite- 


T.  D.  CROTHERS 


403 


ment  of  war  times,  and  the  desire  to  go  into  the  profession,  there 
were  many  difficulties  to  be  overcome.  One  of  the  incidents 
occurring  in  those  stormy  days,  told  by  a  student  of  Dr.  March, 
is  interesting  at  this  time. 

On  the  occasion  of  a  great  battle,  a  demand  was  made  for  vol- 
unteer medical  services  and  Dr.  March  responded,  going  to 
Washington  with  other  leading  men  to  care  for  the  wounded, 
particularly  the  New  York  State  troops.  He  was  assigned  to 
a  hospital  presided  over  by  an  army  surgeon  who  had  been  his 
student  a  few  years  before. 

After  the  first  greeting  the  surgeon  handed  Dr.  March  a  paper, 
on  which  was  noted  the  operations  to  be  performed  in  certain 
wards,  with  directions  concerning  the  nature  and  character  of 
the  operations. 

The  doctor  studied  this  paper  with  a  little  surprise,  not  expect- 
ing that  an  old  student  would  give  him  directions  what  should 
be  done.  It  was  ascertained  that  the  same  instructions  were 
given  to  all,  but  the  doctor  was  a  sensitive  man,  and  felt  the 
chill  of  being  advised  by  an  old  student.  He  proceeded  with  the 
operations,  acting  on  his  own  judgment,  paying  little  or  no 
attention  to  the  instructions. 

In  the  evening  the  work  was  resumed.  Here  he  objected  to 
the  etherization  of  patients  in  close  proximity  to  a  smoking  kero- 
sene lamp,  for  fear  of  an  explosion.  The  attendants  not  com- 
plying with  his  request,  he  stopped  and  refused  to  go  on  until 
there  was  more  caution  and  care  preserved. 

An  explosion  occurred  in  a  neighboring  ward,  in  which  both 
the  surgeon  and  patient  were  burned.  This  was  reported  to  the 
surgeon  in  charge,  who  in  great  anger  declared  that  it  was  the 
fault  of  the  volunteer  surgeons,  and  that  he  was  the  responsible 
head  of  that  hospital  and  no  outside  surgeons  should  dictate  to 
him.  Dr.  March  made  no  reply,  but  his  flashing  black  eyes 
spoke  volumes  of  indignation.  The  next  day  he  called  on  the 
division  surgeon,  and  remarked  that  his  services  were  not 
wanted  any  longer  in  that  hospital.  The  surgeon,  who  was  a 
graduate  of  a  New  York  college,  greeted  him  very  warmly  and 
told  him  to  go  and  operate  in  another  hospital  in  any  way  he 
pleased,  and  detailed  several  assistants  to  attend  him  and  carry 
out  his  instructions. 

He  performed  several  severe  operations  in  his  usual  independ- 
ent, bold  manner,  and  later,  when  dining  with  the  surgeon  in 


404  ALBANY  MEDICAL  COLLEGE  IN  WAR  TIME 

charge,  explained  that  perhaps  he  had  violated  the  general  medi- 
cal work  by  not  following  orders,  but  the  surgeon  replied  saying : 
"  It  was  impossible  for  authority  like  him  to  be  criticized  in  any 
direction,  and  anything  he  did  would  be  legitimate  in  every  par- 
ticular." This  pleased  the  doctor  very  much,  who  remarked 
laconically,  "  that  this  surgeon  was  a  gentleman,  while  his  old 
student  in  the  other  hospital,  was  not."  Years  after,  this  old 
student,  who  was  a  prominent  surgeon  in  central  New  York, 
sent  for  Dr.  March  to  consult  with  him  about  his  only  son,  who 
had  a  hip  joint  fracture.  He  went  promptly,  and  gave  the  as- 
sistance required.  A  few  weeks  later  Dr.  Frank  Hamilton,  a 
very  eminent  surgeon  who  had  disputed  Dr.  March's  theories  of 
intra-capsular  fractures,  was  called  in  consultation,  and  Dr. 
March  was  asked  to  join  them.  This  he  refused  in  a  most  em- 
phatic way,  remarking,  "  That  anyone  who  had  shown  so  little 
confidence  in  his  judgment,  could  not  insult  him  any  more."  As 
showing  his  strong  appreciation  of  kindness,  years  afterward  the 
army  surgeon  who  had  greeted  him  so  warmly  in  Washington, 
was  very  ill  in  Saratoga,  and  finally  died.  The  doctor  visited 
him  frequently,  and  gave  him  unusual  attention.  While  Dr. 
March  was  sometimes  brusque  in  his  manners,  he  respected  gen- 
tility and  courtesy  in  a  very  unusual  degree  among  his  students 
and  friends,  and  was  thoroughly  loyal  and  emphatic  in  his  likes 
and  dislikes. 

During  this  war  period  there  was  a  somewhat  noted  contro- 
versy waged  between  him  and  Dr.  Frank  Hamilton  of  New 
York,  a  highly  cultivated  man  and  distinguished  surgeon.  The 
battle  turned  on  the  evidence  of  the  healing  of  an  intra-capsular 
fracture.  Whether  there  was  such  a  lesion,  and  if  it  occurred, 
whether  any  evidence  that  the  bone  was  united,  was  the  ques- 
tion which  each  one  sought  to  prove  by  evidence  that  the  other 
doubted.  The  discussions  were  bitter  and  acrimonious,  and 
ended  as  all  such  contests  do,  without  definite  conclusions.  Dr. 
March  was  bold,  fearless  and  generous,  while  his  opponent  was 
technical,  personal  and  lawyer-like  in  his  arguments. 

One  of  the  specimens  which  was  used  and  examined  by  a 
large  number  of  surgeons  in  this  controversy,  and  seemed  to 
settle  the  question  of  bony  union  within  the  capsule,  was  found 
to  be  a  fraud,  after  the  controversy  was  ended.  It  was  procured 
in  Paris,  and  consisted  of  a  very  adroitly  formed  plaster  Paris 
head  attached  to  the  bone,  which  was  overlooked  by  all  the  sur- 


T.  D.  CROTHERS 


405 


geons  who  examined  the  specimen.  The  doctor  used  to  laugh 
at  this  incident  and  its  termination,  and  refer  to  it  in  private  as 
evidence  of  the  fallacy  of  human  judgment.  Dr.  Mac  Naugh- 
ton  was  equally  strenuous  for  ethical  courtesy,  and  the  recog- 
nition of  the  proprieties  of  professional  conduct,  and  often  was 
intensely  prejudiced  against  any  one  who,  from  design  or  acci- 
dent, failed  in  this  particular.  During  the  latter  part  of  these 
war  times,  a  number  of  old  graduates  with  the  war  fever  ap- 
pealed to  Dr.  March  and  Dr.  Mac  Naughton  to  secure  appoint- 
ments in  the  army. 

It  was  curious  that  the  history  both  before  and  after  gradua- 
tion, and  the  general  character  of  the  applicants,  was  known  so 
minutely  that  they  could  decide  at  once  what  to  do.  Any  grad- 
uate whose  personal  standing  in  the  community  was  not  above 
suspicion  received  no  encouragement. 

From  time  to  time  much  outside  influence  was  brought  to  bear 
to  secure  an  appointment  or  promotion  in  the  army.  On  one 
occasion  the  appointment  of  a  New  York  physician  as  surgeon 
of  a  prominent  regiment  in  preference  to  his  rival,  who  was  a 
graduate  of  the  Albany  Medical  College,  created  some  bitterness. 
Dr.  March  promptly  announced  .that  he  would  help  no  man  to 
a  professional  position  whose  character  had  been  in  question  in  a 
breach  of  promise  case.  Many  similar  incidents  occurred  in 
which  the  members  of  the  faculty  were  asked  to  sign  petitions 
to  the  governor  and  surgeon-general,  to  make  appointments. 

One  story  is  told  of  Dr.  March  signing  a  petition  of  this  kind, 
and  soon  after  observing  the  petitioner  in  a  violent  altercation 
with  a  hackman,  in  which  the  petitioner  was  very  profane,  he 
called  for  the  petition  and  deliberately  crossed  his  name  out, 
saying  "  That  he  recommended  no  man  who  could  not  control 
his  temper  in  trivial  matters."  Dr.  Armsby  and  Dr.  Quacken- 
bush  were  recognized  as  the  political  members  of  the  faculty; 
the  latter  became  surgeon-general  of  the  State,  and  the  former 
was  consul  general  at  Naples  for  a  short  time.  During  Dr. 
Ouackenbush's  term  of  service  as  surgeon-general,  it  was  thought 
that  he  favored  the  graduates  of  the  college  in  their  appoint- 
ments as  surgeons  in  the  State  troops.  This  was  very  likely 
true,  but  it  was  understood  that  the  graduate  must  be  a  man  of 
character  and  rank  medically  with  the  graduates  of  other  col- 
leges. 

Drs.  March  and  Mac  Naughton  were  very  freely  consulted 


406  ALBANY  MEDICAL  COLLEGE  IN  WAR  TIME 

on  these  matters,  and  it  was  understood  that  all  favoritism  must 
have  some  basis  in  ability  and  character. 

Many  students  came  to  Albany  for  the  last  course,  hoping  that 
some  influence  might  be  obtained  to  secure  them  positions  in  the 
army.  The  faculty  were  generally  considered  independent,  and 
the  governors  and  State  authorities  frequently  consulted  them  as 
to  means  and  measures  not  only  concerning  war  matters,  but 
State  institutions,  and  it  was  an  unwritten  law,  which  probably 
holds  good  even  to-day,  that  State  affairs  opposed  by  the  Albany 
Medical  College  and  physicians  of  that  city  had  most  serious 
obstacles  to  overcome. 

On  one  occasion  a  graduate  was  astonished  that  he  could  not 
get  their  signatures.  He  ventured  into  Dr.  March's  office  to 
inquire  why  he  could  not  secure  his  influence;  the  doctor  re- 
marked "  that  he  drank  too  much  beer,  and  spent  too  much  time 
about  the  theaters  in  Pearl  street  to  make  a  good  physician." 

At  times  there  were  unusual  demands  for  physicians  in  the 
navy,  and  the  surgeon-general  wrote  on  one  occasion  offering 
to  appoint  any  graduates  Dr.  March  could  recommend  for  posi- 
tions. Five  of  the  graduating  class  were  invited  to  call  at  Dr. 
March's  office,  where  he  made  the  offer  to  each  one,  accompanied 
by  the  most  fatherly  advice,  that  they  should  be  conscientious, 
Christian  gentlemen.  One  of  the  men  related  to  me  this  inci- 
dent, and  stated  the  great  surprise  they  all  experienced  at  his 
advice,  so  thoroughly  religious  and  moral,  and  on  the  levels  of 
a  clergyman,  and  that  nothing  in  after  life  was  remembered 
with  more  pleasure  than  this  few  minutes  conversation.  They 
all  went  into  service,  and  two  of  them  continued  for  a  lifetime. 

In  the  latter  part  of  the  war  period  Howard  Townsend  became 
a  member  of  the  faculty.  His  highbred,  polished  manners,  and 
generous  frankness,  were  a  strong  addition  to  the  ethical  ideals 
of  the  college.  He  was  a  courteous  teacher,  and  unconsciously 
impressed  and  gave  tone  to  the  student  life  in  those  days.  It 
has  been  said  that  next  to  Dr.  March  he  was  the  most  influential 
teacher  in  his  personal  magnetism  of  that  period.  The  limit  of 
my  time  prevents  me  from  mentioning  other  members  of  the 
faculty  who  were  both  influential  and  prominent  in  many  ways. 

In  1862  the  wounded  soldiers  of  New  York  began  to  be  sent 
home,  and  they  came  through  Albany  in  large  numbers.  Often 


T.  D.  CROTHERS 


407 


they  were  placed  in  the  hospital  for  temporary  treatment  before 
going  farther. 

At  one  time  the  Hudson  river  boats  brought  up  large  numbers 
daily,  and  the  Albany  hospital  was  often  crowded  with  them. 
Early  in  '64  the  Ira  Harris  hospital  was  established  on  the  ground 
now  occupied  by  the  new  City  hospital,  for  the  New  York 
wounded  soldiers  on  their  way  home,  and  was  quickly  rilled.  Dr. 
Armsby  was  made  surgeon  in  charge.  The  position  was  offered 
to  Dr.  March,  but  he  declined,  saying  that  he  had  had  enough  of 
military  surgery. 

Either  by  accident  or  design  it  was  soon  apparent  that  nearly 
all  the  assistant  surgeons  in  the  hospital  were  graduates  of  the 
college,  many  of  them  living  in  the  neighborhood.  At  one  time 
there  were  six  assistants.  Among  them  was  a  graduate  of  a 
Philadelphia  college,  who  was  bibulous,  and  on  several  occasions 
he  made  himself  offensive. 

Complaint  was  made  against  him,  and  he  was  suspended  and 
ordered  to  report  to  headquarters  at  Washington,  where  he  was 
assigned  for  duty.  For  some  unknown  reasons  he  began  a  sys- 
tematic course  of  persecution  and  slander  of  Dr.  Armsby,  his 
assistants  and  the  hospital  management,  making  various  charges. 
Inspectors  were  sent  to  the  hospital,  and  reported  from  time  to 
time  that  the  charges  were  unfounded.  One  charge  was  that 
the  hospital  was  used  by  the  Albany  Medical  College  for  teach- 
ing purposes,  to  its  great  detriment,  also  that  Dr.  March  operated 
there  twice  a  week  before  the  students,  and  had  patients  brought 
down  to  the  college  for  clinical  work. 

Dr.  Woodward,  who  afterward  became  a  famous  surgeon,  was 
sent  as  an  inspector,  to  observe  if  these  abuses  existed. 

He  reported  that  the  services  rendered  by  Dr.  March  were  of 
the  highest  order,  and  were  gratuitous,  and  that  the  hospital  and 
the  work  done  for  the  soldiers  was  equal  to  that  of  any  other 
institution  in  the  world.  Many  of  the  young  men  attending  the 
college  during  these  days  served  as  hospital  stewards  and  cadets 
at  this  hospital,  and  several  of  the  assistant  physicians  were  emi- 
nent practitioners  in  after  life. 

The  first  two  years  of  the  war  there  was  a  great  deal  of  political 
strain  and  effort  to  get  into  the  service,  by  men  in  active  practice, 
prominent  at  home.  Later  these  men  dropped  out,  either  resign- 
ing or  being  mustered  out,  preferring  civil  life  to  that  of  the 
field  work.    Then  came  a  class  of  recent  graduates,  and  men 


408  ALBANY  MEDICAL  COLLEGE  IN  WAR  TIME 

without  positions,  who  from  that  time  on  to  the  close  of  the  war, 
were  constant  applicants  for  every  vacancy.  These  men  belonged 
to  what  is  now  known  in  the  profession,  by  the  significant  words 
"  tramp  physicians."  They  were  seen  in  large  numbers  about 
Albany,  attending  lectures  at  times,  and  hanging  around  the  sur- 
geon-general's office,  looking  for  appointments  and  vacant  places. 

The  bulletin  boards  of  the  college  during  these  years  were 
always  filled  with  notices  of  vacant  places,  needing  physicians, 
and  want  notices  for  students  to  do  medical  work.  Many  of  the 
last  course  students  had  selected  a  place  for  practice  and  made 
all  the  arrangements  for  starting  immediately  on  the  receipt  of 
the  diploma. 

The  medical  men  who  left  Albany  in  war  times,  have  very 
largely  disappeared  from  the  stage  of  active  life.  A  few  of 
them  attained  some  eminence,  and  the  large  majority  no  doubt 
played  their  part  well,  and  were  known  as  excellent  men  in  their 
surroundings.  In  the  memoirs  of  an  old  teacher,  Dr.  Warren, 
who  died  a  few  years  ago  in  Boston,  and  who  probably  attended 
a  course  of  lectures  in  Albany,  somewhere  in  the  sixties,  occurs 
this  comment :  "  The  Albany  Medical  College  has  a  curious 
combination  of  Edinburg  University  ideals,  with  the  Green 
Mountain  conceptions  of  medical  ethics  and  duties  in  which  the 
highest  requirements  are  suavity,  generosity,  and  a  student  in- 
stinct to  learn."  The  faculty  of  the  college  for  the  fifties  and 
sixties,  were  no  doubt,  very  human  with  their  intense  prejudices, 
and  readiness  to  battle  for  the  right,  but  with  it  all  there  was 
generosity  and  fairness,  always  contending  on  an  open  field, 
with  a  definite  object  in  sight. 

It  is  a  pleasure  to  note  that  this  spirit  of  ethics  still  lives,  and 
although  half  a  century  has  gone  since  the  stormy  days  of  war, 
there  has  been  a  constant  evolution  upwards  and  outwards.  The 
new  hospital  and  the  new  college  to  come,  with  the  new  faculty 
already  in  training,  give  promise  for  a  larger  future  and  greater 
work. 


ALBANY  MEDICAL  COLLEGE 


409 


ASSOCIATION  OF  THE  ALUMNI  OF  THE  ALBANY 
MEDICAL  COLLEGE— THIRTY-THIRD  ANNUAL 
MEETING. 

The  thirty-third  annual  meeting  of  the  Association  of  the 
Alumni  of  the  Albany  Medical  College  was  held  in  the  new  lecture 
room  on  Tuesday,  May  1,  1906.  The  usual  informal  reception 
was  held  in  the  college  library,  where  photographs  were  exhibited 
and  greetings  exchanged,  between  the  hours  of  9  and  10:30  a.  m. 
The  annual  meeting  was  called  to  order  by  the  President,  Dr. 
Charles  B.  Tefft  ('66),  of  Utica,  N.  Y.,  at  half-past  ten  o'clock. 

The  following  named  members  of  the  Association,  with  invited 
guests,  students  of  the  college  and  others  interested,  were  present : 
Alfred  B.  Huested,  ('63)  ;  Charles  B.  Tefft,  ('64)  ;  Charles  E.  Wit- 
beck,  ('66)  ;  Daniel  C.  Case,  Willis  G.  Tucker,  ('70)  ;  John  K. 
Thorne,  Gebhard  L.  Ullman,  ('71)  ;  J.  H.  Blatner,  ('72)  ;  Daniel 
H.  Cook,  Henry  G.  Mereness,  ('74)  ;  Mark  M.  Lown,  ('77)  ; 
Frederick  H.  Brewer,  John  H.  Cotter,  Earl  D.  Fuller,  Henry 
Lilienthal,  George  P.  K.  Pomeroy,  William  O.  Stillman,  ('78)  ; 
William  J.  Nellis,  ('79)  ;  George  S.  Munson,  ('80)  ;  Frederick 
L.  Classen,  James  PL  Mitchell,  ('81)  ;  Wallace  E.  Deitz,  Adam 
Y.  Myers,  William  B.  Sabin,  ('82)  ;  Joseph  D.  Craig,  James  W. 
King,  ('84)  ;  Terence  L.  Carroll,  ('85)  ;  William  P.  Brierley, 
William  B.  Campbell,  Arthur  S.  Capron,  James  A.  Clyne,  William 
H.  Delamater,  Elmer  E.  Finch,  James  A.  Holley,  Richard  H. 
McCarty,  James  H.  Reilly,  John  A.  Robson,  Arthur  D.  Stowitts, 
('86)  ;  Andrew  MacFarlane,  Charles  H.  Moore,  Henry  F.  C. 
Mtiller,  ('87)  ;  Charles  F.  Clowe,  George  G.  Lempe,  ('88)  ;  G. 
Emory  Lochner,  J.  Montgomery  Mosher,  ('89)  ;  Arthur  G.  Root, 
Edgar  S.  Simpkins,  ('90)  ;  William  S.  Ackert,  James  W.  Wiltse, 
('91)  ;  Leo  F.  Adt,  Howard  E.  Lomax,  Leo  H.  Neuman,  Clement 
F.  Theisen,  ('92)  ;  Thomas  W.  Jenkins,  Thomas  A.  Ryan,  ('93)  ; 
John  R.  McElroy,  Arthur  Sautter,  ('94)  ;  Charles  L.  Myers, 
Frederick  J.  Resseguie,  Leonard  G.  Stanley,  ('95)  ;  John  J. 
Dever,  Harry  O.  Fairweather,  George  B.  Grady,  Henry  W. 
Keator,  Parker  Murphy,  Elbert  A.  Palmer,  T.  Avery  Rogers, 
Jesse  M.  W.  Scott,  James  C.  Sharkey,  John  D.  Vedder,  Edward 
J.  Weincke,  ('96)  ;  Eugene  J.  Hanratta,  H.  Judson  Lipes,  ('97)  ; 
L.  Barton  Schneider,  Alvah  H.  Traver,  ('98)  ;  Christian  G. 
Hacker,  Eugene  E.  Hinman,  Daniel  A.  McCarthy,  ('99)  ;  Thomas 


ALBANY   MEDICAL  COLLEGE 


H.  Cunningham,  ('oo)  ;  Arthur  J.  Bedell,  John  M.  Griffin,  (01)  ; 
Thomas  Carney,  ('02)  ;  Charles  R.  Marsh,  ('03)  ;  John  I.  Cotter, 
Marcus  A.  Curry,  Branson  K.  DeVoe,  Daniel  V.  O'Leary,  Jr., 
('04)  ;  Kenneth  D.  Blackfan,  Archie  B.  Chappell,  Miles  J.  Cornth- 
waite,  Thurman  A.  Hull,  Lemuel  R.  Hurlbut,  Roscoe  C.  Water- 
bury,  ('05)  ;  Roy  M.  Collie,  Morey  C.  Collier,  Charles  E.  Collins, 
Frederick  C.  Conway,  Edward  A.  Dean,  Adelbert  S.  Dederick, 
T.  Frederick  Doescher,  Willis  W.  Dutcher,  H.  Ernest  Gak, 
George  R.  Goering,  Stowell  B.  Grant,  Joseph  F.  Harris,  Charles 
B.  Hawn,  Samuel  O.  Kemp,  Jr.,  Winfield  S.  Kilts,  William  A. 
Krieger,  Price  Lewis,  Walter  A.  Reynolds,  J.  Fletcher  Robin- 
son, Willis  N.  Simons,  Eugene  G.  Steele,  Edward  G.  Whipple, 
('06)  ;  James  P.  Boyd,  Frederic  C  Curtis,  Spencer  L.  Dawes, 
Henry  Hun,  Cyrus  S.  Merrill,  Samuel  R.  Morrow,  Richard  M. 
Pearce,  John  A.  Sampson,  Howard  Van  Rensselaer,  Samuel  B. 
Ward,  (Hon.). 

On  motion  of  Dr.  Tucker,  the  reading  of  the  minutes  of  the 
last  annual  meeting  was  dispensed  with  and  the  minutes  were 
approved  as  printed  in  Albany  Medical  Annals. 

The  President  introduced  Professor  Howard  Van  Rensselaer, 
who  delivered  the  following  address  of  welcome  on  behalf  of 
the  faculty: 

Address  of  Welcome. 
Gentlemen  of  the  Alumni: 

On  behalf  of  the  Faculty  of  the  Albany  Medical  College,  it  gives  me 
much  pleasure  to  welcome  you  again,  on  this  the  thirty-third  anniversary 
of  the  annual  meeting  of  the  Alumni  Association. 

As  many  of  you  are  unable  to  return  each  year  to  these  reunions,  it 
is  easy  for  you  to  lose  track  of  what  is  going  on  at  the  Medical  College; 
and,  knowing  your  interest  in  these  matters,  I  thought  it  might  be  well 
to  tell  of  the  new  work  accomplished  here,  and  of  our  plans  and  hopes  for 
the  future. 

The  head  of  each  chair  in  our  college,  is  a  member  of  one  or  another 
of  the  great  national  medical  associations,  each  belonging  to  the  one  whose 
object  is  the  study  along  the  line  of  his  particular  specialty.  At  the  yearly 
meetings  of  these  national  societies,  we  come  in  contact  with  the  best 
medical  teachers  in  the  various  universities,  and  each  of  us  professors 
is  able  therefore  to  make  his  own  teaching  conform  to  the  most  advanced 
and  best  standards  on  his  subject. 

So  that  in  the  old  regular  departments  we  feel  that  our  methods  of 
teaching  are  abreast  of  the  times,  and  that  we  do  not  fall  behind  those 
of  any  other  medical  school. 


ALUMNI  ASSOCIATION  PROCEEDINGS 


411 


There  is  one  modern  branch,  however,  in  which  we  have  been  deficient, 
a  department  that  has  but  lately  come  into  prominence,  and  is  at  present 
taught  in  the  very  best  colleges  only.  I  refer  to  practical  laboratory 
training  in  experimental  pharmacology,  physiological  chemistry,  and  experi- 
mental physiology.  For  several  years  we  have  felt  the  need  of  giving 
instruction  in  these  branches,  but  we  had  neither  the  laboratory,  nor 
the  equipment,  nor  the  means  to  carry  out  our  aim  in  the  best  manner. 

This  year  I  am  pleased  to  tell  you  that  we  have  overcome  some  of 
the  difficulties  and  have  succeeded  in  inducing  Dr.  Holmes  Jackson  to 
come  here  and  teach  these  branches.  He  is  thoroughly  equipped  to  give 
such  instruction.  Concerning  the  methods  of  teaching  these  subjects, 
Dr.  Jackson  says : 

"  The  course  in  physiological  chemistry  in  the  second  year  aims  to 
give  to  the  student  a  fundamental  conception  of  the  normal  and  patho- 
logical composition  of  the  various  tissues,  organs  and  secretions,  as 
well  as  of  the  character  of  the  physiological  and  pathological  chemical 
and  physical  reactions  of  the  animal  organism,  with  the  view  to  enabling 
him  more  clearly  to  understand  the  reasons  for  disease  and  of  the  various 
means  adopted  to  prevent  and  remedy  pathological  conditions. 

"At  the  outset,  the  three  basic  or  proximate  constitutional  compounds 
of  the  body — carbohydrates,  fats  and  proteids — are  studied  as  regards 
their  distribution,  composition,  characteristics,  properties  and  their  origin 
and  fate  in  the  animal  mechanism.  Based  upon  this  follows  the  chemi- 
cal examination  of  the  various  organs  and  tissues — muscle,  brain,  liver, 
etc. — both  as  to  normal  chemical  composition  and  the  effect  of  patho- 
logical processes  upon  this.  Where  possible  the  individual  chemical  com- 
pounds which  may  be  regarded  as  most  characteristic  of  the  tissue  are 
isolated  and  studied.  The  secretions  of  the  gastro-intestinal  tract  are 
next  considered  both  concerning  their  general  composition  and  the  factors 
which  influence  this,  as  well  as  the  action  of  the  numerous  enzymes 
present,  upon  the  three  classes  of  food  stuffs.  Finally  the  urine  receives 
attention  to  the  extent  of  one-third  the  course.  The  important  normal 
and  pathological  constituents  are  separated  and  examined  as  to  methods 
of  detection  and  quantitative  analysis.  Quantitative  determinations  of 
chlorides,  phosphates,  urea,  uric  acid,  dextrose  and  proteid  are  performed 
in  the  laboratory ;  and  the  whole  is  supplemented  by  talks  on  the  various 
pathological  chemical  changes  which  exhibit  themselves  in,  and  allow 
of  diagnosis  by  a  changed  composition  of  the  urine. 

"  If  the  curriculum  can  be  so  arranged  that  such  a  course  would  be 
of  advantage  to  the  student,  it  is  the  expectation  to  introduce  experi- 
mental demonstrations  accompanied  by  talks  on  the  part  of  physiology 
connected  with  secretions,  digestion,  absorption,  excretion  and  general 
metabolism.  Some  of  the  demonstrations  might  be — the  secretion  of  the 
saliva  and  action  of  drugs  (atropine  and  pilocarpine)  upon  it;  the 
mechanism  of  swallowing;  the  influence  of  the  vagus  upon  the  heart 
and  gastric  secretion;  the  secretion  of  gastric  juice  and  the  factors  which 
influence  it:  mechanism  of  pancreatic  secretion;  peristalsis  and  conditions 
influencing  absorption  from  the  intestine  (action  of  salts,  drugs,  etc.)  ; 
effect  of  various  circulatory  factors  upon  the  secretion  of  urine;  attempts 


412 


ALBANY   MEDICAL  COLLEGE 


where  possible  to  simulate  in  experimental  form,  pathological  conditions 
and  to  demonstrate  the  effects  which  follow  such  changes  (experimental 
diabetes,  etc.). 

"  If  time  allows,  the  action  of  various  important  drugs  (nitrites,  arsenic, 
cocaine,  chloral,  digitalis,  strychnine,  etc.)  and  extracts  from  pathological 
chemistry  will  be  demonstrated." 

During  the  fourth  year  of  the  curriculum,  we  are  giving  up  didactic 
lectures  as  much  as  possible,  and  are  substituting  for  them  clinical  instruc- 
tion. There  are  a  great  number  of  these  courses,  covering  almost  every 
specialty  in  medicine,  in  which  the  class  is  divided  into  sections  of  about 
six  men  each.  Every  student,  therefore,  comes  in  intimate  contact  with 
the  patient,  and  is  able  to  train  his  eyes,  ears  and  sense  of  touch,  and 
to  reason  and  make  deductions  in  a  way  that  is  impossible  by  didactic 
teaching. 

Within  the  past  two  years  a  special  voluntary  practical  course  in  obstetrics 
is  given  to  the  senior  students,  in  addition  to  the  regular  instruction  in 
the  hospitals.  This  is  conducted  by  Dr.  Lipes  under  the  auspices  of  the 
Guild  for  the  Sick,  the  women  being  confined  in  their  own  houses. 
During  the  past  year  23  students  have  availed  themselves  of  this  oppor- 
tunity, and  attended  about  60  confinements.  Two  students  go  on  a  case 
so  that  each  has  averaged  three  or  four  confinements.  In  addition  many 
opportunities  have  been  given  them  to  assist  their  local  preceptors,  or 
even  to  attend  cases  in  their  absence,  after  they  have  had  this  practical 
training.  A  touch  course  in  the  examination  of  pregnant  women  is  also 
given.  The  entire  work  of  this  department  is  continued  through  the 
summer;  each  student  being  kept  on  duty  for  a  period  of  two  weeks. 

It  is  hoped  that  in  a  short  time  this  course  may  be  made  compulsory, 
and  become  a  part  of  the  regular  curriculum. 

You  gentlemen  are  undoubtedly  surprised  to  meet  in  this  room  instead 
of  in  the  old  Alumni  Hall.  The  reason  is  that  lack  of  space  has  com- 
pelled us  to  use  that  room  for  a  laboratory,  and  it  emphasises  the  fact 
that  we  are  gradually  outgrowing  our  present  accommodations,  and  that 
our  most  vital  and  urgent  need  now,  is  a  new,  well  equipped,  and  commodious 
laboratory  building.  We  see  but  little  indication  of  its  speedy  fulfillment, 
but  it  is  our  immediate  aim  in  the  future. 

Once  again  we  welcome  you  back  to  the  scenes  of  your  early  struggles, 
and  urge  you  to  make  the  effort  and  sacrifice,  to  return  each  year  to 
meet  your  old  chums,  and  to  form  new  friendships  among  the  younger 
graduates,  that  your  memories  and  hearts  may  ever  keep  fresh  and  young, 
and  constantly  increase  your  loyalty  and  pride  in  your  Alma  Mater. 

On  motion  of  Dr.  Earl  D.  Fuller,  the  thanks  of  the  Association 
were  tendered  Professor  Van  Rensselaer  for  his  address  and  a 
copy  was  requested  for  publication. 

Dr.  John  H.  Cotter  then  moved  that  the  President  appoint 
a  committee  of  five  to  nominate  officers  for  the  ensuing  year. 
Carried.   The  President  appointed  as  such  committee:  Drs.  John 


ALUMNI  ASSOCIATION  PROCEEDINGS 


413 


H.  Cotter  ('78),  Frederick  H.  Brewer  ('78),  James  H.  Mitchell 
('81),  Henry  F.  C.  Miiller  ('87),  and  Daniel  C.  Case,  ('70). 
The  Recording  Secretary  presented  the 

Report  of  the  Executive  Committee  and  Recording 
Secretary. 

Two  meetings  of  the  Executive  Committee  have  been  held  during  the 
year. 

At  the  first  meeting,  held  May  25,  1905,  the  Recording  Secretary  pre- 
sented the  minutes  of  the  thirty-second  annual  meeting  of  the  Association, 
including  an  account  of  the  Commencement  Exercises,  and  on  motion 
this  manuscript  was  referred  back  to  the  Recording  Secretary  to  be  pub- 
lished in  the  usual  way,  and  the  Treasurer  was  authorized  to  meet  the 
expense  of  reprints,  and  envelopes  for  mailing,  and  of  the  Treasurer's 
blanks. 

Dr.  Tucker,  of  the  Alumni  Banquet  Committee,  presented  a  report, 
showing  a  deficit  of  $84.10,  which  had  been  paid  by  the  college  faculty. 

The  second  meeting  of  the  Executive  Committee  was  held  March  1,  1906. 
Arrangements  for  Alumni  Day  were  discussed,  and  a  subcommittee  of  five 
was  appointed  to  carry  out  the  plan  for  the  annual  meeting. 

The  Treasurer  reported  a  deficit  of  ten  dollars  in  the  treasury,  which 
was  made  up  by  the  members  of  the  Executive  Committee  present. 

The  Corresponding  Secretary  was  authorized  to  have  the  usual  notices 
for  the  annual  meeting  printed  and  distributed. 

It  was  decided  to  arrange  for  the  Alumni  dinner  on  the  evening  of 
Commencement  Day,  the  price  per  plate  to  be  three  dollars. 

On  motion  of  Dr.  H.  Judson  Lipes  the  report  was  accepted  and 
ordered  entered  upon  the  minutes. 

The  Treasurer,  Dr.  Robert  Babcock,  presented  his  report  for 


the  years  as  follows : 

Treasurer's  Report. 
Cr. 

Balance  on  hand  May  1,  1905   $35  32 

Dues  received  during  year  1905   85  00 


Total   $120  32 

Dr.  , 

Various  bills  paid  for  which  vouchers  are  presented   120  10 


Balance  on  hand  May  1,  1906   $0  22 

College  Building  Fund   114  10 


[Signed] 


4M 


ALBANY   MEDICAL  COLLEGE 


On  motion  of  Dr.  Charles  H.  Moore,  the  Treasurer's  report  was 
referred  to  an  auditing  committee,  consisting  of  Drs.  Moore, 
G.  L.  Ullman  and  W.  E.  Deitz,  who  subsequently  reported  it 
correct.  The  report  of  the  Auditing  Committee  was  received  and 
the  committee  discharged,  and  the  report  of  the  Treasurer  was 
accepted  and  ordered  placed  on  file. 

The  President's  address  being  the  next  order  of  business,  Dr. 
Mark  M.  Lown,  Vice-President  of  the  Association,  was  called 
to  the  chair,  and  President  TefTt  delivered  the  following  address : 

President  Tefft's  Address. 

Our  Alma  Mater. 

Mother.  No  word  in  any  language  so  stirs  the  blood  as  mother.  No 
word  when  spoken  so  quickly  commands  our  entire  attention  and  we 
stand  amazed  as  the  picture  of  our  lives  with  mother  is  unfolded.  The 
nourishing  mother,  the  fostering  mother.  From  our  first  cry  through 
her  whole  life  she  had  but  one  thought,  our  welfare.  Sang  but  one  song, 
our  praise.  Had  but  one  ever  present  desire,  our  success.  To  her  we 
are  indebted  for  the  foundation  upon  which  a  structure  might  be  laid. 
The  blush  of  shame  must  come  to  our  cheeks  when  we  realize  how  far 
short  of  the  ideal  we  have  builded.  We  may  attempt  an  explanation, 
but  as  a  rule  the  explanation  does  not  only  explain,  but  shows  us  in  a 
worse  light  than  the  first.  Let  us  be  honest  now  and  do  all  we  can  to 
make  amends  for  our  lack  of  appreciation  of  the  good  work  done  for 
our  advancement.  It  might  be  interesting  to  pursue  this  thought  farther, 
but  we  have  not  the  time  and  it  is  not  our  purpose  to  more  than  glance 
at  this  one  feature  of  all  life  in  its  bearing  upon  our  lives  as  physicians 
in  our  relation  to  our  Alma  Mater — the  Albany  Medical  College.  We 
came  to  her  seeking  admittance  to  her  household  expecting  her  fostering 
care.  Many  in  the  olden  time  had  nothing  to  offer  but  a  well  developed 
body  presided  over  by  an  untrained  mind,  yet  filled  with  the  thought  that 
great  possibilities  lay  buried  in  the  gray  matter  of  our  brain  that  needed 
only  to  be  stirred  to  bring  forth  wonderful  results.  I  think  all  will 
agree  the  stirring  was  promptly  done  and  was  of  a  character  to  produce 
results. 

Our  Alma  Mater  with  a  gentle  hand  and  loving  smile  drew  us  to  her- 
self and  opening  wide  the  portals  led  us  through  every  avenue  and  opened 
wide  every  door  and  give  us  free  entrance  to  every  thing,  dead  or  alive, 
that  could  help  to  bring  out  the  undeveloped  and  hidden  in  us.  Did 
we  then  appreciate  the  faculty  of  our  Alma  Mater,  Men,  all  of  them,  who 
stood  for  what  was  accepted  in  theory  or  known  in  practice  throughout 
the  world,  untiring  workers  in  a  field  comparatively  little  known;  earnest 
in  their  search  for  truth,  untiring  in  their  efforts  to  utilize  all  for  the 
advancement  of  those  looking  to  them  for  the  knowledge  that  would 
equip  them  for  their  life  work? 


ALUMNI  ASSOCIATION  PROCEEDINGS 


415 


We  accepted  all  that  came  to  us  no  matter  at  what  cost  to  them  as 
our  due  and  I  fear  without  a  just  appreciation  of  the  kindly  interest 
that  prompted  the  giver  to  lay  it  all  before  us.  The  day  came  that 
brought  the  test  not  of  the  teacher  but  of  the  taught.  Teacher  and 
taught  anxious  for  the  results  of  the  day.  One  question  towered  high 
above  all  other  questions  in  the  teacher's  mind.  How  can  we  be  just 
as  between  student  and  people  and  preserve  our  own  self-respect.  Failure 
to  many  meant  much  for  in  the  three  years  now  closed  their  resources 
had  been  exhausted.  The  representatives  of  our  Alma  Mater  found  a 
way  to  deal  justly  with  us  and  with  few  exceptions  all  received  the 
long  sought  parchment  with  the  God-speed  of  our  Alma  Mater.  Our 
hearts  were  full  of  gratitude  and  blessing  for  the  great  transformation 
our  fostering  mother  had  wrought  in  us,  and  we  felt  then  that  no  sacrifice 
we  could  ever  make  would  be  too  much  for  us  to  do.  Have  we  forgotten? 
Has  time  effaced  the  recorded  or  implied  promise  of  the  hour  to  respond 
to  all  reasonable  calls  from  our  Alma  Mater  to  promote  her  interests, 
enabling  her  to  keep  pace  with  the  spirit  of  today  and  reach  out  into 
any  field  that  should  bring  her  honor.  I  must  plead  guilty  to  a  charge 
of  neglect  were  it  preferred  and  from  some  things  learned  within  the 
year  I  do  not  believe  myself  the  only  one  that  should  so  plead.  Since 
being  called  to  the  present  place  I  have  learned  our  Alma  Mater  has 
met  all  deficiencies  occurring  in  the  provision  for  our  annual  alumni 
meeting  and  banquet.  I  do  not  feel  we  are  altogether  to  be  blamed  in 
the  matter  because  we  were  not  taken  into  the  confidence  of  the  house- 
hold, informed  of  conditions  as  they  existed  and  if  necessary  spanked  into 
doing  what  I  believe  all  would  be  made  to  see  belonged  to  us  to  do. 
We  had  not  realized  we  were  neglecting  our  Alma  Mater.  Let  us  renew 
our  allegiance  to  the  old  home  and  as  we  live  over  again  the  old  days 
renew  our  allegiance  to  our  cherished  college  home  and  be  alert  to  keep 
our  Alma  Mater  ever  in  the  front  rank. 

It  may  be  interesting  to  compare  briefly  the  position  of  the  physician 
of  forty  years  ago  in  the  community  with  the  standing  of  the  doctor  of 
our  times  in  respect  to  his  influence  in  the  development  and  directing  of 
matters  of  public  interest.  In  the  olden  time  he  was  honored  and  respected 
as  a  man  and  gentleman  by  all.  He  held  their  confidence,  his  counsel 
was  sought  in  all  matters  affecting  the  general  welfare,  and  no  one  did 
more  to  promote  the  best  interests  of  the  people  than  did  the  old  time 
country  doctor.  In  politics  he  was  not  an  extreme  partisan,  but  in  local 
matters  sought  the  best  and  was  generally  successful.  It  was  admitted 
he  could  control  more  voters  than  any  other  man  in  the  community.  He 
was  not  an  office  seeker,  made  no  display  of  goodness,  but  practised  the 
Golden  Rule. 

The  people  appreciated  the  doctor's  services  in  the  sick  room  and  felt 
in  honor  bound  to  compensate  him  for  his  faithfulness  in  caring  for 
the  family.  If  the  statement  here  made  is  true  all  will  remark  there 
have  been  some  radical  changes  in  the  attitude  of  the  people  toward  the 
physician.  The  family  physician  with  his  knowledge  of  the  idiosyncrasies 
and  life  history  of  a  generation  of  the  family  no  longer  exists,  and 
instead  the  club,  the  lodge,  and  sometimes  the  distance  and  the  telephone 


5 


416 


ALBANY   MEDICAL  COLLEGE 


determine  who  shall  be  called  when  sickness  enters  the  home.  The  busi- 
ness affairs  of  life  are  not  managed  in  that  way.  Provision  is  made  by 
statute  for  the  formation  of  health  boards  giving  such  board  jurisdiction 
over  all  matters  affecting  the  general  health  of  the  community.  No 
one  would  think  it  necessary  to  direct  in  such  a  statute  that  such  board 
or  a  majority  of  such  board  must  be  physicians  in  good  standing  among 
their  fellows,  well  versed  in  modern  research  and  in  accord  with  methods 
and  practises  that  have  been  proven  best. 

What  is  the  practice?  Men  without  knowledge  of  anything  pertaining 
to  health  either  technical,  theoretical  or  practical  compose  a  majority 
of  nearly  every  board  of  health  in  the  state.  They  formulate  rules  and 
regulations  to  govern  and  control  in  case  of  epidemic  and  demand  that 
the  physicians  under  penalties  of  their  law  must  stamp  out  epidemics 
and  they  hold  the  physician  responsible  for  the  failures  that  follow.  What 
is  the  result?  Water-borne  disease  is  prevalent  in  nearly  every  hamlet 
in  the  State.  The  bacillus  of  typhoid  holds  high  carnival,  The  Adiron- 
dacks  are  not  exempt.  The  beautiful  foot-hills  and  valleys  of  the  Catskills 
furnish  an  abiding  place.  East,  west,  north,  south,  one  story,  yes  the 
sea  through  its  sewerage  fattened  oysters  offers  us  a  tempting  dish  filled 
with  death.  Our  markets  are  filled  with  meats,  vegetables,  cereals  and 
fish  in  all  stages  of  decomposition  and  unwholesomeness.  Untainted  meats 
and  fish  in  our  interior  cities  are  the  exception.  The  stock  selected  for 
our  use  is  not  the  strong,  hearty  animals  that  could  be  cared  on  foot. 
The  Pacific  coasts  send  us  our  fish.  The  middle  west  our  fowls  dead, 
heads  on  and  undrawn.  I  do  not  know  a  more  disgusting,  unappetizing 
sight  than  is  found  in  a  market  where  western  killed  fowls  are  kept. 
Let  us  look  around  and  see  whither  we  are  drifting.  The  men  interested 
in  the  dollar  he  gets  out  of  it  has  control  of  all  these  things  in  our  State 
and  has  no  care  for  the  consumer  or  his  family  so  long  as  he  can  con- 
trol the  market.  We  who  profess  to  follow  the  teachings  of  the  Bible 
in  many  things  ignore  its  teaching  along  these  lines,  and  are  paying  the 
penalties  of  their  disobedience  every  day  of  their  lives.  Let  us  begin 
the  work  of  return  to  right  ways  and  do  the  best  work  any  physician  or 
man  can  do  in  teaching  the  people  how  to  live  and  be  full  of  vigor  during 
their  life  time. 

This  may  appear  overdrawn,  by  some  out  of  place  at  such  a  meeting  as 
this.  The  medical  profession  do  not  occupy  the  position  they  should  in 
these  matters.  The  alumni  of  the  Albany  Medical  College  should  take 
high  ground  in  matters  affecting  the  public  health. 

There  must  be  no  uncertain  sound  in  what  we  may  offer.  Our  position 
should  be  clearly  defined  along  lines  that  will  receive  the  united  support 
of  our  brother  practitioners  without  reference  to  school  of  medicine  or 
college,  with  but  one  thought,  the  advancement  of  the  medical  profession 
for  the  good  of  all.  Let  our  Shiboleth  be  Physicians  to  the  front  where 
a  physician's  work  is  to  be  done,  boards  of  health  composed  of  physicians 
with  one  exception,  that  exception  to  be  the  attorney  versed  in  municipal 
law,  a  health  officer  appointed  by  the  board  subject  to  their  orders. 

Will  this  Association  be  the  pioneer  in  the  inauguration  of  a  movement 


ALUMNI  ASSOCIATION  PROCEEDINGS 


417. 


that  shall  restore  the  medical  profession  to  its  logical  and  legitimate  place 
in  the  affairs  of  mankind? 

I  hope  at  this  meeting  our  Executive  Committee  may  be  authorized 
to  give  us  a  detailed  report  of  all  matters  connected  with  our  State  Board 
of  Health  at  our  next  meeting.  That  they  may  ascertain  the  amount  of 
money  necessary  to  carry  on  the  work  of  the  Board  and  pledge  the  influence 
of- this  association  to  secure  from  the  legislature  the  money  necessary  to 
properly  carry  on  their  work. 

Young  Gentlemen:  Permit  me  to  greet  you  as  brothers  and  congratu- 
late you  upon  your  entrance  to  the  profession  of  medicine.  Your  name 
is  inscribed  upon  a  high  and  honorable  roll.  Many  noble-minded  men 
have  stood  where  you  stand  to-day,  upon  the  threshold  of  your  life  work. 
You  have  followed  the  training  prescribed  by  your  Alma  Mater;  have 
finished  your  course  with  honor,  and  it  gives  me,  as  representing  the 
Alumni  of  this  College,  great  pleasure  to  give  you  all  a  most  hearty 
welcome  to  membership  in  the  Alumni  Association  of  the  Albany  Medical 
College.  You  are  now  a  part  of  the  great  fraternity  of  physicians  entitled 
to  the  benefits  that  come  to  all,  but  do  not  forget  you  must  also  share  the 
responsibilities  common  to  all.  Act  well  your  part  to-day,  build  up  the 
foundations  laid  by  our  Alma  Mater,  determine  success  by  the  good  you 
do,  for  by  this  standard  we  shall  be  judged. 

The  members  of  the  Class  of  1906  were  present  in  a  body, 
and  rose  as  the  President  addressed  them  at  the  conclusion  of 
his  address,  and  received  them  into  membership  in  the  Asso- 
ciation. 

The  President  then  offered  to  the  Association  a  gavel,  pre- 
sented by  Dr.  John  H.  Cotter,  of  the  Class  of  1878,  an  ex-president, 
stating  that  the  gavel  was  made  from  the  wood  of  an  apple  tree 
planted  by  Dr.  Cotter,  in  his  own  garden.  On  motion  of  Dr. 
Mosher  the  gift  was  accepted,  the  thanks  of  the  Association  were 
tendered  Dr.  Cotter,  and  the  gavel  was  placed  in  the  hands  of 
the  Executive  Committee  for  a  suitable  inscription. 

Dr.  Tucker  moved  a  vote  of  thanks  to  the  President  for  his 
interesting  address,  a  copy  of  which  he  was  requested  to  furnish 
for  publication  in  the  Albany  Medical  Annals.  Vice-President 
Lown  put  the  motion  to  a  vote,  and  declared  it  unanimously 
carried. 

President  Tefft  then  resumed  the  chair. 

The  report  of  the  Historian  of  the  Association,  Dr.  Hinman, 
was  then  presented,  and  ordered  entered  on  the  minutes. 


4i8 


ALBANY   MEDICAL  COLLEGE 


Report  of  the  Historian,  E.  E.  Hinman,  M.  D. 

Fellozv  Alumni: 

During  the  year  that  has  passed  since  my  last  report  we  have  added 
much  valuable  information  to  the  archives  of  our  Alma  Mater.  Letters 
of  inquiry  have  been  written  to  each  member  of  the  classes  reported  upon 
this  year  whose  address  we  have  but  many  have  failed  to  reply.  In  all 
such  cases,  unless  we  chanced  to  have  some  personal  knowledge  as  to 
their  whereabouts,  I  have  been  compelled  to  report  them  with  those  of 
whom  we  have  no  record.  There  was  no  class  of  '76  because  the  class 
of  '75  graduated  December  23rd  of  that  year  and  the  next  class  did  not 
graduate  until  January  31,  1877. 

Of  the  forty-four  who  graduated  in  '46  but  one  survives,  Dr.  Rensselaer 
Platner,  who,  at  the  advanced  age  of  84,  is  in  active  practice  and  is 
health  officer  of  Germantown,  N.  Y.  Nineteen  have  died,  of  which  num- 
ber we  have  biographical  records  of  seven  and  only  notices  of  death  of 
twelve.    We  have  no  records  of  the  remaining  twenty-four. 

The  class  of  '56  numbered  sixty-five.  We  have  biographical  records 
of  five  who  are  living.  Twenty-eight  have  died,  of  which  number  we  have 
biographical  records  of  eleven  and  only  notice  of  death  of  seventeen.  We 
have  no  records  of  the  remaining  thirty-two. 

The  class  of  '66  numbered  fifty-two.  We  have  biographical  records  of 
seventeen  who  are  living.  Sixteen  have  died,  of  which  number  we  have 
biographical  records  of  three  and  only  notices  of  death  of  thirteen.  We 
have  no  records  of  the  remaining  nineteen. 

The  class  of  '86  numbered  forty.  We  have  biographical  records  of 
twenty  who  are  living.  Six  have  died,  of  which  number  we  have  biographi- 
cal records  of  three  and  only  notice  of  death  of  three.  We  have  no 
records  of  the  remaining  fourteen. 

The  class  of  '96  numbered  fifty-one.  We  have  biographical  records 
of  thirty-five  who  are  living.  Two  have  died,  of  which  number  we  have 
biographical  records  of  one.  We  have  no  records  of  the  remaining 
fourteen. 

Necrology. 

Since  our  last  annual  meeting  I  have  received  announcement  of  the 
following  deaths : 
Jared  Bassett  ('39),  at  Evanston,  111.,  May  10,  1905. 
Wilson  T.  Bassett  (  44),  at  Cooperstown,  N.  Y.,  January,  1906. 
Abisha  Shumway  Hudson  ('46),  at  Mt.  Vernon,  Ohio,  October  9,  1905. 
John  Dennison  C46),  at  De  Witt,  Iowa,  1903. 
Samuel  S.  Guy  ('46),  at  Philadelphia,  Pa.,  January,  1900. 
Ransom  H.  Vedder  C46),  at  Chatham  Center,  N.  Y.,  August  12,  1905. 
Abram  Van  Wert  ('46),  at  Visschers  Ferry,  N.  Y.,  March  27,  1900. 
Jonathan  Nichols  ('48),  at  Los  Angeles,  Cal.,  January  17,  1905. 
James  Henry  Salisbury  ('50),  at  Dobb's  Ferry,  N.  Y.,  August  28,  1905. 
John  Flickinger  ('56),  at  Trumansburg,  N.  Y.,  June  22,  1899. 
S.  T.  Beardslee  ('56),  at  Armada,  Fla.,  1898. 
Henry  Van  Wert  ('56),  at  Ramertown,  N.  Y.,  February  10,  1898. 


ALUM XI  ASSOCIATION 


PROCEEDINGS 


419 


George  M.  Beakes  ('56),  at  Bloomingburg,  N.  Y.,  June  15,  1900. 

J.  Henry  Robinson  ('56),  at  Southboro,  Mass.,  March  11,  1904. 

Lorenzo  Traver  ('57),  at  Providence,  R.  I.,  October  24,  1903. 

John  Yanney  ('57),  at  Ephratah,  N.  Y.,  July  24,  1905. 

Lemuel  H.  Hammond  ('58),  at  Waterbury,  Conn.,  September,  1905. 

Ira  P.  Smith  ('59),  at  Bath,  N.  Y.,  May  26,  1905. 

Norman  B.  Sherman  ('61),  at  Marshall,  Mich.,  December  22,  1905. 

William  N.  Bonesteel  ('63),  at  Troy,  N.  Y.,  March  20,  1905. 

Levi  Wood  ('65),  at  Ephratah,  N.  Y.,  January,  1906. 

George  Archie  Stockwell  ('66),  at  Houston,  Tex.,  January  29,  1906. 

Adelbert  D.  Head  ('66),  at  Syracuse,  N.  Y.,  January  21,  1906. 

George  P.  Johnson  ('67),  at  Mexico,  N.  Y.,  July  17,  1904. 

Fordyce  H.  Benedict  ('68),  at  Weedsport,  N.  Y.,  March  8,  1906. 

John  Smithwick  ('69),  at  Sharon,  Mass.,  May  21,  1905. 

John  U.  Haynes  ('72),  at  Cohoes,  N.  Y.,  March,  1906. 

Nathan  F.  Sweatman  ('72),  at  Amsterdam,  N.  Y.,  February  18,  1905. 

Henry  Giles  C74),  at  Albany,  N.  Y.,  June  5,  1905. 

James  Duane  Featherstonhaugh  ('74),  at  Cohoes,  N.  Y.,  October  21,  1905. 

Clarkson  C.  Schuyler  ('75 ),  at  Plattsburg,  N.  Y.,  August  16,  1905. 

Selwyn  A.  Russell  ('77)  >  at  Poughkeepsie,  N.  Y.,  January  10,  1906. 

J.  A.  Smeallie  ('79),  at  Cass  Lake,  November  25,  1905. 

William  M.  White  ('86),  at  Amsterdam,  N.  Y.,  December  29,  1905. 

James  Carr  ('86),  at  New  York  City,  December,  1905. 

Chas.  Darius  Rogers  ('88),  at  Denver,  Col.,  July  8,  1905. 

Rudolph  Bestle  ('88),  at  Hunter,  N.  Y.,  August  9,  1905. 

Charles  E.  Greenman  ('89),  at  Troy,  N.  Y.,  April  25,  1905. 

William  W.  Clark  ('94),  at  Maine,  N.  Y.,  July  12,  1905. 

Thomas  G.  Wright  ('96),  at  Troy,  N.  Y.,  February  10,  1906. 

Amasa  Parker  Muir  C96),  at  New  York  City,  June  2,  1905. 

Joseph  Allen  O'Neill  ('97),  at  Cavite,  P.  I.,  January  24,  1905. 

I  also  beg  to  submit  the  histories  of  the  decennial  classes  and  trust 
that  you  may  find  a  perusal  of  the  work  of  your  classmates  and  friends 
interesting  and  encouraging. 

Respectfully  submitted, 

Eugene  E.  Hinman, 

Historian,  A.  A.,  A.  M.  C. 


HISTORY  OF  THE  CLASS  OF  1846. 

Henry  A.  Almy.    No  record. 

John  D.  Arnold.    No  record. 

Henry  G.  Bates.    No  record. 

Diodorus  S.  Beals.    No  record. 

Jeptha  S.  Bingham.    No  record. 

David  E.  Bostwick.    Died  at  Litchfield,  Conn.,  1872. 

Daniel  D.  Bucklin.    Died  at  Lansingburg,  N.  Y.,  April  19,  1890. 

Eldridge  G.  Buswell.    No  record. 


420 


ALBANY   MEDICAL  COLLEGE 


I.  W.  Chesebrough.    No  record. 

George  W.  Chittenden.    Died  at  Janesville,  Wis.,  May  28,  1899. 

Conrad  J.  Crounse.    Died  at  Clarksville,  N.  Y.,  December  12,  1901. 

John  Dennison.  Started  practice  at  Alden,  N.  Y.,  at  30  years  of  age. 
Married  about  one  year  later  to  Miss  Eleanor  M.  Farnsworth.  After  a 
good  practice  of  twenty  years  he  removed  to  DeWitt,  Iowa,  where  he 
practiced  twenty  years  longer  then  stopped.  Since  that  time  he  traveled 
and  enjoyed  a  quiet  life  until  his  death  in  1903,  at  DeWitt. 

Henry  D.  Didama.  First  located  in  Romulus,  N.  Y.,  and  remained  there 
five  years.  He  then  married  Miss  Sarah  Miller  and  removed  to  Syracuse, 
N.  Y.,  where  he  at  once  took  a  leading  position  and  became  conspicuous 
in  the  life  of  the  city.  In  1850  the  Syracuse  Medical  School  was  founded 
and  Dr.  Didama  was  made  professor  of  physiology  and  pathology.  He 
was  professor  of  the  science  and  art  of  medicine  in  the  Syracuse  Uni- 
versity Medical  College  from  the  time  of  its  organization  in  1872  and 
was  its  dean  emeritus  at  the  time  of  his  death.  He  served  as  president 
of  the  New  York  State  Medical  Association  and  of  the  New  York  State 
Medical  Society.  He  was  vice-president  of  the  American  Medical  Asso- 
ciation and  for  thirty  years  has  been  a  member  of  the  British  Medical 
Association,  his  reputation  as  a  physician  extending  to  the  other  side  of 
the  Atlantic.  In  his  public  addresses  and  through  private  efforts  he 
endeavored  to  establish  a  high  standard  of  medical  education.  He  was 
a  member  of  the  Presbyterian  Church  and  in  politics  a  Republican.  His 
wife  died  May  1,  1900,  having  survived  all  her.  three  children.  Dr.  Didama 
died  October  4,  1905,  aged  82  years. 

John  J.  Flint.    Albany,  N.  Y.    Died  July  19,  1873,  aged  73. 

Eliakim  R.  Ford.    No  record. 

Charles  J.  Fox.    No  record. 

Samuel  H.  Freeman.  After  a  long  life-time  of  work  in  Albany,  N.  Y., 
he  died  March  15,  1906,  aged  86.  His  work  was  that  of  the  general 
family  practitioner  and  was  large  and  appreciated.  Was  at  one  time 
president  of  the  County  Medical  Society  and  its  representative  in  the 
State  Society  at  a  time  when  to  be  a  delegate  was  a  highly  prized  honor. 
He  was  an  active  worker  in  the  Presbyterian  Church  and  in  many  public 
activities. 

Stephen  V.  R.  Goodrich.    No  record. 

Fred  S.  Greene.    Died  at  Coxsackie,  N.  Y.,  September  30,  1891,  aged  71. 

Samuel  S.  Guy.  Began  practice  at  Brooklyn,  N.  Y.,  in  1846  and  con- 
tinued there  until  about  1890  when  he  went  to  California,  where  he 
remained  several  years.  He  was  a  general  practitioner  and  was  a  man 
of  a  great  deal  of  ability.  His  death  occurred  at  Hahnemann  Hospital, 
Philadelphia,  Pa.,  January  2,  1901,  at  the  age  of  82  years. 

Martin  C.  Hall.    No  record. 

Forrest  H.  Harwood.    No  record. 

Charles  House.    No  record. 

Abisha  S.  Hudson.  Shortly  after  his  graduation  he  located  at  Sterling, 
111.,  where  he  practiced  with  marked  success  for  twenty  years.  He  became 
very  prominent  in  medical  circles  and  his  name  became  well  known  all 
over  the  United  States.    During  the  Civil  War  he  served  as  surgeon  of 


ALUMNI  ASSOCIATION  PROCEEDINGS 


421 


the  Thirty-fourth  Illinois  Infantry.  In  1871  Dr.  Hudson  moved  to  Stock- 
ton, Cal.,  and  later  to  Oakland  in  the  same  state.  He  was  married  May 
2,  1853,  and  had  one  son,  who  has  since  died.  In  1899  Dr.  and  Mrs. 
Hudson  moved  to  Mount  Vernon,  Ohio,  where  he  remained  until  his  death, 
which  took  place  October  9,  1905. 

Jerome  Milton.    No  record. 

James  Keeler,  Jr.    Died  at  Bristol,  Iowa. 

Christopher  Kiersted.    Last  known  to  be  at  435  W.  23rd  St.-,  New 
York  City.    Made  no  response  to  inquiry  of  1906. 
Sylvester  Lewis.    No  record. 
Allan  C.  Livingston.    No  record. 
George  Lorillord.    No  record. 

Robert  S.  McCurdy.  Last  known  at  Minneapolis,  Minn.  Did  not  reply 
to  inquiry  of  1906. 

Robert  Morris,  Jr.  Most  of  his  professional  life  was  passed  in'  Ogdens- 
burg,  N.  Y.,  where  he  died  November  14,  1904,  aged  96.  He  served  as 
surgeon  during  the  Civil  War  and  was  a  surgeon  of  very  large  reputation 
in  the  neighborhood  of  his  home.  He  retained  all  of  his  mental  faculties 
until  his  death. 

Henry  M.  Neff.    No  record. 

David  W.  Patrick.  Last  known  at  Schuyler's  Lake,  N.  Y.  No  answer 
to  inquiry  of  1904  and  1906. 

Rensselaer  Platner.  Is  still  in  active  practice  at  Germantown,  N.  Y., 
where  he  is  also  Health  Officer.  Dr.  Platner  first  located  at  Taghkanic, 
Columbia  county,  N.  Y.,  where  he  continued  for  twenty  years.  From  there  he 
moved  to  Clermont,  N.  Y.,  and  practiced  there  for  twenty  years  longer. 
In  1892  he  again  moved  and  started  in  practice  at  Germantown,  N.  Y., 
during  which  year  he  was  appointed  Postmaster,  which  post  he  held  four 
years.  He  is  now  Health  Officer  of  the  town  and  active  at  the  age  of  84. 
His  wife  is  dead  and  he  has  one  son  and  a  daughter  living. 

James  H.  Read.    No  record. 

Charles  H.  Roberts.    No  record. 

Francis  H.  Simpson.    No  record. 

Josefh  H.  Smith.    Died  at  Plattsburg,  N.  Y.,  October  4,  1899. 

John  Swineburne.  Practiced  as  a  surgeon  of  very  large  reputation 
in  Albany,  N.  Y.,  where  he  conducted  a  private  hospital  until  his  death, 
March  28,  1889,  aged  68. 

Howard  Townsend.    Dead.    No  other  record. 

Abram  Van  Woert.  Began  practice  in  partnership  with  Dr.  Boughton 
of  Middletown,  N.  Y.  From  there  he  went  to  Pittstown,  N.  Y.,  where 
he  practiced  until  1849.  He  then  spent  three  years  in  California  and 
returned  to  practice  in  his  native  village,  Visscher's  Ferry,  N.  Y.,  and 
remained  there  the  rest  of  his  life.  He  died  March  27,  1900,  aged  78 
years. 

Ransom  H.  Vedder.  After  a  year  of  practice  with  Dr.  Roberts,  an 
eminent  physician  of  New  York,  he  located  at  Chatham  Centre,  N.  Y., 
where  within  a  few  months  of  fifty  years  he  had  an  extended  practice.  He 
was  a  respected  member  of  the  Columbia  County  Medical  Society  and  at 
one  time  its  president,  and  was  also  a  member  of  the  Holland  Society. 


422 


ALBANY  MEDICAL  COLLEGE 


He  was  married  to  Miss  Emily  Leach  in  1854  and  is  survived  by  a 
son  and  daughter.    Dr.  Vedder  died  August  12,  1896. 
John  S.  Weidman.    Died  at  Etna,  N.  Y.,  December  20,  1865. 
Respectfully  submitted, 

E.  E.  Hinman, 

Historian,  A.  A.,  A.  M.  C. 


HISTORY  OF  THE  CLASS  OF  1856. 

W.  E.  Allen.  Began  practice  soon  after  graduation  in  Pike  county,  Pa. 
He  soon  moved  to  Hyde  Park,  Pa.  (now  Scranton,  Pa.),  where  he  con- 
tinued until  his  death,  August  25,  1903.  During  the  Civil  War  he  served 
in  the  medical  department  at  Fortress  Monroe  and  at  Philadelphia,  resum- 
ing practice  at  the  end  of  the  war.  Besides  acting  as  physician  and 
surgeon  to  several  large  hospitals  he  was  appointed,  in  1886,  health  officer 
and  filled  the  position  for  fifteen  years  and  was  then  appointed  Commis- 
sioner of  Public  Health,  serving  one  year.  He  is  survived  by  his  wife 
and  daughter. 

William  Arthur,  Jr.    No  record. 

Charles  E.  Bates.    No  record. 

George  M.  Beakes.  Began  practice  at  Bergen  Point,  N.  J.  In  1857 
located  at  Burlingham,  N.  Y.,  remaining  there  until  September,  1861,  when 
he  was  appointed  assistant  surgeon  of  the  First  New  York  Cavalry; 
served  with  that  regiment  until  1863  when  he  was  promoted  to  surgeon 
assigned  to  the  141st  N.  Y.  Vols.;  was  mustered  out  in  June,  1865,  and 
returned  to  Burlingham.  In  1870  he  removed  to  Bloomingburg,  N.  Y. 
He  was  health  officer  of  that  town  and  was  member  of  Assembly  for 
Sullivan  county  in  1891  and  '92.    He  died  June  15,  1900. 

S.  F.  Beardslee.  He  located  at  Armada,  Fla.,  in  1857  and  followed  his 
profession  until  1896  when  his  health  failed.  After  a  lingering  sickness 
of  two  years  he  died  in  1898,  leaving  a  wife  and  two  sons.  He  was 
married  in  1876  to  Miss  McCauley  of  Richmond,  Va. 

Isaac  S.  Becker.  First  located  at  Berne,  N.  Y.,  and  there  practiced 
until  1891;  moved  to  Altamont,  N.  Y.,  and  is  there  at  the  present  time 
and  very  successful.  Was  married  in  i860  to  Miss  Kate  E.  Shultes.  Was 
health  officer  of  Berne  and  also  of  Altamont. 

Henry  J.  Bennett.    No  record. 

Truman  S.  Brinckerhoff.    Died  September  3,  1888.    No  other  record. 

Alfred  H.  Brundage.  Began  practice  in  Delaware  county,  Ohio,  and 
remained  there  until  1861.  Entered  United  States  service  as  assistant 
surgeon,  Thirty-second  Ohio  Infantry;  was  promoted  surgeon  in  1863; 
served  as  member  of  operating  board,  Third  Division,  Seventeenth  Army 
Corps,  during  Vicksburg  and  Atlanta  campaigns;  located  at  Xenia,  Ohio, 
in  1865.  Married  Miss  Frances  H.  Trail  of  Berkshire,  Ohio,  by  whom  he 
is  survived. 

John  Cipperley.  First  located  at  Middle  Falls,  N.  Y.,  and  remained 
there  twenty-five  years.    Then  he  removed  to  Greenwich,  N.  Y.,  where 


ALUMNI  ASSOCIATION  PROCEEDINGS 


423 


he  is  still  in  active  practice.  Writes  that  nothing  out  of  the  ordinary  has 
happened  to  him. 

Jerome  R.  Collins.  Last  known  at  Leavenworth,  Ind.  No  reply  to 
inquiry  of  1906. 

Jeremiah  A.  Cross.    Died  at  Newark,  N.  J.,  March  30,  1881. 

Lemuel  Cross.  Spent  first  two  years  in  obtaining  experience  for  future 
work  and  two  more  in  giving  public  lectures  on  hygiene.  In  i860  located 
in  Cobleskill,  N.  Y.,  where  he  is  now  in  practice.  He  was  appointed 
by  Governor  Morgan  an  examining  surgeon  of  the  draft;  examined  nearly 
three  thousand  subjects.    Has  been  married  three  times. 

Albert  C.  Dedrick.  He  first  settled  in  the  village  of  Crompton,  R.  I., 
and  married  there  Sarah  Abbott.  In  1862  he  was  commissioned 
assistant  surgeon,  Fourth  Regiment,  R.  I.  Infantry,  and  served  until 
November,  1864;  resumed  practice  at  Crompton  and  Centreville,  R.  I. 
Represented  the  town  of  Warwick  in  the  State  Legislature  in  1872-3-4. 
He  was  active  in  the  state  medical  circles  and  held  many  positions  of 
trust  in  his  town.  Pneumonia  suddenly  cut  short  his  active  life  and 
he  died  April  16,  1889,  aged  58. 

H.  H.  DuBois.    Died  at  Watertown,  Conn.,  April  11,  1891,  aged  59. 

Henry  M.  Edsall.    Died  at  Worthborough,  N.  Y.,  in  1876. 

Obediah  T.  Ellison.    No  record. 

E.  Lee  Ensign.  Located  in  McDonough,  N.  Y.,  March  20,  1857,  and 
practiced  there  until  1880,  when  he  relinquished  practice  for  five  years 
to  regain  lost  health.  He  then  resumed  practice  at  Oxford,  N.  Y.,  remain- 
ing there  a  few  years  and  again  moved  to  Erieville,  N.  Y.,  where  he 
remained  until  his  death,  which  occurred  December  3-,  1903,  after  an 
illness  of  six  months  from  heart  and  stomach  trouble.  Married  in  1859 
and  had  three  children. 

Edward  A.  Everitt.    Died  at  Burlington,  Vt,  December,  1904,  aged  72. 

John  Flickinger.  Was  born  in  Seneca  county,  September  18,  1831, 
and  spent  his  early  life  upon  a  farm.  He  first  located  for  medical  practice 
at  Milo  Centre,  N.  Y.,  remaining  there  a  few  months,  moving  to  Seneca 
county  and  remaining  there  until  1870.  He  served  as  assistant  surgeon 
with  the  First  Division  of  the  Army  of  the  Potomac  at  Alexandria,  Va. 
In  1870  he  moved  with  his  family  to  Clinton,  Iowa,  and  lived  there  until 
1874.  In  1874  he  again  returned  east  and  took  up  his  residence  and 
practice  at  Trumansburg,  N.  Y.,  where  he  remained  until  his  death,  which 
occurred  June  22,  1899.  Was  a  member  of  county  and  state  medical 
societies. 

Edward  J.  Frisselle.    No  record. 
P.  J.  Galloway.    No  record. 
Benjamin  P.  Grinnell.    No  record. 
J.  J.  Harris.    No  record. 

John  B.  Hartwell.    Died  at  Woodmere,  N.  Y.,'  June  23,  1902. 
L.  B.  Healey.    Died  February,  1880.    No  other  record. 
Charles  E.  Heath.    Died  at  Lee,  Mass.,  October  5,  1887,  aged  57. 
Lewis  W.  Hodgkins.    Last  known  at  Ellsworth,  Maine.    Did  not  reply 
to  inquiry  of  1906. 


424 


ALBANY  MEDICAL  COLLEGE 


Harvey  A.  Horton.  Died  as  result  of  railroad  accident.  No  other 
record. 

Delos  W.  Hunt.    No  record. 
Urban  Jansen.    No  record. 
Hammond  Johnson.    No  record. 
James  A.  Johnson.    No  record. 
J.  Russell  Little.    No  record. 

H.  W.  Lobdell.  Last  known  at  Flat  Rock,  Mich.  No  reply  to  inquiry 
of  1906. 

Thomas  Lockrow.  No  record. 
John  McAllister.  No  record. 
Henry  McKennan.    No  record. 

Henry  G.  McNaughton.  Died  at  his  home  in  Albany,  N.  Y.  in  April, 
1898. 

Alvarado  Middleditch.  Located  at  Waterloo,  Iowa,  soon  after  gradua- 
tion. Remained  there  in  active  practice  forty-seven  years,  making  a 
specialty  of  chronic  diseases  and  meeting  with  a  great  deal  of  success. 
Married  Miss  Pauline  Griffith  soon  after  graduation  and  has  one  son  and 
a  daughter.  In  the  fall  of  1903  moved  to  Pasadena,  Cal.,  where  he  now 
resides. 

John  N.  Miller.    Died  at  Poughkeepsie,  N.  Y. 

R.  V.  K.  Montfort.  Located  at  Newburg,  N.  Y.,  immediately  after  his 
graduation;  was  elected  superintendent  of  schools  in  1859;  resigned  in 
1862  to  accept  a  commission  as  assistant  surgeon  of  the  124th  N.  Y. 
Vol.  Infantry;  was  mustered  out  of  service  June,  1865,  at  the  close  of 
the  war  as  surgeon.  In  1866  he  was  appointed  as  the  first  health  officer 
of  Newburgh  and  served  four  years.  In  1872  he  was  again  appointed 
superintendent  of  schools  and  served  continuously  until  1883;  in  1887 
again  appointed  and  served  until  about  1898.  Was  married  in  1861  and  again 
in  1864  and  has  had  three  children.  Dr.  Montfort  was  a  prominent  mem- 
ber of  the  Orange  County  Medical  Society  as  well  as  several  army 
societies.    He  died  at  Newburgh  December  18,  1900. 

Charles  M.  Mosher.    Died  at  Graysville,  Ga.,  June  18,  1894. 

Wolcott  W.  Paige.    No  record. 

Rufus  Palmer.    No  record. 

Castanus  B.  Park.    Died  at  Des  Moines,  Iowa,  August  22,  1892. 
P.  Gould  Parker.    No  record. 

C.  M.  Pierce.    Died  at  Warrington,  Fla.,  October  11,  1878. 
Samuel  A.  Richardson.    No  record. 

Charles  S.  Richardson.  Died  at  Cortland,  N.  Y.,  a  short  time  after 
his  graduation,  a  victim  of  consumption. 

Aaron  W.  Riker.    Fenton,  Mich.    No  reply  to  inquiry  of  1906. 

J.  Henry  Robinson.  Began  practice  in  Southboro,  Mass.,  in  1857  and 
remained  there  in  practice  until  1896  when  he  retired.  The  doctor  was 
a  quiet,  unobtrusive  man  but  very  ambitious  and  always  had  a  large 
country  practice.  He  was  married  and  had  two  sons,  both  of  whom  were 
drowned,  his  wife  being  his  only  surviver.  He  died  March  11,  I904r 
aged  74. 

Charles  W.  Robinson.    No  record. 


ALUMNI  ASSOCIATION  PROCEEDINGS 


425 


Edward  B.  Root.  After  graduation  located  in  West  Stockbridge,  Mass., 
where  he  remained  six  years.  He  then  entered  the  service  of  the  govern- 
ment as  contract  surgeon  and  for  a  short  time  was  stationed  at  David's 
Island,  near  New  York  City.  From  there  enlisted  as  assistant  surgeon 
in  168th  N.  Y.  Infantry,  remaining  with  that  regiment  until  mustered 
out,  then  locating  at  Painesville,  Ohio,  where  he  is  still  living  in  active 
practice.  He  writes  that  his  poor  ability  as  a  collector  has  kept  a  great 
deal  more  to  his  credit  than  he  wishes. 

Robert  H.  Sabin.  Began  practice  at  Poestenkill,  N.  Y.  In  i860  he 
removed  to  West  Troy,  N.  Y.,  where  he  resided  until  his  death,  which 
occurred  on  December  4,  1888.  He  was  a  member  of  the  Masonic  fra- 
ternity of  Troy  and  of  the  Reformed  Church  of  West  Troy.  He  was 
survived  by  his  wife  and  one  son,  who,  also  a  graduate  of  our  college, 
is  in  active  practice  in  Watervliet,  N.  Y. 

Arnold  Strothotte.  Left  for  Europe  immediately  after  graduation, 
attending  universities  at  Wurzburg,  Vienna,  Prague  and  Berlin  until  1858. 
Settled  in  Newport,  Ky. ;  early  in  1861  entered  Union  Army  as  surgeon 
of  the  23rd  Regiment,  Kentucky  Vol.  Infantry;  left  army  at  end  of  1862 
on  account  of  ill  health ;  moved  to  St.  Louis,  Mo.,  where  he  was  still 
living  when  last  heard  from.  He  married  in  i860  Miss  Anna  Grazer 
of  Cincinnati.    Did  not  reply  to  inquiry  of  1906. 

George  B.  Todd.  Is  reported  to  have  died  at  the  U.  S.  Navy  Yard  at 
Pensacola,  Fla.,  of  yellow  fever.  No  date  obtained.  Held  rank  as  acting 
passed  assistant  surgeon,  U.  S.  N. 

John  Van  Buren.    No  record. 

Samuel  D.  Van  Scoy.    No  record. 

H.  Van  Tuyl.    No  record. 

Henry  -Van  Wert.  First  located  at  Pittstown,  N.  Y.,  where  he 
remained  until  1870.  From  there  he  went  to  Raymertown,  N.  Y.,  and 
practiced  there  until  he  died,  February  10,  1898,  aged  67,  of  Bright's  disease. 
He  married  April  2,  1864,  Miss  Martha  J.  Russell  and  had  three  sons, 
only  one  of  whom  survives  him.  Dr.  Van  Wert  at  one  time  served  as 
health  officer  and  justice  of  the  peace. 

Jacob  Vreeland.    No  record. 

Fleming  Webster.    No  record. 

John  P.  Wheeler.    Died  about  1864.    No  other  record. 
George  A.  Wilkins.    No  record. 

Respectfully  submitted, 

E.  E.  Hinman, 

Historian,  A.  A.,  A.  M.  C. 


426 


ALBANY  MEDICAL  COLLEGE 


HISTORY  OF  THE  CLASS  OF  1866. 

James  L.  Allaben.  Practiced  for  many  years  at  Margaretville,  N.  Y., 
where  he  died  June  II,  1890. 

Russell  G.  Andrew.  Located  at  once  at  Neversink,  N.  J.,  his  home 
town,  where  he  is  still  in  active  practice.  Married  in  1867  Miss  Susie  E. 
Johnson  of  Neversink.    He  had  two  children  both  of  whom  are  living. 

Charles  B.  Barber.  Soon  after  graduation  commenced  practice  in 
Bloomingdale,  N.  Y.  He  was  there  four  years  then  went  to  Black  Brook, 
Clinton  county,  N.  Y.,  where  he  remained  six  years.  His  next  move 
was  to  Keesville,  N.  Y.,  where  he  is  now  located  but  is  doing  very  little 
work  on  account  of  poor  health. 

Harvey  W.  Bell.    Died  at  Hatton,  Miss.,  February,  1897. 

Henry  W.  Boorn.  Soon  after  graduation  located  at  Schenevus,  N.  Y., 
where  he  is  still  enjoying  a  good  practice.  He  has  been  active  in  the 
Otsego  County  Medical  Society  and  is  now  its  secretary,  a  post  that  he 
has  filled  for  15  years.  He  has  been  actively  interested  in  educational 
matters  and  has  been  a  member  of  the  board  of  education  for  20  years. 
Was  married  in  1886  to  Miss  Kate   A.  Lane,  and  has  two  sons. 

Henry  W.  Boynton.  First  opened  his  office  for  practice  at  Laporte 
City,  Iowa,  in  1867,  remaining  there  until  the  fall  of  1870.  He  then 
moved  to  Toledo,  Iowa,  where  he  still  practices.  Was  married  while  at 
LaPorte  City  to  Miss  Ida  Elwell.  Has  been  president  of  his  county 
medical  society,  a  member  of  the  county  board  of  commissioners  of  in- 
sanity, county  physician  and  a  member  of  the  Toledo  Board  of  Health. 
He  is  U.  S.  Pension  examiner  and  examines  for  the  leading  life  insurance 
companies. 

David  S.  Bradford.    Last  known  at  Janesville,  Iowa.    No  reply  to 
inquiry  of  1906. 
William  A.  Brown.  Dead. 

Arthur  H.  Burger.    Last  known  to  be  at  Ballston  Spa,  N.  Y.  No 
reply  to  inquiry  of  1906. 
William  G.  Burnham.    No  record. 

Ovid  L.  Butts.    Died  early  in  his  practice  at  Broomeville,  N.  Y. 
Henry  A.  Clark.    No  record. 

Albert  V.  D.  Collier.  Last  known  at  Coxsackie,  N.  Y.  Did  not  reply 
to  inquiry  of  1906. 

Henry  A.  Crary.  After  graduation  he  opened  an  office  in  Albany,  where 
he  practiced  for  a  time,  being  made  ward  physician.  Later  he  removed 
to  Closter,  N.  J.,  where  he  practiced  until  the  spring  of  1876  when  he 
returned  to  Albany,  occupying  the  house  of  Dr.  Swinburne.  The  fol- 
lowing spring  he  again  returned  to  Closter,  N.  J.,  where  he  continued 
to  practice  until  1892.  On  account  of  failing  health  he  then  moved  to 
Knox,  N.  Y.,  at  which  place  he  practiced  until  obliged  to  abandon  work 
on  account  of  illness  which  resulted  in  his  death  December  25,  1903.  Dr. 
Crary  was  married  and  had  three  children. 

William  H.  DeLong.  Located  at  Salisbury  Corners,  Herkimer  county, 
N.  Y.,  and  resided  there  for  two  years.  From  there  he  moved  to 
Equinunk,  Pa.    After  a  severe  illness,  in  1873,  he  again  moved,  this  time 


ALUMNI  ASSOCIATION  PROCEEDINGS  427 

to  Emporium,  Cameron  county,  Pa.  There  he  opened  a  drug  store  and 
did  mostly  an  office  practice.  In  1884  an  attack  of  pneumonia  compelled 
him  to  go  to  Florida  for  the  winter,  recovered  and  resumed  practice  for 
two  years  longer  when  another  pneumonia  compelled  him  to  remove  to 
Florida  permanently.  He  is  doing  some  general  practice  at  his  home  in 
Emporia,  Fla.,  and  in  fair  health  at  66  years  of  age.  He  is  married  but 
has  no  children. 

Edward  J.  Dickinson.    Is  in  practice  at  Corydon,  Iowa. 

Isaac  Fowler.    No  record. 

Ezekial  W.  Gallup.  Soon  after  graduating  located  in  Stamford, 
N.  Y.,  where  he  is  still  in  active  practice.  In  1864  married  Miss 
Jennie  Rowley  of  Jefferson,  N.  Y.  Has  had  one  son  who  served  as 
chaplain  during  the  Spanish-American  War.  Dr.  Gallup  has  been  fairly 
successful  both  professionally  and  financially.  Has  served  as  coroner, 
president  of  Delaware  County  Medical  Society  and  Stamford  village  y 
was  for  many  years  a  member  of  the  board  of  education,  and  has  been 
actively  interested  in  church  circles. 

Benjamin  D.  Gifford.  Last  known  to  be  in  Boston.  Did  not  reply 
to  inquiry  of  1906. 

Charles  S.  Grant.    Died  at  Saratoga,  N.  Y.,  February  6,  1899,  aged  53. 

Allen  C.  Grover.  Practiced  for  a  number  of  years  at  Port  Henry, 
N.  Y.    He  is  reported  to  have  died  during  the  year  of  1900. 

Charles  S.  Hazeltine.  On  leaving  Albany  went  to  New  York  City 
for  post-graduate  work,  and  the  following  winter  was  appointed  attend- 
ing physician  to  the  Lying-in  Hospital  at  Buffalo,  N.  Y.  Then  went  to 
Jamestown,  N.  Y.,  and  practiced  for  a  year  and  a  half.  Results  not 
being  satisfactory  he  closed  business  and  went  into  retail  drug  business 
which  was  ..successful.  In  1874  he  sold  out  his  business  and  established 
a  wholesale  drug  business  in  Grand  Rapids,  Mich.,  which  is  now  developed 
into  large  proportions  and  is  managed  under  the  name  of  Hazeltine  & 
Perkins  Drug  Co.  In  1893  was  appointed  by  President  Cleveland  as 
United  States  Consul  at  Milan,  serving  in  that  capacity  for  two  years. 
Is  also  vice-president  of  a  national  bank  at  his  home  city,  is  married 
with  a  grown  up  family  of  four  children  and  is  a  grandfather. 

Guy  Holbrooke.  Is  supposed  to  be  at  Lowell,  Mass.  No  reply  to 
inquiry  of  1906. 

William  H.  Hull.    Died  at  Poestenkill,  N.  Y.,  about  1893. 

Peter  H.  Hulst.  Immediately  after  graduating  began  practice  in 
Schuylerville,  N.  Y.  Two  years  later  moved  to  Greenwich,  N.  Y.,  where 
he  is  still  in  practice.  He  has  been  married  three  times  and  has  several 
children.    Has  had  the  usual  ordinary  life  of  a  country  doctor. 

James  L.  Humphrey.  Last  known  at  Saratoga,  N.  Y.  No  reply  to 
letter  of  1906. 

Enoch  E.  Johnson.    No  record  except  a  report  that  he  is  dead. 
John  W.  Johnson.    No  record. 

Otho  S.  Knox.  Reported  to  have  died  at  Waterloo,  Iowa,  in  1894, 
where  he  had  practiced  for  many  years. 

Sylvester  D.  Lewis.  Last  known  at  Syracuse,  N.  Y.  No  reply  to* 
inquiry  of  1906. 


428 


ALBANY  MEDICAL  COLLEGE 


Edward  S.  May.  Last  known  to  be  in  the  Treasury  Department  at 
Washington,  D.  C.    No  reply  to  inquiry  of  1906. 

James  F.  McKown.  Began  practice  soon  after  graduation  in  Albany, 
N.  Y.,  where  he  remained  all  his  life  in  general  family  practice.  Was 
married  and  his  son  is  now  in  medical  practice  in  Albany  at  the  old  family 
home.    Dr.  McKown  died  Aug.  25,  1892,  aged  48. 

Daniel  Merville.    No  record. 

Isaac  T.  Monroe.  First  settled  in  practice  at  West  Pawlet,  Vt.  In 
1874  he  went  to  Granville,  N.  Y.,  where  he  resided  and  practiced  until 
his  death,  which  took  place  December  30,  1901,  of  broncho-pneumonia. 
In  1874  he  married  Miss  Ada  Burch  of  West  Pawlet  who  survives  him 
with  one  daughter.  He  was  a  careful  and  earnest  worker  and  greatly 
missed  in  the  community. 

James  F.  Murray.  Resided  at  Gloversville,  N.  Y.  Is  reported  to 
be  dead. 

Philip  C.  Neher.  Died  March,  1893.  He  practiced  many  years  at 
Nassau,  N.  Y. 

Albert  S.  Newcomb.  First  located  at  Centre  Brunswick,  N.  Y.,  where 
he  was  well  received  and  successful  in  practice.  Moved  from  there  to 
Troy,  N.  Y.,  where  he  made  a  specialty  of  life  insurance  examinations. 
While  there  was  also  attending  physician  to  Troy  Orphan  Asylum  and 
held  commission  as  surgeon,  National  Guard  of  the  State,  from  1868 
to  1872.  In  1875  he  moved  to  New  York  City,  where  he  has  been  in 
general  practice  ever  since.  From  1881  to  1887  was  medical  officer  to 
U.  S.  Postoffice  there.  From  1887  to  1892  was  examining  physician  for 
the  Department  of  Charities  and  Corrections  for  New  York  City  and  in 
that  time  there  were  admitted  to  the  public  hospitals  on  his  diagnosis 
more  than  150,000  destitute  sick.  From  1892  to  1899  was  medical  in- 
spector for  the  Mutual  Life  Insurance  Company  and  in  that  time  visited 
all  of  the  principal  cities  of  the  United  States  and  investigated  and 
rated  each  of  their  examiners  in  all  of  the  states  east  of  the  Rockies, 
in  all  more  than  ten  thousand  doctors. 

Daniel  V.  O'Leary.  Began  practice  in  Albany  in  the  spring  of  1867. 
Was  married  in  1878.  Has  three  sons,  the  oldest  being  a  graduate  of  the 
A.  M.  C.  class  of  1904  and  is  in  practice  with  his  father.  Has  been 
very  successful  as  a  general  practitioner  and  is  still  actively  at  work. 

Darius  S.  Orton.  Immediately  entered  upon  the  practice  of  medicine 
at  Northampton,  N.  Y.,  and  is  still  there  in  practice.  Was  appointed 
pension  examiner  in  1869  and  held  office  until  1884.  Has  always  been 
an  active  Republican  and  has  taken  a  prominent  part  in  Masonic  affairs. 
Served  four  terms  as  coroner  of  Fulton  county.  Has  been  president  of 
his  county  medical  society  and  has  been  a  permanent  member  of  the 
State  Medical  Society  since  1880.  Was  married  July  18,  1868,  to  Miss 
Anna  M.  Austin  and  has  had  five  children,  one  of  whom  died.  Is  also 
an  active  worker  in  the  Presbyterian  Church.  Has  been  successful  and 
is  well. 

George  H.  Overholt.  After  graduation  in  1866  went  to  Canada  and 
practiced  there  until  1870  when  he  movel  to  Minnesota.  He  is  now 
located  at  Kenyon,  Minn.,  and  makes  a  specialty  of  electrical  and  X-Ray 
treatments. 


ALUMNI  ASSOCIATION  PROCEEDINGS 


429 


Clair  S.  Parkhill.  Spent  the  first  six  years  of  practice  in  the  town 
of  Howard,  N.  Y.,  in  partnership  with  his  brother.  Moved  to  Hornells- 
ville,  N.  Y.,  in  September,  1873,  and  nas  been  practicing  medicine  and 
surgery  there  ever  since.  Has  been  successful  and  is  now  beginning  to 
relax  his  hard  work  a  little. 

Truman  E.  Parkman.  Died  October  24,  1904,  at  Rock  City  Falls, 
N.  Y.,  where  he  had  practiced  for  many  years  prior. 

Henderson  A.  Phillips.    Died  August  19,  1877.    No  other  record. 

Isaac  E.  Randall.  Located  at  West  Bay  City,  Mich.,  January  19,  1867, 
and  has  never  moved.  He  attended  Bellevue  Hospital  Medical  College  in 
'72  and  '73  and  graduated.  Was  married  in  1869  and  has  three  children. 
Is  president  of  the  local  board  of  pension  examining  surgeons  and  local 
surgeon  for  the  Grand  Trunk  and  Michigan  Central  railroads,  and  feels 
that  he  is  good  for  twenty  years  more  of  work. 

Thomas  O.  Reynolds.  Last  known  at  Kingston,  N.  Y.  No  reply  to 
inquiry  of  1906. 

George  W.  Rossman.    Is  doing  a  successful  practice  at  Ancram,  N.  Y. 
George  A.  Stockwell.    Last  known  at  Brooklyn,  N.  Y.    No  reply  to 
inquiry  of  1906. 
Uriah  J.  Swain.    No  record. 

Anthony  P.  Ten  Eyck.  Married  shortly  after  graduation  and  prac- 
ticed successfully  for  many  years  at  Bloomingrove,  N.  Y.,  where  he  died 
February-  4,  1893. 

John  C.  White.  Last  known  at  Port  Chester,  N.  Y.  No  reply  to 
inquiry  of  1906. 

George  O.  Williams.  Commenced  practice  at  Smithville  Flats,  N.  Y., 
on  March  27,  1867,  and  remained  there  six  years.  From  there  he  removed 
to  Greene,  N-  Y.,  and  is  still  there  in  active  practice.  He  is  married 
and  has  three  children. 

Charles  E.  Witbeck.  First  located  in  Cohoes,  N.  Y.,  where  he  is 
still  in  active  general  practice  and  very  successful.  Has  been  health 
officer  seven  terms,  is  president  of  the  Cohoes  Hospital  Staff  and  of 
the  Training  School  for  Nurses  and  is  the  dean  of  the  profession  in  that 
city.  Was  married  in  1872  and  has  one  son,  also  a  graduate  of  our 
college  who  is  associated  with  him  in  practice. 

Respectfully  submitted, 

Daniel  V.  O'Leary, 

Class  Historian. 


HISTORY  OF  THE  CLASS  OF  1886. 

George  H.  Baker.  First  located  in  Eatontown,  N.  J.,  and  remained 
there  until  1892  making  a  fair  living  and  then  moved  to  Long  Branch, 
N.  J.,  about  five  miles  distant.  He  is  still  there  enjoying  a  good  practice. 
He  is  a  member  of  the  State,  County  and  District  medical  societies  and 
last  year  was  president  of  the  Alumni  Association  of  Greater  New  York. 
Served  as  a  member  of  the  board  of  health  for  four  years,  the  last  year 


43Q 


ALBANY  MEDICAL  COLLEGE 


as  its  president,  and  is  at  the  present  time  president  of  the  Long  Branch 
Board  of  Trade.    Has  never  mingled  in  politics. 

Joseph  E.  Baynes.  Was  last  known  to  be  in  practice  in  Troy,  N.  Y. 
No  reply  to  inquiry  of  1906. 

Adam  J.  Blessing.  Has  built  up  a  successful  practice  in  Albany,  N.  Y. 
Is  married. 

William  P.  Brierley.  After  graduating  remained  with  Dr.  Swinburne 
of  Albany  two  years.  In  March,  1888,  went  to  Kansas  City,  Mo.,  but 
soon  returned  to  Albany  where  he  is  still  doing  a  successful  family 
practice.    Is  married  and  has  three  sons. 

Alfred  L.  Browne.  Started  in  practice  at  Cornwall-on-Hudson,  N.  Y., 
where  he  died  May  3,  1898. 

William  B.  Campbell.  Started  in  practice  in  Albany,  N.  Y.,  but  after 
a  year  moved  to  Garratsville,  N.  Y.,  where  he  remained  over  thirteen 
years,  moving  from  there  to  Edmeston,  N.  Y.,  where  a  good  paying 
general  practice  has  developed.    Is  married  and  has  one  daughter. 

Arthur  T.  Capron.  Has  always  practiced  in  Albany,  N.  Y.,  where 
he  is  at  present. 

James  Carr.  For  a  great  many  years  after  graduation  was  connected 
with  a  pharmaceutical  manufacturing  house  in  New  York  City.  He 
died  December,  1905,  of  pneumonia. 

James  A.  Clyne.  First  located  at  Joliet,  111.  At  the  end  of  his  second 
year  there  was  appointed  surgeon  of  the  Chicago  and  Alton  Railroad, 
which  position  he  held  many  years.  In  the  autumn  of  1891  was  married. 
In  1893  was  appointed  health  commissioner  for  two  years.  Did  not  reply 
to  inquiry  of  1906. 

Eugene  H.  Coons.  Last  known  at  Gloversville,  N.  Y.  Did  not  reply 
to  inquiry  of  1906. 

John  A.  Cutter.  Has  been  located  in  New  York  City  ever  since 
graduation  except  while  away  for  a  few  months  of  special  study.  Gives 
special  attention  to  the  treatment  of  chronic  diseases.  Was  married  but 
lost  his  wife  in  1896.    Has  never  remarried. 

William  H.  Delamater.  Last  known  at  Mariaville,  N.  Y.  No  reply 
to  inquiry  of  1906. 

Noah  L.  Eastman.  Began  practice  in  Albany,  N.  Y.,  very  soon  after 
his  graduation  where  he  continued  in  general  family  work  until  his 
death,  which  occurred  October  23,  1905.  He  was  married  and  had  one 
child. 

Elmer  E.  Finch.  First  practiced  in  Watervliet,  N.  Y.,  one  year  as 
assistant  to  Dr.  Orson  Cobb.  From  there  he  moved  to  New  York  City 
and  remained  one  year.  Leaving  New  York  he  moved  to  Schodack 
Centre,  N.  Y.,  where  he  still  practices.    He  was  married  in  1893. 

John  F.  Fitzgerald.  After  a  term  of  service  as  interne  at  St.  Peter's 
Hospital  entered  the  state  service  as  assistant  physician  at  the  Bingham- 
ton  State  Hospital  where  he  remained,  passing  through  the  various  grades 
until  1893  when  he  was  appointed  superintendent  of  the  Rome  State 
Custodial  Asylum,  remaining  such  until  1902  at  which  time  he  was  trans- 
ferred to  the  position  of  general  medical  superintendent  of  the  boroughs 
of  Brooklyn  and  Queens  in  the  Department  of  Public  Charities,  where 
he  is  at  present.    Is  married  and  has  two  children. 


ALUMNI  ASSOCIATION  PROCEEDINGS 


431 


Alfred  K.  Freiot.  Was  last  known  to  be  in  Troy,  N.  Y.  No  reply 
to  inquiry  of  1906. 

Hermon  C  Gordinier.  Has  a  very  large  practice  in  Troy,  N.  Y.  He 
has  made  a  specialty  of  physiology  of  the  nervous  system  and  has  pub- 
lished a  book  on  the  subject.  Is  a  member  of  the  faculty  of  the  college 
in  that  department. 

Alfred  H.  Hoadley.  After  serving  as  interne  at  the  old  Albany  Hos- 
pital went  directly  to  Northampton,  Mass.,  where  he  is  doing  a  general 
practice.  He  serves  on  the  surgical  staff  of  the  hospital  at  that  place. 
Is  married  and  has  two  boys. 

James  A.  Holley.  First  located  at  Delancy,  N.  Y.,  and  remained  there 
about  six  months.  From  there  he  moved  to  Walton,  N.  Y.,  where  he 
is  still  doing  a  general  practice.  Has  prospered  and  is  successful  in 
his  profession.    He  is  married  but  has  no  family. 

Dayton  L.  Kathan.  Remained  in  the  Albany  Hospital  for  eighteen 
months  and  then  located  at  Schenectady,  N.  Y.,  where  he  has  been  con- 
tinuously in  general  practice  ever  since.    He  is  married  and  has  one  son. 

Arie  V.  Klock.  Was  last  known  at  Ames,  N.  Y.  No  reply  to  inquiry 
of  1906. 

William  H.  Lemrow.    Died  at  New  York  City  May  17,  1897. 

Harry  M.  Lincoln.  Began  practice  at  Wilton,  N.  Y.,  soon  after 
graduation  and  is  still  there  in  general  work.  Was  supervisor  of  the 
town  in  1891  and  1892.  He  has  been  health  officer  for  a  number  of 
years.    He  lives  with  his  mother,  never  having  married. 

Charles  B.  Mallery.  In  1896  was  in  practice  in  Corinth,  N.  Y.,  from 
which  place  he  wrote  that  he  was  having  good  success.  He  is  said 
now  to  be  in  Aberdeen,  South  Dakota,  but  did  not  reply  to  inquiry 
of  1906. 

Richard  H.  McCarty.  Began  practice  in  Schuylerville,  N.  Y.,  remain- 
ing there  seven  years  and  then  moved  to  Saratoga,  N.  Y.,  where  he  is 
at  present.  Was  coroner  of  Saratoga  county  for  eighteen  years,  town 
doctor  of  Schuylerville  for  seven  years  and  is  now  town  physician  of 
Saratoga.  He  has  been  active  in  Republican  politics.  He  has  a  private 
hospital  and  is  enjoying  a  first-class  practice. 

Francis  T.  McIntosh.  First  located  in  Troy,  N.  Y.,  where  he  remained 
until  his  death,  which  took  place  May  5,  1901.  He  served  for  several 
years  as  district  physician  faithfully  doing  his  duty  in  spite  of  the  ravages 
of  pulmonary  tuberculosis. 

William  McNaughton.  Practiced  for  years  in  West  Troy,  N.  Y.  Did 
not  reply  to  inquiry  of  1906. 

Joseph  S.  Parent.  First  located  for  practice  at  Birchton,  N.  Y.,  this 
address  has,  since  the  advent  of  rural  free  delivery,  been  changed  to 
Ballston  Spa,  R.  F.  D.  No.  2.,  N.  Y.,  where  he  is  still  in  general  practice. 

Ransom  J.  Perry.  Last  known  at  Key  West,  Fla.  No  reply  to  inquiry 
of  1906. 

James  H.  Reilly.  Spent  the  first  six  years  in  Rutland  county,  Vt. 
In  1894  accepted  the  position  of  medical  examiner  for  the  Metropolitan 
Life  Insurance  Company  at  Memphis,  Tenn.  Is  now  examiner  in  chief 
for  this  place  with  five  assistants.    Is  married  and  has  two  children. 

& 


432 


ALBANY   MEDICAL  COLLEGE 


John  A.  Robson.  Has  been  in  practice  at  Halls  Corners,  N.  Y.,  and 
immediate  vicinity  ever  since  graduation.  He  is  married  and  has  three 
children. 

J.  Wesley  Sheffield.  In  1896  was  in  practice  at  Sidney,  N.  Y.  Later 
advices  report  him  to  be  located  at  present  at  Binghamton,  N.  Y.  No 
reply  to  inquiry  of  1906. 

Wellington  G.  Steele.  Began  practice  at  Mongaup  Valley,  N.  Y., 
where  he  is  still  in  active  practice.  He  was  married  in  1889  and  has 
four  children. 

Arthur  D.  Stowitz.  Last  known  to  be  at  Sidney,  Neb.  No  reply  to 
inquiry  of  1906. 

Edward  H.  Tafft.  Last  known  at  Adams,  N.  Y.  No  reply  to  inquiry 
of  1906. 

Adrian  P.  Van  Deinse.  In  1896  was  enjoying  a  good  practice  at 
Sayville,  L.  I.    No  reply  to  inquiry  of  1906. 

Charles  T.  Walton.  Last  known  at  Port  Henry,  N.  Y.  No  reply  to 
inquiry  of  1906. 

Stephen  H.  Webster.  Spent  one  year  after  graduating  in  post- 
graduate study  in  New  York  City.  He  spent  the  year  1889  in  Europe. 
Was  married  and  practiced  in  Troy,  N.  Y.,  until  his  death,  which  occurred 
January  6,  1899. 

William  M.  White.  Began  practice  soon  after  graduation  in  Amster- 
dam, N.  Y.  In  1890  he  came  into  the  practice  of  his  father  who  died. 
Was  at  various  times  secretary,  treasurer  and  president  of  the  Montgomery 
County  Homeopathic  Medical  Society  and  one  of  the  Board  of  Censors 
of  the  State  Homeopathic  Society.    He  died  December  29,  1905,  aged  50. 

Richard  A.  Woodruff.  Soon  after  graduating  located  in  Spottville, 
N.  Y.,  where  he  remained  until  1889.  The  next  few  months  were  spent 
in  travel.  In  December,  1889,  located  at  Philmont,  N.  Y.,  and  remained 
there  until  1900.  The  next  year  was  devoted  to  special  study  at  Johns 
Hopkins  Hospital  with  a  few  months  preparatory  work  under  Dr.  Blumer 
at  Albany.  In  August,  1901,  located  at  Pittsfield,  Mass.,  where  he  is 
at  work.  He  has  the  supervision  of  the  pathological  work  at  the  hospital 
in  that  city  and  is  the  medical  examiner  of  the  board  of  health.  Was 
married  in  1896  and  has  one  son. 

Respectfully  submitted, 

W.  P.  Brierley, 

Class  Historian. 


HISTORY  OF  THE  CLASS  OF  1806. 

Sanford  Bessler.  Is  in  practice  at  Joliet,  111.  He  writes  that  he 
has  been  in  poor  health  since  1896  and  has  had  to  eliminate  all  charity 
work. 

Albert  C.  Baxter.  Is  said  to  be  in  practice  at  Scriba,  N.  Y.  No 
reply  to  inquiry  of  1906. 

Julius  W.  Blakely.  Is  said  to  be  in  practice  at  Meridale,  N.  Y. 
No  reply  to  inquiry  of  1906. 


ALUMNI  ASSOCIATION  PROCEEDINGS 


453 


William  I.  Brandow.    No  record. 

John  P.  Carver.  First  located  at  New  Hartford,  Conn.  During  his 
third  year  there  he  was  married  to  Miss  Eno  of  Limsbury,  Conn.  In 
1900  he  moved  from  New  Hartford  and  took  a  year's  post-graduate 
course,  returning  to  Limsbury,  where  he  has  continued  in  general  practice 
ever  since.     He  has  two  daughters. 

Frederick  T.  Clark.  Immediately  after  graduation  was  appointed 
interne  at  the  State  Hospital  at  Poughkeepsie,  remaining  there  until 
September  first,  when  he  resigned  and  was  appointed  house  officer  at 
the  Albany  Hospital.  After  a  year's  service  at  Albany  resigned  to  accept 
another  appointment  at  Poughkeepsie  as  junior  assistant  physician.  He 
remained  there  two  years  and  a  half,  becoming  interested  while  there  in 
the  treatment  of  diseases  of  the  nose,  throat,  eye  and  ear,  which  specialty 
he  is  now  following.  After  spending  a  few  months  in  study  in  New 
York  he  opened  his  office  at  Westfield,  Mass.,  his  native  city.  He  is 
now  attending  specialist  at  Noble  Hospital  and  Shurtleff's  Children's 
Home.    He  married  in  June,  1902,  Miss  Emily  Rogers  of  Milwaukee,  Wis. 

Walter  M.  Clark.  Shortly  after  graduation  was  appointed  interne 
at  the  Matteawan  State  Hospital  where  he  has  remained  and  is  now 
second  assistant  physician.  In  1904  married  Miss  Edith  Simpkins  of 
Ticonderoga,  N.  Y.    Has  one  child,  a  daughter. 

Edward  J.  Collier.  Is  in  practice  at  Amsterdam,  N.  Y.  Did  not  reply 
to  inquiry  of  1906. 

John  J.  Dever.  Is  in  practice  at  Glens  Falls,  N.  Y.  Did  not  reply 
to  inquiry  of  1906. 

Fred  B.  Dezell.  Soon  after  graduation  opened  his  office  in  Lynn, 
Mass.,  where  he  has  a  large  practice.  Confines  himself  to  general  medical 
work.  He  is  medical  inspector  for  the  city  schools.  Is  a  member  of 
several  medical  societies.  Was  married  April  10,  1901,  to  Miss  Minnie 
Haines  of  Colliers,  N.  Y. 

Rudolph  Deidling.  In  the  fall  of  1896  was  appointed  physician  at 
the  Reformatory  at  Elmira,  N.  Y.,  which  position  he  held  until  1898, 
going  from  there  into  active  practice  at  Saugerties,  N.  Y.,  where  he 
still  remains.  Is  at  present  surgeon  for  the  Alsen  American  Portland 
Cement  Company,  the  American  Ice  Company  and  the  Catskill  Cement 
Company.    Was  married  January  2,  1900,  and  has  a  son  and  daughter. 

Harry  O.  Fairweather.  After  graduation  served  one  year  as  interne 
in  the  Saratoga  Hospital.  Spent  the  following  year  in  post-graduate 
work  at  Baltimore,  Md. ;  returned  to  Troy,  N.  Y.,  and  served  as  assistant 
pathologist  in  Troy  Hospital.  He  opened  his  offices  in  the  spring  of  1899 
in  Troy  and  devotes  himself  to  the  diseases  of  the  throat  and  nose.  Is 
attending  specialist  to  the  House  of  Good  Shepherd  and  St.  Vincent's 
Asylum  and  assistant  on  the  staff  of  the  Troy  Hospital.  Is  assistant 
surgeon  in  the  National  Guard,  ranking  as  first  lieutenant,  and  a  mem- 
ber of  the  Association  of  Military  Surgeons  of  the  United  States.  He 
is  unmarried. 

Arthur  E  Falkenbury.  After  graduating  remained  in  Albany  one 
year  and  then  opened  an  office  in  New  York,  remaining  there  until 
January  4,  1900,  when  he  located  in  Whitehall,  N.  Y.,  where  he  is  now 


434 


ALBANY  MEDICAL  COLLEGE 


in  general  practice.  Has  met  with  good  success,  is  married  and  has 
one  daughter. 

Henry  Field.  After  practicing  a  short  time  at  Cold  Brook,  N.  Y., 
he  removed  to  Marathon,  N.  Y.,  where  he  is  now  in  general  practice. 
Has  been  married  and  has  two  boys.  He  is  a  trustee  of  the  Methodist 
Church,  health  officer  of  the  town  and  a  member  of  the  Board  of 
Education. 

Leland  L.  Fillmore.  After  leaving  college  was  interne  at  the  Albany 
Hospital  until  May,  1897,  when  he  married  Miss  E.  Josephine  Moore 
of  Bennington,  Vt,  and  a  few  months  later  went  to  Sheffield,  Vt.,  where 
he  remained  two  years  and  a  half.  He  then  returned  to  Bennington 
where  he  practiced  until  November,  1904.  During  that  time  held  office 
of  village  president  for  one  term.  Owing  to  his  wife's  poor  health  he 
moved  to  Los  Angeles,  Cal.,  but  has  not  been  in  active  practice. 

John  C.  Fusmer.  Was  last  known  at  Palatine  Bridge,  N.  Y.  No  reply 
to  inquiry  of  1906. 

Edward  Gillespie.  After  graduating  went  directly  to  Binghamton 
State  Hospital.  He  has  continued  in  the  service  and  is  now  assistant 
physician.  Was  married  November  20,  1902,  to  Miss  Rose  Curran  of 
Binghamton.    He  has  no  family. 

George  B.  Grady.  Located  in  Watervliet,  N.  Y.,  soon  after  graduation 
and  is  still  there  in  general  practice.  He  has  served  as  health  officer 
for  two  terms. 

Ira  D.  Hasbrouck.  Is  doing  a  general  practice  at  Washington,  R.  I. 
He  is  married  but  mentions  no  family. 

Frank  A.  Hennessy.  Last  known  at  Westport,  N.  Y.  No  reply  to 
inquiry  of  1906. 

Irving  Holley.  Worked  for  the  first  fourteen  months  after  graduation 
at  the  Marshal  Sanitarium,  Troy,  N.  Y.  He  then  moved  to  Watervliet, 
N.  Y.,  remaining  there  four  months.  He  was  appointed  to  service  at 
the  Manhattan  State  Hospital,  New  York  City,  where  he  remained  for 
two  years,  at  which  time  he  was  transferred  to  Willard  State  Hospital 
where  he  is  now  located.  He  writes  that  he  is  single,  has  learned  to 
swear  and  use  tobacco  but  has  never  written  for  the  medical  press. 

John  W.  Jennings.  First  located  at  Fly  Creek,  N.  Y.,  but  now  lives 
at  East  Springfield,  N.  Y.,  and  is  doing  a  good  practice.  He  has  been 
married  seven  years  and  has  one  son. 

Garrett  V.  Johnson.  Began  practice  in  Oneonta,  N.  Y.,  where  he 
stayed  until  1898  when  he  went  to  the  front  at  the  outbreak  of  the 
Spanish  War,  being  a  member  of  Co.  G,  First  Regiment,  N.  G.  N.  Y. 
On  October  6,  1898,  was  sent  from  Honolulu,  H.  I.,  to  Washington, 
D.  C,  on  detached  service;  was  mustered  out  of  service  February,  1899. 
He  then  located  in  Schenectady,  N.  Y.,  where  he  is  doing  a  fine  business. 
He  is  married  and  has  one  daughter. 

Henry  W.  Keater.  Fie  is  located  at  Griffins  Corners,  N.  Y.,  and  is 
doing  a  good  business.    He  is  married  and  has  one  son. 

Frank  A.  Keller.  January,  1897,  started  from  Toronto,  Canada,  for 
China,  reaching  Shanghai  March  4th.  After  studying  the  language  was 
sent  to  the  province  of  Hunan  and  began  the  work  of  a  medical  missionary. 


ALUMNI  ASSOCIATION  PROCEEDINGS 


435 


At  that  time  there  was  not  a  single  missionary  in  that  province  number- 
ing over  twenty  million  people.  In  March,  1899,  was  driven  from  his 
station  by  rioters,  losing  everything.  A  few  months  later  was  re-estab- 
lished in  Hunan  by  the  kind  offices  of  the  Governor  of  Hunan.  In 
June,  1900,  was  once  more  driven  out  by  the  Boxers,  and  for  two  weeks 
in  great  peril.  He  was  next  sent  to  Chefoo,  in  North  China,  to  take 
charge  of  a  large  hospital  there  and  relieve  the  missionary  in  charge, 
who  was  ill.  He  spent  seven  months  there  and  then  again  returned  to 
Changsha,  the  capitol  city  of  Hunan,  where  he  did  a  very  extensive 
work  as  a  pioneer.  In  November,  1902,  was  married  to  Miss  Tilley  of 
Toronto,  the  ceremony  being  performed  at  Shanghai.  In  August,  1905, 
they  sailed  for  home  and  is  now  in  Philadelphia  taking  a  post-graduate 
work  at  the  Polyclinic  preparing  for  another  term  of  work  in  China. 

Frank  B.  Maynard.  Soon  after  graduation  began  practice  at  Brock- 
port,  N.  Y.,  and  removed  to  Rochester  in  1899  where  he  is  now  doing 
general  practice. 

James  T.  McKenna.  Is  in  practice  in  Troy,  N.  Y.,  where  he  gives 
special  attention  to  expert  work  in  court  as  specialist  in  insanity  and 
nervous  disorders.    He  is  married  and  has  three  children. 

Frank  McLean.  He  first  located  at  Tunnel,  N.  Y.,  but  soon  removed 
to  Chenango  Forks,  N.  Y.,  where  he  has  since  been.  He  also  owns 
and  runs  the  local  drug  store.    He  is  married  and  has  three  children. 

Amasa  Parker  Muir.  Immediately  after  graduation  was  appointed 
to  a  position  at  Manhattan  State  Hospital,  serving  there  for  a  number 
of  years.  He  then  took  up  his  residence  in  New  York  City  where 
he  was  making  a  good  record.  At  the  time  of  his  death  he  was  an 
officer  of  the  New  York  City  Alumni  Association. 

Parker  Murphy.  Began  practice  at  his  present  address,  Rochester, 
N.  Y.,  and  is  doing  well.  He  is  married  and  has  "  less  than  ten 
children." 

Francis  P.  O'Brien.  Last  known  at  Fort  Edward,  N.  Y.  No  reply  to 
inquiry  of  1906. 

Elbert  A.  Palmer.    Is  in  practice  at  Saratoga,  N.  Y. 

Edward  J.  Parish.  Last  known  to  be  in  New  York  City.  No  reply 
to  last  inquiry  and  postal  authorities  advise  that  he  is  not  in  the 
directory. 

Francis  X.  Pidgeon.  Was  last  known  at  467  Hudson  street,  New  York 
City.    No  reply  to  inquiry  of  1906. 

Albert  H.  Rodgers.  Was  house  physician  at  Albany  Hospital  until 
1897.  He  then  took  a  course  in  Homeopathic  treatment,  graduating 
May  5,  1898,  from  the  New  York  Homeopathic  Medical  College  and 
Hospital.  He  is  now  located  at  Corning,  N.  Y.  Was  married  December 
12,  1901,  to  Miss  Mary  Stoneman  of  Albany. 

Thomas  Avery  Rogers.  Located  in  Plattsburg,  N.  Y.,  in  1896  and 
has  remained  there  in  general  practice.  The  Clinton  County  Medical 
Society  elected  him  president  in  1901  and  he  has  been  for  the  past  two 
years  secretary  of  the  Physicians'  Club.  Was  recently  elected  member  of 
the  House  of  Delegates  of  the  State  Medical  Society  from  Clinton 
County  Society.    He  was  married  in  1902. 


436 


ALBANY   MEDICAL  COLLEGE 


Waldo  Sanford.  After  graduation  served  a  term  at  St.  Peter's  Hos- 
pital. From  there  he  went  to  Brewsters,  N.  Y.,  and  remained  for  about 
two  and  a  half  years.  While  there  he  was  married  to  Miss  Hannah 
Hamlin  of  Albany.    He  is  now  located  at  Saratoga,  N.  Y. 

Will  H.  Swartz.  Soon  after  graduating  located  at  Colton,  N.  Y., 
where  he  is  still  at  work.    He  is  married  and  has  two  children. 

Jesse  M.  W.  Scott.  First  served  one  year  as  medical  interne  at 
Matteawan  State  Hospital;  the  following  year  as  resident  interne  at 
Albany  Hospital;  July,  1898,  to  April,  1899,  junior  assistant  physician  at 
Matteawan  State  Hospital;  April,  1899,  to  February,  1902,  assistant 
physician,  and  February,  1902,  the  last  year,  as  acting  superintendent. 
He  is  now  located  at  Schenectady,  N.  Y.,  doing  general  practice.  He 
was  married  March  15,  1903,  to  Miss  Leila  Mapes  of  Fishkill,  N.  Y.,  and 
has  one  daughter. 

James  C.  Sharkey.  Is  in  general  practice  in  Rensselaer,  N.  Y.,  where 
he  first  located  in  1896.  Was  married  in  June,  1904,  but  lost  his  wife 
in  November,  1905.  He  has  been  three  times  health  officer  and  has  held 
several  minor  political  offices. 

Henry  L.  K.  Shaw.  After  graduating  was  interne  at  St.  Peter's 
Hospital  and  later  junior  physician  at  the  Utica  State  Hospital.  After 
spending  some  time  abroad  in  the  study  of  pediatrics  he  returned  to 
Albany  where  he  is  now  in  practice  giving  his  special  attention  to 
children.  He  takes  a  prominent  part  in  all  local  and  state  medical  affairs 
and  has  been  elected  to  membership  in  the  American  Pediatric  Society. 
On  March  29,  1906,  he  married  Miss  Burrell  of  Little  Falls,  N.  Y.,  and 
at  the  present  time  is  abroad  on  his  honeymoon. 

Edward  G.  Stout.  Was  last  known  at  the  Utica  State  Hospital.  No 
reply  to  inquiry  of  1906. 

Roscoe  J.  Taylor.  Was  last  known  at  Antwerp,  N.  Y.  No  reply  to 
inqury  of  1906. 

Burton  Van  Zandt.  Is  practicing  at  Schenectady,  N.  Y.  He  did  not 
reply  to  inquiry  of  1906. 

John  D.  Vedder.  Remained  in  Albany  about  six  months  after  gradua- 
tion and  then  settled  at  Johnstown,  N.  V.,  where  he  is  still  in  practice. 
He  has  been  health  officer  and  city  physician,  is  married  and  has  one  son. 

Joseph  E.  Vigeant.  After  leaving  college  went  to  his  home  in  Massa- 
chusetts where  he  only  remained  a  short  time  and  then  located  at 
Elizaville,  N.  Y.  There  he  remained  seven  years  and  moved  to  Red 
Hook,  N.  Y.,  his  present  home.  He  was  married  in  1901  and  has  two 
children. 

Edward  J.  Wiencke.  Has  practiced  in  Schenectady,  N.  Y.,  ever  since 
his  graduation  and  has  no  complaint  to  make.  He  is  married  and  has 
two  children. 

Thomas  G.  Wright.  He  practiced  in  Troy,  N.  Y.,  from  the  time  of 
his  graduation  until  his  death,  which  occurred  February  9,  1906,  follow- 
ing an  attack  of  typhoid  fever.  He  was  ill  about  twelve  weeks  and 
succumbed  to  complications  which  followed  the  fever.  He  was  buried 
with  military  honors,  being  at  the  time  of  his  death  assistant  surgeon, 
Co.  D,  Second  Regiment.  N.  G.  N.  Y.,  with  rank  of  first  lieutenant. 


ALUMNI  ASSOCIATION  PROCEEDINGS 


437 


His  class  was  represented  at  the  funeral  by  Drs.  Fairweather  and  Grady 
who  acted  as  bearers. 

Jerome  E.  Young.  He  was  last  known  at  Lansingburg,  N.  Y.  No 
answer  to  inquiry  of  1906. 

Phillip  S.  Young.    Began  practice  at  East  Springfield,  N.  Y.,  con- 
tinuing there  until  1904  when  he  removed  to  Bainbridge,  N.  Y.,  where 
he  is  at  present.    He  was  married  in  the  spring  of  1809. 
K.  A.  Bushnell.    Died  at  Little  Falls,  N.  Y.,  December  23,  1896. 

Respectfully  submitted, 

Thomas  Avery  Rogers, 

Class  Historian. 


The  Nominating  Committee,  by  its  Secretary,  Dr.  Mitchell, 
then  made  the  following-  report: 

Report  of  the  Nominating  Committee. 

For  President, 
Thomas  Wilson  ('74),  Hudson,  N.  Y. 

For  Vice-Presidents, 
Frederick  L.  Classen  ('81),  Albany,  N.  Y. 
James  A.  Clyne  ('86),  Joliet,  111. 
Charles  P.  McCabe  ('83),  Greenville,  N.  Y. 
Robert  W.  Andrews  ('98),  Poughkeepsie,  N.  Y. 
James  W.  King  ('84),  Tivoli,  N.  Y. 

For  Recording  Secretary, 
J.  Montgomery  Mosher  ('89),  Albany,  N.  Y. 

For  Corresponding  Secretary, 
Andrew  MacFarlane  ('87),  Albany,  N.  Y. 

For  Treasurer, 
Robert  Babcock  ('84),  Albany,  N.  Y. 

For  Historian, 
Eugene  E.  Hinman  C99),  Albany,  N.  Y. 

For  Members  of  the  Executive  Committee  (term  three  years), 
Arthur  Sautter  ('94),  Albany,  N.  Y. 
Terence  L.  Carroll  ('85),  Albany,  N.  Y. 
Leo  F.  Adt  ('92),  Albany,  N.  Y.  ' 
E.  Gerald  Griffin  ('01),  Albany,  N.  Y. 


438 


ALBANY  MEDICAL  COLLEGE 


On  motion  of  Dr.  Tucker,  the  Secretary  was  directed  to  cast 
one  ballot  for  the  names  contained  in  the  report.  The  Secretary 
then  read  these  names  and  President  Tefft  declared  the  members 
named  in  the  report  the  duly  elected  officers  of  the  Association, 
for  their  respective  terms. 

Dr.  Earl  D.  Fuller  and  Dr.  Willis  G.  Tucker,  being  called  upon, 
made  brief  extemporaneous  remarks. 

The  Recording  Secretary  made  the  usual  announcements  of 
the  further  program  of  the  day,  and  no  other  business  appear- 
ing, the  meeting  adjourned. 

Commencement  Exercises. 

The  seventy-fifth  commencement  exercises  of  the  Albany 
Medical  College  were  held  at  Odd  Fellows'  Hall,  on  Tuesday 
Afternoon,  May  I,  1906,  at  three  o'clock,  in  the  presence  of  a 
large  audience.  Rev.  Dr.  A.  V.  V.  Raymond,  Chancellor  oi 
Union  University,  presided,  and  upon  the  stage  were  seated  the 
members  of  the  Faculty,  officers  of  the  Alumni  Association  and 
prominent  citizens. 

The  following  was  the 

ORDER  OF  EXERCISES. 

Overture — "  Summernight's  Dream  "  

Prayer — Rev.  J.  V.  Moldenhauer 

Music — Intermezzo,  "  Poppies  "  

Essay — Theobald  Frederick  Doescher 

Music — Selection,  "  Mexicana  "  

CONFERRING  DEGREES 
By  Andrew  Van  Vranken  Raymond,  D.  D.,  LL.D., 
Chancellor  of  the  University 

Music — Idylle,  "The  Flatterer"  Chatninade 

Address  to  the  Graduating  Class — Hon.  Andrew  S.  Draper.  LL.D. 

Music — March  Espangnol,  "  Sorella  "  Gallini 

Valedictory — Lemon  Dwight  Washburn 
Report  on  Prizes  and  Appointments — Joseph  D.  Craig,  M.  D. 

Music — Finale,  "Down  the  Field"  Friedman 

[Holding's  Orchestra] 


.  .Suppe 
.  .Moret 

Hubbell 


ALUMNI  ASSOCIATION  PROCEEDINGS 


439 


The  Graduating  Class  was  as  follows; 

Henry  Francis  Albrecht  Troy,  N.  Y. 

Fred  Nicholas  Bibby  Pottersville,  N.  Y. 

John  Breen  Wevertown,  N.  Y. 

Roy  Munro  Collie  Johnstown,  N.  Y. 

Morey  Charles  Collier,  Ph.  B  Savona,  N.  Y. 

Charles  Elisha  Collins,  Ph.  G  Troy,  N.  Y. 

Frederick  Charles  Conway  Albany,  N.  Y. 

Edward  Adt  Dean  Sardinia,  N.  Y. 

Adelbert  Stephen  Dederick  Cohoes,  N.  Y. 

Theobald  Frederick  Doescher  Albany,  N.  Y. 

Lee  Roy  Dunbar  Gloversville,  N.  Y. 

Willis  Woodford  Dutcher  Albany,  N.  Y. 

Vernon  R.  Ehle  Gloversville,  N.  Y. 

Hermon  Ernest  Gak  Fairmount,  N.  Y. 

George  Reinhold  Goering  Utica,  N.  Y. 

Stowell  Burroughs  Grant  Afton,  N.  Y. 

Percival  William  Harrig  Albany,  N.  Y. 

Joseph  Friend  Harris  Albany,  N.  Y. 

Clinton  Benjamin  Hawn,  B.  S  Albany,  N.  Y. 

Samuel  Orestes  Kemp,  Jr  Albany,  N.  Y. 

Winfield  Snell  Kilts  Fort  Plain,  N.  Y. 

William  Andrew  Krieger  Poughkeepsie,  N.  Y. 

Price  Lewis  Remsen,  N.  Y. 

Floyd  Dempster  Michael  Lassellsville,  N.  Y. 

David  Cushing  Nolan  Albany,  N.  Y. 

Charles  Albert  Prescott  North  Creek,  N.  Y. 

Walter  Ancel  Reynolds  Albany,  N.  Y. 

John  Fletcher  Robinson,  A.  B  Albany,  N.  Y. 

Willis  Nelson  Simons  Canajoharie,  N.  Y. 

Eugene  Gillis  Steele  North  Adams,  Mass. 

Lemon  Dwight  Washburn  Fort  Ann,  N.  Y. 

Edward  Gove  Whipple  Malone,  N.  Y. 


Dr.  Craig  presented  the  prizes.  He  read  a  report  on  the  Vander 
Poel  prize,  endowed  by  Mrs.  Gertrude  W.  Vander  Poel,  in 
memory  of  her  husband,  the  late  S.  Oakley  Vender  Poel,  for 
many  years  a  professor  in  the  college,  stating  that  the  prize,  con- 
sisting of  a  clinical  microscope  and  accessories,  offered  to  the 
senior  student  passing  the  best  bedside  examination  in  general 
medicine,  has  been  awarded  to  Dr.  Frederick  Doescher,  with 
honorable  mention  of  Dr.  Vernon  R.  Ehle,  and  that  the  com- 
petitive examination  for  house  physicians  and  surgeons  at  the 
Albany  Hospital  the  following  appointments  had  been  made: 
Drs.  Percival  W.  Harrig,  T.  Frederick  Doescher,  LeRoy  Dunbar, 
William  A.  Krieger,  Walter  A.  Reynolds,  Joseph  F.  Harris  and 


440 


ALBANY  MEDICAL  COLLEGE 


Fred  N.  Biddy;  at  St.  Peter's  Hospital,  Drs.  Morey  C.  Collier, 
John  Breen  and  Willis  N.  Simons;  at  the  Samaritan  Hospital, 
Troy,  Drs.  Adelbert  S.  Dederick  and  Winfield  S.  Kilts;  at  the 
Ellis  Hospital,  Schenectady,  Drs.  Roy  M.  Collie,  Clinton  B.  Hawn 
and  Vernon  R.  Ehle ;  at  Seton  Hospital,  New  York  City,  Dr. 
Edward  G.  Whiffle;  at  the  Utica  Hospital,  Dr.  Stowell  B.  Grant. 
Dr.  John  Fletcher  Robinson  had  been  appointed  assistant  in 
surgical  pathology  at  the  Bender  Hygienic  Laboratory,  and  Dr. 
Charles  W.  L.  Hacker,  of  the  Class  of  1905,  pathologist  at  the 
Albany  Hospital. 

The  prize  offered  by  Drs.  Vander  Veer  and  Macdonald  for 
the  best  report  of  the  surgical  clinics  was  awarded  to  Dr.  J. 
Fletcher  Robinson.  For  the  second  best  report  of  these  clinics, 
the  prize  offered  by  Drs.  Hale  and  Morrow  was  awarded  to 
Dr.  Percival  W.  Harrig,  with  honorable  mention  of  Dr.  Joseph 
F.  Harris. 

The  prize  consisting  of  an  ophthalmoscope,  offered  by  Dr. 
Merrill  for  the  best  report  of  the  eye  and  ear  clinics,  was  awarded 
to  Dr.  Joseph  F.  Harris. 

The  Townsend  Physiological  prize  endowed  by  the  late  Pro- 
fessor Franklin  Townsend,  Jr.,  M.  D.,  was  awarded  to  Mr. 
Charles  E.  Slater,  for  passing  the  best  examination  in  physiology 
at  the  end  of  the  first  year  of  study.  The  second  best  examination 
was  passed  by  Mr.  ,W.  F.  Conway. 

Dr.  Boyd's  prize  to  the  student  passing  the  best  final  examina- 
tion in  obstetrics  was  awarded  to  Dr.  LeRoy  Dunbar. 

The  prize  consisting  of  a  case  of  surgical  instruments,  offered 
to  the  senior  student  passing  the  best  final  examination,  by  the 
late  Dr.  T.  W.  Nellis,  was  awarded  to  Dr.  LeRoy  Dunbar,  with 
honorable  mention  of  Drs.  T.  Frederick  Doescher  and  Percival 
W.  Harrig. 

The  prize  offered  by  Dr.  H.  R.  Powell  to  the  second-year 
student  passing  the  best  final  examination,  consisting  of  a  general 
operating  case,  was  awarded  to  Mr.  Jerome  Myers,  with  honor- 
able mention  of  Mr.  David  Kidd  and  Mr.  Joseph  Levi  Donhauser. 

A  prize  consisting  of  Gross'  complete  pocket  case  of  instru- 
ments, offered  by  A.  B.  Huested  &  Co.  to  the  first-year  student 
passing  the  best  final  examination,  was  awarded  to  Mr.  W.  F. 
Conway,  with  honorable  mention  of  Mr.  Charles  J.  Kelley. 

The  Daggett  prizes,  consisting  of  eighty  and  forty  dollars, 


ALUMNI  ASSOCIATION  PROCEEDINGS 


441 


respectively,  for  the  best  "  anatomical  specimens,"  were  both 
awarded  to  Mr.  Robert  S.  Lipes. 

The  Daggett  prize  for  the  best  "  deportment  irrespective  of 
scholarship,"  consisting  of  eighty  dollars,  was  awarded  to  Dr. 
John  Fletcher  Robinson,  and  the  second  prize,  consisting  of  forty 
dollars,  was  awarded  to  Dr.  Henry  F.  Albrecht. 

The  Alumni  Dinner. 

The  thirty-third  annual  dinner  of  the  Alumni  Association  was 
held  at  the  "Ten  Eyck,"  on  Tuesday  evening,  May  1,  1906,  at 
half  past  eight  o'clock.  About  one  hundred  were  present,  includ- 
ing members  of  the  Association,  the  guests,  and  members  of  the 
graduating  class. 

After  the  tables  had  been  cleared  and  cigars  passed,  the  Toast- 
master,  Dr.  Arthur  G.  Root,  read  the  following  telegram  from 
the  President-elect  of  the  Association,  Dr.  Thomas  Wilson: 

"  I  regret  that  my  recent  illness  compels  me  to  be  absent  to-day.  Please 
extend  to  the  Alumni  my  most  sincere  thanks  for  the  honor  conferred 
upon  me.  I  feel  deeply  the  honor  and  if  devotion  and  loyalty  to  Alma 
Mater  count  for  anything  I  hope,  in  a  measure,  to  meet  their  expectations." 

The  following  toasts  were  then  responded  to : 

1.  "  The  Retiring  President,"  Dr.  Charles  B.  Tefft. 

2.  "  Union  University,"  Chancellor  A.  V.  V.  Raymond. 

3.  "The  Clergy,"  Rev.  Roelif  H.  Brooks. 

4.  'The  Faculty,"  Dr.  Frederic  C.  Curtis. 

5.  "  The  Law,"  Hon.  Joseph  A.  Lawson. 

6.  "  The  Class  of  1906,"  Dr.  Edward  A.  Dean. 


442 


EDITORIAL 


BMtorial 

Each  man  diagnosed  the  weather  for  himself.  Six 
doctors  over  a  patient  with  a  hidden  disease  are  never 
so  impressive  nor  so  obstinate  as  six  seafaring  men 
over  a  probable  change  of  wind. 

Caleb  West,  Master  Diver.  J.  Hopkinson  Smith. 

4«  4°  4* 

The  1906  meeting  of  the  Alumni  Association  was 
The  Alumni  notable  in  several  respects.  At  the  preliminary 
Association  meeting  of  the  Executive  Committee  it  was  decided 
to  attempt  an  annual  dinner  without  a  deficit, 
and  this  was  accomplished.  An  apparently  increasing  lethargy 
of  the  Association  was  discussed,  and  the  opinion  of  out-of-town 
members,  emphasized  by  Dr.  Tefft,  the  retiring  president,  was  to 
the  effect  that  this  state  of  hebetudejwas  largely  due  to  the  in- 
activity of  the  home  officers.  At  a  later  meeting,  under  the 
chairmanship  of  Dr.  Wilson,  the  newly  elected  president,  meas- 
ures were  taken  to  revive  the  Association.  It  was  generally  be- 
lieved that  the  dependence  of  the  Association  upon  the  Faculty 
of  the  College  is  the  factor  most  prominent  in  curtailing  its  use- 
fulness, and  the  effort  is  to  be  made  to  demonstrate  its  individu- 
ality. Two  objects  are  to  be  sought  at  once:  first,  the  awaken- 
ing of  some  spirit  in  the  choice  of  officers,  for  which  an  Australian 
scheme  of  balloting  is  proposed;  and,  secondly,  the  securing  of 
a  fund  to  justify  the  Executive  Committee  in  preparation  of  a 
suitable  annual  celebration.  The  details  are  now  under  consid- 
eration by  the  Committee.  It  is  hoped  that  a  plan  may  be 
perfected  whereby  the  voting  may  be  opened  to  every  member 
of  the  Association,  whether  present  at  the  meeting  or  not.  For- 
tunately for  the  Association  at  this  critical  period  of  its  exist- 
ence, its  president  is  well  qualified  to  execute  its  needs.  Dr. 
Wilson  was  one  of  the  founders  of  the  Association,  is  entirely 
familiar  with  its  history,  and  is  now  chosen  for  the  presidency 
after  two  years  of  active  service  upon  the  Executive  Committee. 
He  is  well  acquainted  with  the  sentiments  of  graduates  of  the 
college  outside  of  Albany,  and  may  be  expected  to  harmonize 
the  many  different  interests  now  helpless  by  reason  of  incoordina- 
tion. As  an  indication  of  the  catholic  purpose  of  the  committee 
the  vacancy  in  its  membership  was  filled  by  the  selection  of  an 
out-of-town  alumnus,  Dr.  Thomas  Carney  of  Schlnectady  and 
Dr.  Carney  has  indicated  his  desire  for  active  work. 


EDITORIAL 


443 


As  the  first  step  toward  obtaining  the  co-operation  of  members 
of  the  Association  the  committee  has  issued  a  circular,  the  first 
of  a  series,  in  which  the  objects  desired  to  be  attained  are  indi- 
cated. This  manifesto,  which  has  been  not  inappropriately 
described  as  a  "Declaration  of  Independence,"  is  in  part  as 
follows : 

The  Executive  Committee  believe  that  the  Association  should  no  longer 
continue  a  burden  upon  the  College,  but  should  be  a  help.  The  expense 
of  maintaining  the  College  under  the  new  demands  of  medical  instruction 
of  the  last  decade,  has  greatly  increased.  It  is  only  necessary  to  mention 
the  cost  of  the  new  laboratories  and  the  subsidies  to  the  hospitals,  with 
constantly  growing  requisition  for  apparatus  and  material  of  all  kinds, 
to  indicate  in  how  many  directions  money  is  used.  It  is  not  right  that 
the  Association  should  increase  the  difficulties.  Upon  the  executive 
officers  falls  the  task  of  directing  its  machinery,  and  of  preparing  for  its 
meetings.  But  the  need  of  close  figuring,  the  uncertainty  of  attendance , 
doubt  as  to  the  means  to  entertain  the  members  at  the  annual  meeting, 
have  placed  a  restraint  upon  the  Executive  Committee  which  seriously 
embarrasses  its  work. 

We  have  every  reason  to  believe  that  the  graduates  of  the  College  not 
only  wish  the  continuance  of  the  Association,  but,  by  a  very  comfortable 
majority  feel  an  active  personal  interest'  and  in  many  cases  enthusiasm. 
But  they  have  never  been  asked  to  manifest  a  steady,  perennial  purpose. 
In  fact,  the  College  Faculty  has  discouraged  any  appeal,  and  through  mis- 
taken generosity,  has  suffered  the  present  state  of  affairs  to  develop.  Your 
Committee  now  asks  you,  personally,  to  assist  in  launching  the  Association 
on  an  independent  career.  In  the  last  annual  address,  Dr.  Tefft,  the 
retiring  president,  urged  this,  and  it  is  done  without  the  suggestion  of  the 
College  Faculty,  in  our  belief  that  this  step  is  essential  to  the  usefulness  and 
the  existence  of  the  Association. 

We  need,  in  the  first  place  more  money.  There  are  now  approximately, 
fifteen  hundred  correct  addresses  on  our  rolls.  You  will  be  doubtless  sur- 
prised to  learn  that  in  response  to  the  Treasurer's  annual  request  for  dues, 
the  number  of  payments  has  been  as  low  as  three.  Payment  of  dues  is 
not  obligatory,  has  never  before  been  urged,  and  we  do  not  expect  to 
advocate  that  it  be  made  a  requirement  now.  But  we  believe  that  every 
alumnus  should  regard  this  small  annual  payment  of  one  dollar  as  a  duty , 
and  we  make  this  statement  with  knowledge  of  what  is  done  in  other 
organizations  of  the  same  kind. 

We  propose,  first,  to  use  this  money  more  liberally,  in  printer's  ink. 
Instead  of  one  communication  a  year,  several  of  value  could  very  profit- 
ably be  issued.  A  plan  is  in  contemplation  to  arrange  for  the  election  of 
officers  by  ballot,  so  that  every  member  of  the  Association  may  vote  each 
year  whether  he  attends  the  meeting  or  not. 

Secondly,  much  more  could  be  done  to  make  the  annual  celebration 
entertaining  and  pleasant.  We  wish  to  curtail  the  cost  of  alumni  day  to 
those  who  come,  and  to  introduce  some  variety  and  attractiveness  be- 
yond a  formal  dinner.    You  have  on  this  Committee  representatives  who 


444 


LITTLE  BIOGRAPHIES 


know  how  to  get  the  good  things  of  life,  and  they  needed  only  your  co- 
operation to  make  each  alumni  day  an  occasion  of  lasting  remembrance. 
Many  of  our  members  say  that  this  day  is  their  only  respite  from  work, 
and  they  should  return  compensated,  rejuvenated,  and,  if  you  say  the 
word, — exhilarated. 

Perhaps  this  is  enough  to  say.  But  the  Committee  has  faith  in  the 
Association,  and  believes  it  has  only  to  ask  to  receive.  It  is  possible 
that  a  generous  response  may  be  made,  and  a  gradually  accumulating 
fund  made  available  for  any  of  the  many  good  purposes  to  which  the  As- 
sociation might  decide  to  place  it. 


Xittle  Biographies 

VI.    FRANCIS  GLISSON. 

FRANCIS  GLISSON,  whose  name  is  indissolubly  con- 
nected in  the  minds  of  students  of  medicine  with  the 
capsule  of  the  liver,  was  born  in  1597,  in  the  little  vil- 
lage of  Rampisham,  in  the  County  of  Dorset,  England. 
His  father  was  William  Glisson,  and  the  family  was  one  in  com- 
fortable circumstances.  Of  his  early  life  and  education  little  is 
definitely  known,  and  the  first  important  event  recorded  by  his 
biographers  is  his  entrance  as  a  student  into  Gonville  and  Caius 
College,  Cambridge,  where  he  received  the  degree  of  B.  A.  in 
1621,  and  of  M.  A.  in  1624.  After  his  graduation  he  was  engaged, 
for  a  time,  in  teaching  Greek,  but  did  not  take  holy  orders,  as 
was  common  among  the  teachers  in  the  English  Universities  in 
those  days.  He  received  the  degree  of  M.  A.  from  the  University 
of  Oxford,  in  1627,  but  did  not  receive  his  medical  degreee  until 
1634  when,  at  the  age  of  thirty-seven,  he  obtained  his  M.  D.  from 
the  University  of  Cambridge.  He  probably  did  most  of  his  actual 
medical  study  in  London,  and,  according  to  Foster,  was  possibly 
influenced  to  take  up  this  subject  by  the  work  of  Harvey.  Two 
years  after  his  graduation  (1636)  he  was  appointed  Regius  Pro- 
fessor of  Physic  at  the  University  of  Cambridge,  a  position  which 
lie  held  until  his  death.  There  is  evidence  that  he  did  not  take 
the  position  very  seriously,  as  he  lived  at  Colchester  from  1640 
to  1648,  and  after  that  in  London.  In  his  latter  days  a  substitute 
did  his  work  for  him.  Most  likely  the  atmosphere  of  Cambridge 
was  not  conducive  to  his  peace  and  quietude  of  mind,  for  Glisson 
was  a  Presbyterian,  and  the  University  was  strongly  Royalist. 


LITTLE  BIOGRAPHIES 


445 


Aside  from  his  chair  in  Cambridge,  Glisson  also  lectured  on 
Normal  and  Pathological  Anatomy  at  the  College  of  Physicians 
in  London,  and  in  1640  delivered  the  Goulstonian  Lectures.  He 
was  also  actively  interested  in  the  formation  of  the  Royal  Society, 
and  was  one  of  its  charter  members.  He  was  President  of  the 
College  of  Physicians  during  1667,  1668  and  1669. 

Glisson's  professional  reputation  does  not  rest  solely  on  his 
work  on  the  Liver.  He  published,  in  fact,  on  several  subjects, 
and  his  most  important  monographs  are  those  on  Rachitis  (de 
Rachitide  sive  Morbo  puerile  qui  vulgo  the  Rickets  dicitur, 
Tractatus,  1650),  his  work  on  the  Liver  (Anatomia  Hepatis, 
1654),  his  philosophical  treatise  (Tractatus  de  Naturae  Substan- 
tia? energetica,  seu  de  vitae  naturae  ej usque  tribus  primus  facul- 
tatibus,  1672),  and  his  book  on  the  Stomach  and  Intestines 
(Tractatus  de  ventriculo  et  intestinis,  1677). 

The  work  on  Rickets  (1650),  was  the  first  important  medical 
monograph  published  in  England.  It  is  a  book  of  416  pages, 
and  gives  internal  evidence  of  having  been  based  on  careful  clini- 
cal and  anatomical  study  of  a  large  number  of  instances  of 
the  disease.  In  gathering  material  for  the  work  Glisson  was 
assisted  by  seven  Fellows  of  the  College  of  Physicians,  Sheafe, 
Bate.  Regemorter,  R.  Wright,  N.  Paget,  J.  Goddard,  and  Trench. 
It  was  intended  originally  that  the  book  should  be  a  joint-author- 
ship affair,  but  it  was  found  that  Glisson's  observations  were  so 
much  more  numerous  and  detailed  than  those  of  his  colleagues, 
that  he  produced  the  book  alone,  giving  due  credit  to  the  others. 
Little  has  been  added  to  his  descriptions  of  the  clinical  and 
gross  pathological  aspects  of  the  disease,  and  but  little  has  had 
to  be  subtracted. 

The  work  on  the  Liver  (1654)  was  a  formal  treatise  on  the 
gross  anatomy  of  this  organ,  and  beside  the  accurate  description 
of  the  capsule,  contained  facts  which  added  a  great  deal  to  the 
knowledge  of  the  distribution  of  the  blood  vessels.  Glisson  dis- 
covered the  capsule,  and,  though  he  does  not  specifically  say  so, 
no  doubt  studied  the  vessels,  during  his  preparations  for  a 
course  of  public  lectures  delivered  at  the  mandate  of  the  College 
of  Physicians  of  London.  A  great  deal  of  the  work  was  carried 
on  by  a  method  which  involved  the  careful  scraping  away  of 
the  parenchyma,  a  difficult  and  tedious  operation. 

The  "  Tractatus  de  naturae  substantias  energetica  "  was  the  most 
philosophic  of  Glisson's  treatises,  and  was  an  attempt  to  show 


446 


LITTLE  BIOGRAPHIES 


that  all  the  phenomena  of  either  dead  or  living  beings  are  the 
successive  developments  of  the  one  fundamental  energy  of  nature. 
In  his  study  he  first  introduced  the  idea  of  the  "  irritability  99  of 
living  tissues,  and  was,  in  fact,  the  first  to  use  the  word  in  this 
sense.  He  observed,  during  his  experiments  on  the  liver,  that 
the  gall  bladder  and  ducts  excreted  better  when  irritated,  and 
reasoned  from  this  that  they  could  not  be  irritated  unless  they 
possessed  the  power  of  irritability.  Glisson  used  the  word  irrita- 
bility in  its  widest  sense  to  mean  any  kind  of  response,  physical, 
chemical,  or  vital,  to  irritation.  His  idea  was  too  deep  for  his 
contemporaries,  and  was  shelved  for  a  century  to  be  finally 
revived,  in  a  much  more  restricted  sense,  by  the  celebrated  Haller. 

The  work  on  the  Stomach  and  Intestines,  published  in  the  year 
of  his  death,  is  barely  mentioned  in  most  of  Glisson's  biographies, 
and  appears  to  have  been  of  less  importance  than  his  other 
writings. 

Of  Glisson  as  a  man  and  a  practicing  physician,  little  appears 
to  be  known.  According  to  Foster  he  did  his  duty  manfully 
during  the  great  plague  of  London  (1665),  and  earlier  than 
this  (1640),  he  was  among  the  besieged  in  Colchester  when  that 
city  was  attacked  by  Fairfax,  to  whom  he  was  an  unsuccessful 
applicant  for  better  terms  of  surrender.  That  he  was  widely  and 
favorably  known  as  a  physician  there  is  little  doubt.  He  is  men- 
tioned as  one  of  the  four  celebrated  physicians  who  were  con- 
sulted by  John  Locke  in  the  case  of  Lord  Ashley,  who  was  suffer- 
ing from  an  abdominal  abscess.  There  is  a  portrait  of  Glisson 
in  the  possession  of  the  Royal  College  of  Physicians,  but  I  have 
been  unable  to  find  any  authentic  description  of  his  personal 
appearance.  Mentally  he  was  essentially  a  philosopher,  as  his 
writings  show.  Most  of  his  books  are  written  in  a  formal 
academic  style,  didactic,  and  at  times  cumbrous. 

George  Blumer. 

bibliography. 

The  Life  of  John  Locke.    Harpers,  1876. 
Lectures  on  the  History  of  Physiology.    Cambridge,  1901. 
Art.    Francis  Glisson  in  The  Dictionary  of  National  Biography. 
1800,  xxi,  437. 

The  History  of  the  First  Treatise  on  Rickets.    Saint  Bartholo- 
mew's Hospital  Reports.    1884,  xx,  71. 
History  of  Medicine.     Translation  by  Comegys.  Cincinnati, 
1856. 


Fox  Bourne. 

Sir  Michael  Foster. 

Norman  Moore. 

Norman  Moore. 

P.  V.  Renouard. 


SCIENTIFIC  REVIEW 


447 


Scientific  "Review 

THE  CEREBRO-SPINAL   FLUID  IN  HEALTH  AND 

DISEASE 

The    Diagnostic    and    Therapeutic    Value    of  Lumbar 

Puncture. 
(Continued  from  Annals  of  May,  igo6  ,page  364.) 

From  the  standpoint  of  bacteriology  the  study  of  the  cerebro- 
spinal fluid  offers  considerable  interest  as  a  number  of  micro- 
organisims  and  even  certain  parasites  may  be  encountered. 

In  purulent  meningitis  the  staphylococcus  and  streptococcus 
and  especially  the  pneumococcus  and  diplococcus  intra- 
cellularis  meningitidis  of  Weichselbaum  have  been  repeatedly 
found.  (Lichtheim,  Furbruger,  Heubner).  In  epidemic  men- 
ingitis the  diplococcus  of  Weichselbaum  is  usually  present,  but 
not  infrequently,  the  pneumococcus  of  Frankel  is  the  micro- 
organism concerned.  In  the  recent  epidemic  in  Boston,  Council- 
man states  that  lumbar  puncture  was  performed  in  fifty-five  cases 
and  that  the  diplococcus  intracellularis  was  found  in  thirty- 
eight  cases ;  in  seven  cases  the  pneumococcus  was  also  present 
and  in  one  case  Friedlander's  bacillus.  Osier  reports  sixteen  cases 
of  cerebro-spinal  meningitis,  the  diplococcus  of  Weichselbaum 
was  found  in  thirteen  cases.  Of  associated  organisms,  the 
pneumococcus  and  colon  bacillus  were  each  found  once,  and  the 
staphylococcus  was  present  in  several  cases. 

Langer  and  Mya  have  each  reported  a  case  of  meningitis  oc- 
curring in  the  course  of  influenza  and  in  which  Pfeiffer's  bacillus 
was  detected  in  the  fluid. 

The  colon-bacillus  was  found  in  several  cases  by  Nobecourt 
and  du  Pasquier,  Peltier  and  others. 

In  tubercular  meningitis,  the  tubercle  bacillus  is  often  detected, 
but  special  precautions  are  usually  necessary  and  not  infrequently 
the  most  careful  search  remains  fruitless.  In  order  to  facilitate 
its  detection,  it  is  generally  recommended  to  let  the  fluid  stand 
in  a  cool  place  for  from  6-24  hours  when  the  fine  spider  web 
like  coagula  may  be  spread  out  in  thin  layers  and  stained  by  the 
usual  methods.  The  chances  of  finding  the  bacilli  are  of  course 
much  greater  if  the  fluid  be  centrifugalized. 

According  to  Furbringer,  the  bacilli  are  found  in  70  per  cent,  of 
cases.  Schwarz  states  that  he  obtained  positive  results  in  1 6  out  of 
22  cases.  Slawyk  and  Manicatide  obtained  them  in  all  of  19  cases 


7 


448 


SCIENTIFIC  REVIEW 


(16  times  by  direct  examination,  three  times  by  the  animal 
experiments).  It  must  be  said  that  the  majority  of  observers 
have  not  had  the  same  experience  and  admit  that  more  often, 
they  have  been  unable  to  find  the  tubercle  bacillus.  Guinon 
and  Simon  have  reported  16  cases  of  tubercular  meningitis, 
they  did  not  detect  the  micro-organism  in  a  single  case,  and 
the  cultures  remained  sterile. 

Very  recently  Nattan-Larrier  and  Griffon  have  devised  a 
novel  method  of  obtaining  the  bacilli.  A  small  quantity  of 
the  cerebro-spinal  fluid  is  injected  into  the  mammary  gland  of 
a  lactating  guinea  pig;  the  bacilli  rapidly  multiply  and  pass  into 
the  milk  within  a  few  days.  Jemma  has  employed  the  method 
in  three  cases  of  tubercular  meningites  and  obtained  a  positive 
result  each  time. 

Of  other  organisms  occasionally  concerned  in  the  production 
of  purulent  meningitis  and  which  may  be  found  in  the  cerebro- 
spinal fluid,  mention  must  be  made  of  the  bacillus  typhosus, 
bacillus  of  Neumann-Schoeffer,  bacillus  pyogenes  fcetidus,  bacil- 
lus aerogenes  meningitides,  bacillus  mallei,  bacillus  of  bubonic 
plague,  bacillus  pyocyaneus  and  the  gonococcus.  The  micro- 
coccus tetragenes  albus  has  been  recently  found  (Sicard,  Haute- 
feuille  and  Thery). 

Hartmann  has  reported  a  case  in  which  cysticercus  of  the 
brain  was  diagnosticated  by  lumbar  puncture,  and  in  one  case 
published  by  Jacob,  the  hooklets  of  echinococcus  were  detected 
in  the  fluid. 

In  the  disease  known  as  "sleeping  sickness,"  and  which  is  due 
to  the  presence  within  the  system  of  a  parasite  called  the  "try- 
panosome,"  the  parasite  is  almost  invariably  present  in  the 
cerebro-spinal  fluid  during  the  final  stage  of  the  disease. 

Castellani,  who  was  the  first  to  detect  its  presence  in  the 
cerebro-spinal  fluid,  found  it  in  twenty  of  thirty-four  cases; 
these  facts  have  been  corroborated  by  Bruce,  Nabarro,  Greig 
and  others.  The  trypanosome  was  found  in  all  of  the  thirty- 
eight  cases  reported  by  Bruce. 

As  to  the  spirocheta  pallida  of  syphilis,  there  are  yet  but  few 
observers  who  have  attempted  to  find  it  in  the  cerebro-spinal 
fluid.  Gordon  made  careful  examinations  in  ten  cases.  In 
eight  of  these  cases  either  cerebro-spinal  syphilis  or  tabes  was 
clinically  evident,  and  the  result  was  negative.  The  two  re- 
maining cases  presented  a  syphilitic  chancre  still  in  evolution, 


SCIENTIFIC  REVIEW 


449 


and  doubtful  bodies  were  found  in  the  fluid  of  one  of  them. 
Metchnikoff  and  Roux  assert  that  positive  results  are  only 
obtainable  in  primary  and  secondary  lesions,  and  one  may  natur- 
ally infer  therefrom  that  of  all  syphilitic  lesions,  those  of  the 
nervous  system  are  the  least  likely  to  favor  the  clinical  micro- 
scopist. 

In  malignant  tumors  (sarcoma,  glioma)  characteristic  tumor 
cells  have  been  observed  in  the  fluid  obtained  by  lumbar  punc- 
ture by  Philippe-Cestan-Oberthur,  Rindfleisch,  Dufour,  Loeper 
and  Crouzon,  etc. 

Granular  bodies,  phagocytes,  etc.,  have  also  been  described 
(Kronig,  Sabrazes,  Muratet). 

Of  late  years  much  importance  has  been  attached  to  the 
cytologic  examination  of  the  cerebro-spinal  fluid  and  it  is  to 
Widal,  Sicard  and  Ravaut  that  we  owe  both  its  introduction 
as  a  valuable  means  of  clinical  diagnosis  and  the  greater  part 
of  the  knowledge  acquired  as  the  result  of  its  application.  Not 
only  is  the  method  of  use  in  the  various  forms  of  infectious 
diseases  of  the  nervous  system,  but  also  in  certain  affections  of 
a  chronic  character  and  where  the  absence  of  micro-organisms 
renders  it  the  sole  means  of  diagnosis. 

Normally  there  are  usually  no  cellular  elements  in  the  cerebro- 
spinal fluid;  at  most  may  one  find  a  few  lymphocites  after  using 
the  centrifugal  machine,  but  in  the  various  forms  of  meningitis 
acute  and  chronic,  cellular  elements,  generally  abundant  are 
observed.  The  nature  of  the  elements  varies  with  the  form 
of  meningitis  under  consideration  and  is  especially  influenced 
by  the  acuteness  or  chronicity  of  the  affection.  In  a  general 
way  polymorphonuclear  leucocytes  predominate  in  all  forms  of 
acute  meningitis  (epidemic  cerebo-spinal,  purulent),  whereas 
lymphocytes  are  characteristic  of  tubercular  meningitis;  this 
latter  form  being  usually  considered  as  running  a  sub-acute 
or  chronic  course. 

It  must  not  be  forgotten  however  that  lymphocites  are  found 
during  the  convalescence  of  acute  non-tubercular  meningitis, 
especially  of  the  epidemic  cerebro-spinal  form.  While  these  facts 
have  been  confirmed  by  the  researches  of  numerous  observers 
(Achard-Loeper,  Souques,  Faisans,  Meri,  Guinon-Simon,  Bendix, 
Milian,  Concetti,  Devaux,  Seglas  and  many  others)  so  that  a 
classic  formula  has  found  its  place  in  text  books,  it  must  be 
stated  that  some  divergence  of  opinion  still  exists.  Thus, 


SCIENTIFIC  REVIEW 


Lewkowicz,  Brion,  Leri,  Guinon,  Laederich, etc.,  have  observed 
cases  of  tubercular  meningitis  where  the  polymorphonuclear 
leucocytes  were  equal  in  number  to  the  lymphocites  or  even 
predominated.  Zambelli  maintains  that  lymphocites  are  en- 
countered in  tubercular  meningitis  wherever  the  bacilli  are  absent 
otherwise  polynuclears  are  observed.  Vaquez  and  Sicard 
state  that  lymphocites  are  the  rule  in  the  meningitis  occurring 
in  the  course  of  typhoid  fever. 

From  all  this,  it  would  seem  preferable  to  consider  a  poly- 
nucleosis as  the  indication  of  an  acute  process  and  a  lymphocytosis 
as  characteristic  of  a  subacute  or  chronic  one,  rather  than  to 
draw  conclusions  as  to  the  nature  of  the  infection  merely  from 
the  cytologic  formula. 

Widal  has  himself  admitted  that  any  meningeal  irritation 
may  ultimately  determine  a  lymphocytosis. 

Aside  from  the  various  forms  of  meninigites  just  considered, 
variations  in  the  cylotogy  of  the  cerebo-spinal  fluid  occur  in 
the  course  of  many  affections  of  the  nervous  system  whenever 
the  meninges  are  implicated  and  that  is  especially  true  in  the 
syphilitic  and  parasyphilitis  lesions  of  the  brain  and  cord. 

Widal,  Monod,  Sicard  and  Ravaut  have  shown  that  a  well- 
marked  lymphocitosis  is  invariably  present  in  cerebro-spinal 
syphilis,  tabes  and  general  paresis  and  the  later  researches  of 
Babinski  and  Nageotte,  Marie  and  Crouzon,  Milian,  Clergier 
and  a  host  of  others  have  confirmed  this. 

Ravaut  says  that  the  cerebro-spinal  fluid  is  normal  in  indi- 
viduals suffering  from  tertiary  syphilis  affecting  the  skin, 
mucous  membranes  and  osseous  system — but  that  a  marked 
lymphocitosis  is  always  found  when  there  are  ocular  manifes- 
tations. Unless  the  nervous  system  is  implicated,  the  fluid  is 
normal  in  patients  who  have  once  presented  evidences  of  syphilis, 
however  marked  these  may  have  been.  A  lymphocitosis  is  the 
signature  of  the  cerebro-spinal  localization  of  the  virus. 

Milian  has  observed  a  lymphocitosis  in  most  individuals 
suffering  from  severe  headache  in  the  course  of  secondary  and 
tertiary  syphilis. 

In  tabes  the  lymphocitosis  is  usually  abundant  and  occurs 
very  early  in  the  course  of  the  disease — a  fact  which  is  of  the 
utmost  diagnostic  value.  Milian  states  that  the  lymphocitosis 
is  most  abundant  in  incipient  tabes  and  where  the  syphilis 
infection  is  comparatively  recent,  and  slightest  in  cases  run- 


SCIENTIFIC  REVIEW 


451 


ning  a  slow  course  and  coming  on  late  after  infection.  Lym- 
phocitosis  is  invariably  present  in  any  case  presenting  ataxia 
and  the  other  typical  manifestations  of  the  disease. 

de  Lapersonne  was  the  first  author  to  report  the  occurrence 
of  lymphocitosis  in  ocular  syphilis.  It  was  well  marked  in 
two  cases  of  recent  optic  neuritis  and  in  one  case  of  paralysis 
of  the  motor  oculi,  moderate  in  a  case  of  old  optic  neuritis; 
he  maintains  that  the  lymphocites  gradually  disappear  as 
restoration  of  function  takes  place. 

In  general  paresis  the  cytology  of  the  cerebro-spinal  fluid 
yields  the  same  valuable  information  as  in  tabes.  Widal  and 
Ravaut,  Sicard,  Joffroy  and  Mercier,  Monod,  Nageotte,  Seglas 
and  Nageotte,  Dupre  and  Devaux,  etc.,  to  whom  we  owe  most 
of  our  knowledge  concerning  the  cytology  of  this  affection,  have 
definitely  established  the  constant  occurrence  of  a  well  marked 
lymphocitosis  in  the  very  earliest  stages  of  general  paresis. 

Widal  and  Lemierre  have  observed  a  polynucleosis  when 
paralytic  strokes  came  on  in  the  course  of  the  disease.  Belin 
and  Bauer  have  reported  a  case  in  which  the  cytologic  exami- 
nation was  performed  five  times  within  five  months  and  in 
which  a  distinct  polynucleosis  (ninety  per  cent)  was  each  time 
observed. 

These  rare  facts  in  literature  compromise  in  no  way  the  well- 
grounded  principle  that  a  lymphocitosis  is  present  in  over 
ninety  per  cent  of  cases  and  that  it  constitutes  an  invaluable 
aid  in  the  early  diagnosis  of  the  disease. 

Both  in  general  paresis  and  tabes,  the  lymphocitosis  appears 
early,  is  well  marked  and  is  moreover  permanent,  being  found 
even  in  the  terminal  coma  of  general  paresis  (Widal,  Clergier, 
etc.). 

A  lymphocytosis  also  occurs  in  other  diseases.  Dufour  has 
had  positive  results  in  one  case  of  alcoholic  meningitis,  verified 
at  the  autopsy  and  Moindrot  states  that  a  lymphocitosis  is  not 
infrequent  in  cerebral  tumor.  Again  a  positive  cytology  is 
not  uncommon  in  pachy -meningitis  cervicalis  hypertrophica  and 
multiple  sclerosis. 

In  the  various  forms  of  herpes  and  in  the  herpetic  types  of 
syphilides,  a  lymphocitosis  is  almost  constant,  as  has  been 
demonstrated  by  the  researches  of  Brissaud  and  Sicard  and 
later  by  the  contributions  of  Widal  and  Le  Sourd,  Achard, 
Loeper  and  Laubry,  Chauffard  and  Froin  and  others.  Sicard 


452 


SCIENTIFIC  REVIEW 


insists  upon  the  persistence  of  the  reaction  especially  in  cases 
where  painful  manifestations  continue  for  a  long  time  after  the 
disappearance  of  the  eruption. 

Ravaut  and  Darre  have  reported  the  existence  of  lymphoci- 
tosis  in  connection  with  relapsing  herpes  of  the  genitalia  in 
twenty-one  of  twenty-five  cases. 

Laudouzy  mentions  a  case  in  which  he  observed  herpes  zoster 
in  the  incipient  stage  of  Pott's  disease;  four  relapses  occurred 
later  in  the  course  of  the  affection.  Although  no  mention  is 
made  of  a  cytologic  examination,  the  observation  is  a  precious 
one,  inasmuch  as  it  confirms  the  spinal  origin  of  herpes  and 
furthermore  implies  its  close  relationship  to  tubercular  lesions. 

It  is  a  well-known  fact  that  herpes  is  fairly  common  in  menin- 
gitis, more  so  perhaps  in  the  tubercular  form,  although  Evans 
maintains  the  contrary. 

Ralliou  who  has  devoted  his  thesis  to  this  subject,  states 
that  lymphocitosis  occurs  in  about  two-thirds  of  cases  of  herpes. 

Sicard  and  Bouchaud  have  reported  three  cases  of  herpeti- 
form  syphilide  in  which  an  abundant  lymphocitosis  was  present. 
Two  of  these  patients  were  tabetics. 

Dopter  mentions  one  case  of  urticaria  affecting  an  herpeti- 
form  distribution  and  where  the  cytology  was  equally  positive. 

In  the  course  of  various  infectious  diseases  cytodiagnosis 
acquires  again  much  importance  whenever  nervous  manifesta- 
tions appear. 

Thus,  Dufour  and  Giroux  have  observed  a  true  meningeal 
formula  in  scarlatina  and  in  seven  cases  examined  to  that  effect 
by  Dopter  a  distinct  lymphocitosis  was  found  in  every  case. 

Monod,  Chauffard  and  Boidin  have  called  attention  to  the 
marked  reaction  occurring  under  the  same  circumstances  in  the 
course  of  epidemis  parotitis.  Dopter  obtained  a  positive  result 
in  cases  of  associated  facial  paralysis,  and  Sicard  has  reported 
similar  facts  in  connection  with  the  occurrence  of  herpetic  lesion 
in  the  domain  of  the  trigeminal  nerve  as  a  complication  of 
parotitis. 

A  well-marked  lymphocytosis  has  also  been  observed  in  many 
cases  of  trigeminal  (facial)  neuralgia  (Sicard,  Pitres,  etc.). 

Bearing  these  facts  in  mind,  it  is  not  improbable  that  a  posi- 
tive reaction  may  exist  in  the  course  of  any  general  infectious 
disease,  whenever  nervous  manifestations  of  appreciable  in- 
tensity appear,  and  it  would  seem  desirable  in  such  cases  to 


SCIENTIFIC  REVIEW 


453 


determine  by  lumbar  puncture  whether  or  not  a  true  meningeal 
implication  has  developed. 

The  examination  of  the  cerebro-spinal  fluid  is  negative  in 
hysteria,  neurasthenia,  the  various  psychoses  and  dementias, 
chronic  alcoholism,  etc. 

It  has  always  been  considered  that  a  lymphocytosis  is  absent 
in  epilepsy,  but  in  a  recent  publication  Mehrzbacher  claims  that 
a  moderate  reaction  was  present  in  six  of  twelve  cases  which  he 
examined. 

From  all  that  has  been  said  concerning  cytodiagnosis,  it  is 
perfectly  evident  that  lumbar  puncture  has  become  an  invalu- 
able means  of  diagnosis,  and  it  is  rather  inexplicable  that  the 
method  has  not  been  more  generally  adopted. 

That  a  lymphocytosis  occurs  in  a  host  of  affections  constitutes 
no  serious  objection  to  its  real  value  in  diagnosis.  In  the  more 
common  forms  of  meningitis,  although  the  micro-organism  is 
frequently  detected,  such  good  fortune  is  not  constant,  and 
there  are  many  eminent  clinicians  who  willingly  admit  that  in 
tubercular  meningitis  at  least,  they  have  been  less  fortunate  than 
Furbringer  and  his  optimistic  followers.  Thus  Osier,  Heubner, 
Marfan  and  the  majority  of  French  observers  hold  that  the 
fluid  is  very  often  sterile.  In  such  cases  lymphocytosis,  which  is 
the  rule,  will  certainly  throw  much  light  on  the  diagnosis,  which 
could  otherwise  be  made  only  by  culture  methods  or  intraperi- 
toneal inoculation,  both  of  which  means  require  such  length  of 
time  as  to  be  hardly  suitable  for  clinical  purposes. 

Then  the  possibility  of  confusing  tubercular  meningitis  and 
the  parasyphilitic  affections  will  hardly  present  itself  to  any 
one's  mind.  At  all  events,  one  fact  is  certain,  the  cytologic 
examination  of  the  cerebro-spinal  fluid  enables  us  to  determine 
the  presence  or  absence  of  meningitis,  and  that  alone  is  of  ex- 
treme value.  How  often  does  the  question  come  up  of  establish- 
ing the  functional  or  organic  nature  of  a  disease  ? 

There  is  no  doubt  that  in  obscure  affections  of  the  nervous 
system,  lumbar  puncture  may  prove  to  be  the  most  potent  fac- 
tor in  arriving  correctly  at  a  diagnosis,  which  might  otherwise 
have  remained  impossible.  That  is  especially  true  of  syphilitic 
and  para-syphilitic  diseases,  and  the  well-known  fact  that  they 
contribute  largely  to  the  percentage  composition  of  neuro- 
pathology adds  additional  value  to  cytology.  Incipient  tabes 
and  general  paresis  are  not  always  easy  of  diagnosis,  and  it  may 


454 


SCIENTIFIC  REVIEW 


be  important  (generally  it  is,  and  the  patient  may  insist  on 
knowing  the  exact  nature  of  his  affection)  to  rapidly  arrive  at 
one;  it  may  be  said  without  hesitancy  "the  first  symptoms  have 
barely  become  manifest  when  an  abundant  lymphocitosis  already 
exists." 

It  frequently  happens  that  patients  in  a  comatose  condition 
are  admitted  at  hospitals  and  that  no  information  regarding 
them  can  be  obtained;  a  hemiplegia  may  or  may  not  be  present, 
and  very  often  no  definite  diagnosis  can  be  made ;  if  a  lympho- 
citosis is  detected,  we  may  safely  conclude  to  the  syphilitic 
nature  of  the  condition  and  the  prognosis  will  be  thereby  much 
bettered.  It  may  be  stated  in  this  connection  that  Widal  and 
Lemierre  found  an  abundant  lymphocitosis  in  twelve  of  thirteen 
cases  of  syphilitic  hemiplegia  and  in  thirteen  cases  of  cerebral 
hemorrhage  and  softening  due  to  other  causes  the  cytologic  exam- 
ination was  negative. 

The  prognosis  will  also  be  influenced  by  lumbar  puncture  in 
the  various  acute  infectious  diseases  associated  with  meningeal 
complications. 

Even  in  surgical  diagnosis  lumbar  puncture  may  prove  of 
decided  value.  In  traumatic  cases,  with  severe  cerebral  symp- 
toms, trephining  should  not  be  resorted  to  if  pure  blood  is  ob- 
tained by  puncture  of  the  subarachnoidean  space,  as  this  would 
indicate  extensive  injury  to  the  brain  substance  proper.  On 
the  contrary  if  no  blood  is  found,  one  may  reasonably  infer  that 
the  hemorrhage  is  epidural  and  an  operation  may  be  then 
advised. 

Again,  in  cases  of  sinus  thrombosis  and  cerebral  abscess,  oper- 
ative intervention  should  only  be  encouraged  if  lumbar  puncture 
has  definitely  established  the  integrity  of  the  meninges. 

Although  lumbar  puncture  has  yielded  brilliant  results  in 
clinical  diagnosis  and  may  even  have  an  important  bearing 
upon  prognosis,  it  must  be  admitted  that  as  a  therapeutic 
measure,  its  value  is  rather  limited.  Inasmuch  as  it  elucidates 
the  nature  of  disease,  it  serves  to  direct  our  efforts  along  more 
rational  lines  of  treatment  and  thus  indirectly  contributes  to 
therapy;  but  in  itself,  the  removal  of  certain  quantities  of  the 
cerebro-spinal  fluid  is  only  beneficial  in  a  few  affections. 

La  Salle  Archambault. 
(To  be  continued.) 


PUBLIC  HEALTH 


455 


public  feealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 

Department  of  Health — City  of  Albany,  N.  Y. 

Abstract  of  Vital  Statistics,  April,  1906. 
Deaths. 


1902 

1903 

1904 

1905 

1006 

Consumpt  ion 

18 

21 

16 

14 

26 

1 

2 

4 

0 

I 

0 

0 

0 

56 

I 

Scarlet  Fever  

0 

4 

1 

O 

0 

1 

0 

0 

1 

0 

0 

2 

2 

2 

I 

Grippe  

0 

2 

2 

1 

2 

8 

12 

20 

13 

10 

Broncho-pneumonia  

4 

3 

3 

7 

3 

Bright 's  Disease  

17 

16 

i5 

i7 

6 

16 

13 

8 

7 

Cancer  

10 

4 

12 

13 

9 

Accidents  and  violence  

9 

13 

8 

4 

4 

26 

32 

37 

37 

30 

1  year  and  under  

14 

12 

14 

23 

19 

Total  deaths  

136 

169 

158 

Death  rate  

16.53 

20 

•  25 

22 

•  25 

17.30 

1  n  on 

Death  rate  less  non- 

residents  

14.78 

l8.  l6 

Deaths  in  Institutions. 

1902 

1903 

1904 

1906 

1VUO 

Non- 

Non- 

Non- 

Non- 

Non- 

Resi-  Resi- 

Resi- 

resi- 

Resi- 

resi-  Resi-  resi- 

Ren- resi- 

dent  dent 

dent 

dent  dent 

dent  dent  dent 

dent  dent; 

7  9 

9 

9 

8 

7 

7  9 

T  A  A 

Albany  Orphan  Asylum  

1  0 

0 

0 

0 

O 

3  0 

O  O 

Child's  Hospital  

1  0 

0 

0 

0 

0 

0  0 

I  0 

Home  for  Aged  Men  

1  0 

2 

1 

2 

0 

0  0 

0  I 

County  House  

4  0 

2 

0 

5 

I 

0  0 

4  0 

0  0 

0 

0 

1 

0 

0  0 

0  0 

Home  for  Friendless  

1  1 

0 

0 

1 

0 

1  1 

1  0 

0  0 

5 

1 

3 

O 

2  1 

1  0 

Hospital  for  Incurables.  .  .  . 

0  0 

0 

0 

2 

0 

1  0 

0  0 

House  of  Shelter  

0  0 

0 

0 

0 

0 

0  0 

0  0 

Little  Sisters  of  the  Poor.  . 

0  0 

1 

0 

0 

0 

1  0 

0  1 

Penitentiary  

0  0 

0 

0 

0 

0 

1  0 

0  0 

0  0 

1 

1 

0 

2 

1  0 

0  0 

St.  Margaret's  House  

1  0 

0 

0 

0 

0 

3  2 

0  0 

St.  Peter's  Hospital  

2  0 

3 

0 

3 

1 

5  0 

4  0 

Sacred  Heart  Convent  

0  0 

0 

0 

0 

O 

0  0 

1  0 

45^  PUBLIC  HEALTH 

Births   87 

Marriages   52 

Still  and  premature  births   2 

Total   141 

Bureau  of  Contagious  Diseases. 
Cases  Reported. 


1902 

1903 

1904 

i9°5 

1906 

Typhoid  Fever  

  9 

4 

8 

2 

6 

Scarlet  Fever  

10 

20 

5 

22 

Diphtheria  and  Croup  

  9 

22 

24 

7 

6 

Chickenpox  

  9 

6 

6 

1 

4 

Measles  

  27 

134 

25 

201 

3 

Whooping-cough  

2 

0 

0 

1 

Consumption  

2 

4 

0 

0 

Total  

Contagious  Diseases  in  Relation  to  Public  Schools. 


Reported  Deaths 
D.    S.  F.  D.    S.  P 

Public  School  No.  6   1  3 

Public  School  No.  12   1  1 

Public  School  No.  13   1 

Public  School  No.  14   2 

Public  School  No.  17   2 

Public  School  No.  21   2 

Public  School  No.  22   1 

St.  Mary's  School   1 

St.  John's  School   1 

Number  of  days  quarantine  for  diphtheria : 

Longest   24    Shortest   13    Average   17! 

Number  of  days  quarantine  for  scarlet  fever : 

Longest   50    Shortest   11    Average   2  8T3T 

Fumigations : 

Houses   29    Rooms   60 

Antitoxin. 

Cases  of  diphtheria  reported   6 

Cases  of  diphtheria  in  which  antitoxin  was  used   6 

Cases  in  which  antitoxin  was  not  used   o 

Deaths  after  use  of  antitoxin   2 


Bureau  of  Plumbing. 
In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  two 
hundred  and  thirty-four  inspections  made,  of  which  one  hundred  and 
seventy-two  were  of  new  buildings  and  sixty-two  of  old  buildings.  There 
were  thirty-five  iron  drains  laid  and  twenty-six  connections  with  street 


MEDICAL  NEWS 


457 


sewers,  thirty-seven  tile  drains,  sixty-five  urinals,  fifty-two  cesspools,  six 
hundred  and  nine  wash  basins,  one  hundred  and  seventy-two  sinks,  two 
hundred  and  seventy  bath  tubs,  fifty-six  wash  trays,  eleven  trap  hoppers 
in  yard,  five  hundred  and  eighteen  tank  closets,  one  drinking  fountain, 
thirty-eight  slop  hoppers  and  nine  shower  baths. 

There  were  one  hundred  and  fifty  permits  issued,  of  which  one  hundred 
and  ten  were  for  plumbing  and  forty  for  building  purposes.  There  were 
forty-one  plans  submitted  of  which  twenty  were  of  old  buildings  and 
twenty-one  for  new  buildings.  There  were  ten  houses  examined  on  com- 
plaint, ten  with  blue,  red.  There  were  five  water  tests  made.  Fifty- 
four  houses  examined  on  complaint  and  seventy-seven  re-examined. 
Forty-three  complaints  were  found  to  be  valid  and  eleven  without  cause. 


/©eDtcal  iRews 

Edited  by  Arthur  J.  Bedell,  M.  D. 

Dinner  to  Dr.  Ferguson. — A  testimonial  dinner  to  Dr.  E.  D.  Ferguson 
by  his  colleagues  of  Troy,  N.  Y.,  was  given  on  April  18,  1906.  The  presen- 
tation speech  of  the  evening  was  made  by  Dr.  Reuben  H.  Irish,  as  follows : 

Mr.  Toastmaster  and  Gentlemen: 

I  wish  to  express  my  appreciation  of  the  honor  that  has  been  conferred 
upon  me  by  the  members  of  this  committee  in  requesting  me  to  present 
this  cup.  It  "is  one  of  the  pleasantest  duties  that  it  has  been  my  privilege 
in  life  to  perform. 

It  is  especially  fitting  that  a  testimonial  to  Dr.  Ferguson  should  come 
from  this  society  of  which  he  was  the  founder  and  which  has  grown 
and  flourished  under  his  eye  and  largely  under  his  guidance,  until  it 
is  now  recognized  as  one  of  the  first  scientific  organizations  of  this  sec- 
tion. The  growth  and  development  of  this  association  is,  in  itself,  one 
of  the  best  testimonials  to  his  untiring  perseverance,  and  sincere  devotion 
to  the  cause  of  medical  advancement. 

This,  I  believe,  is  the  first  occasion  upon  which  we,  as  a  body,  have 
come  together  to  honor  a  fellow  member  while  still  among  the  living 
and  actively  engaged  in  practice — and  I  am  sure  the  activities  of  our 
honored  guest  in  the  past  six  months,  are  good  evidence  that  he  is  still 
very  much  alive,  and  that  his  energies  are  not  on  the  wane. 

But  why  should  we  wait  until  a  man  has  at  least  one  foot  in  the  grave 
to  say  a  few  pleasant  things  of  him? 

I,  for  one,  am  glad  that  we  have  taken  the  opportunity  to  pay  this 
tribute  of  respect,  while  he  is  in  full  physical  and  mental  vigor  to  enjoy  it. 

I  have  used  the  term  to  honor  him,  and  yet  to  such  a  man  as  Dr. 
Ferguson  a  demonstration  of  this  kind  can  scarcely  be  called  an  honor. 
It  is  only  one  of  many  well  earned  rewards  of  his  profession. 

Yet  each  word  spoken  in  his  praise  here  to-night  brings  reflected 


458 


MEDICAL  NEWS 


honor  to  this  association,  for  we  are  proud  to  have  one  among  us, 
who  in  the  past  has  done  so  much  to  advance  the  interests  of  the  medical 
profession  at  large,  and  who  is  still  recognized  as  one  of  the  most  careful 
diagnosticians  and  most  skilful  surgeons. 

But  above  all  he  reflects  credit  upon  this  body,  not  so  much  for  what 
he  has  done  or  may  still  do,  in  the  advancement  of  science,  but  for  what 
he  is — a  gentleman  of  the  old  school,  who  never  by  word  or  deed  has 
deviated  from  the  principles  of  professional  ethics,  which  should  govern 
professional  men. 

Doctor  Ferguson: 

In  appreciation  of  your  sterling  qualities  as  a  citizen,  in  recognition 
of  your  high  standard  in  the  medical  profession  of  your  city,  state 
and  country,  and  in  token  of  the  love  and  respect  which  we  all  bear 
you,  I,  in  behalf  of  the  "  Medical  Association  of  Troy  and  vicinity," 
have  the  honor  of  presenting  you  with  this  loving  cup. 

It  is  the  hope  and  earnest  desire  of  every  member  that  you  may  long 
continue  actively  engaged  as  at  present  in  the  practice  of  your  pro- 
fession, for  we  need  the  example  of  your  life  before  us,  and  we  wish 
still  to  enjoy  the  benefits  of  your  wise  counsel  and  that  ripe  experience 
which  time  alone  can  give. 

And  we  are  further  united  in  the  hope  that  occasions  such  as  this  may 
establish  a  closer  bond  of  fellowship  between  the  members  of  that  pro- 
fession in  the  interests  of  which  the  labors  of  your  life  have  been  spent. 

The  Albany  Guild  for  the  Care  of  the  Sick. — Number  of  new 
cases,  131,  classified  as  follows:  Dispensary  patients  receiving  home 
care,  3;  district  cases  reported  by  the  health  physicians,  19;  charity 
cases  reported  by  other  physicians,  46;  patients  of  limited  means,  63; 
old  cases  still  under  treatment,  52;  total  number  of  patients  under  nursing 
care  during  the  month,  183. 

Classification  of  diseases  (new  cases)  :  Medical,  38;  surgical,  10; 
gynaecological,  4;  obstetrical  work  of  the  Guild,  32  mothers  and  32 
infants  under  professional  care ;  dental,  3 ;  throat  and  nose,  2 ;  removed 
to  hospitals,  2;  deaths,  10. 

Special  Obstetrical  Department:  Number  of  obstetricians  in  charge  of 
cases,  4;  attending  obstetricians,  3;  medical  students  in  attendance,  6; 
Guild  nurses,  6;  patients,  6;  number  of  visits  by  head  obstetrician,  64; 
by  attending  obstetricians,  4;  by  the  medical  students,  30;  by  the  Guild 
nurses,  128;  total  number  of  visits  for  this  department,  226. 

Visits  of  Guild  nurses  (all  departments)  :  Number  of  visits  with 
nursing  treatment,  1,354;  f°r  professional  supervision  of  convalescents, 
200;  total  number  of  visits,  1,554.  Six  graduate  nurses  and  six  assistant 
nurses  were  on  duty.  Cases  were  reported  to  the  Guild  by  four  of  the 
health  physicians  and  by  38  other  physicians  and  by  three  dentists. 

Pocahontas  Hospital  at  Jamestown  Exposition. — The  first  building 
f  be  completed  at  the  Jamestown  Exposition  will  be  the  Pocahontas 
Hospital.    Every   exposition   has   taught   the   absolute   necessity  of  a 


MEDICAL  NEWS 


459 


well-equipped  hospital,  under  the  charge  of  a  competent  medical  director, 
with  a  staff  of  dependable  house  doctors  and  trained  nurses. 

The  Pocahontas  Hospital  is  not  a  very  large  building,  as  exposition 
hospitals  go,  but  it  has  been  planned  to  meet  every  ordinary  demand.  It 
has  offices  for  the  medical  staff,  sleeping  apartments  for  house  doctors, 
nurses,  and  the  necessary  help.  There  are  bright,  airy  wards,  both  for 
male  and  female  patients,  and  private  rooms  for  such  sufferers  as  may  be 
too  ill  to  occupy  cots  in  the  wards  and  require  isolation.  In  the  base- 
ment will  be  a  kitchen,  dining  room,  store  rooms,  and  apart  from  these 
there  will  be  installed  a  first-class  heating  outfit. 

The  hospital  will  contain  a  room  for  medical  and  surgical  supplies, 
a  sterilizing  room,  and  an  operating  theatre,  planned!  and  equipped  accord- 
ing to  the  most  modern  methods.  A  complete  outfit  of  hospital  instru- 
ments and  appliances  will  be  placed  in  this  building.  In  this  respect, 
the  Pocahontas  Hospital  will  in  many  ways  be  superior  to  any  other 
in  the  South.  The  outfit  is  elaborate  in  every  detail,  the  manufacturer 
taking  a  special  pride  in  this  equipment  which  must  of  necessity  prove 
valuable  to  him  as  an  advertisement  if  it  is  excellent,  while  detrimental 
to  him  if  the  reverse  were  true. 

Already  a  competent  corps  of  resident  surgeons  and  nurses  is  being 
congregated.  These  will  live  in  the  hospital,  and  be  ready  at  any  hour 
of  the  day  or  night  to  care  for  emergency  cases  needing  attention. 

A  temporary  telephone  system  will  soon  be  installed,  connecting  the 
hospital  with  all  points  of  the  grounds,  and  an  ambulance  service,  already 
organized  and  soon  to  be  put  into  operation,  will  answer  these  calls 
from  a  central  station  in  a  very  few  minutes. 

The  medical  director  will  exercise  direct  supervision  over  the  work 
of  the  medical  staff,  from  each  of  whom  he  will  receive  a  daily  report, 
and  will  have  inspectors  who  will  inform  him  regarding  any  facts  relating 
to  the  general  sanitation  and  hygiene  of  the  exposition  grounds.  These 
sanitary  inspectors  will  make  semi-daily  visits  to  each  exposition  building 
and  concession  edifice,  twice  a  day  rendering  their  reports,  so  that  any 
nuisance  may  be  at  once  abated.  The  grounds  have  been  placed  in  a 
most  perfect  sanitary  condition,  well  drained  throughout;  and  it  will 
be  a  part  of  the  medical  director's  duty  to  see  that  this  condition  is 
maintained  throughout  the  exposition  period. 

Aid  for  San  Francisco  County  Medical  Society. — The  Physicians' 
Relief  Committee  of  Kings  County  has  sent  out  a  request  for  contributions 
of  instruments,  books,  and  money  for  those  members  of  our  profession  who 
lost  their  all  in  the  San  Francisco  disaster.  These  contributions  will  be 
received  and  packed  by  the  local  Red  Cross  and  transmitted  by  the 
Wells-Fargo  Express  Company  free  of  charge,  or  contributions  may  be 
sent  direct  to  the  Annals. 

Albany  Hospital  Training  School  for  Nurses. — The  commencement 
of  the  class  of  1906  Albany  Training  School  for  Nurses  was  held  Friday, 
May  4th,  at  the  Albany  Academy  for  Girls,  Albany,  N.  Y.  The  address 
to  the  graduates  was  given  by  the  Rt.  Rev.  Henry  R.  Nelson,  Bishop 


460  MEDICAL  NEWS 

Coadjutor  of  Albany.  The  diplomas  were  presented  by  Dr.  Samuel  B. 
Ward.    Eighteen  were  graduated. 

The  Albany  Hospital  Training  School  Alumnae  announce  the 
opening  of  their  clubhouse  No.  351  Hudson  avenue,  Albany,  N.  Y., 
on  Thursday,  May  10th. 

Personal — Dr.  Isaac  Becker  (A.  M.  C.f  1856)  has  removed  from 
Berne,  N.  Y.,  to  Altamont,  N.  Y. 

—Dr.  Aleert  Vander  Veer  (A.  M.  C,  1862)  was  elected  Regent  of  the 
University  of  the  State  of  New  York  April  26,  1906. 

—Dr.  Henry  W.  Boynton  (A.  M.  C,  1866)  has  moved  from  La  Porte, 
Iowa,  to  Toledo,  Ohio. 

—Dr.  Harry  M.  Lincoln  (A.  M.  C,  1886)  has  moved  from  Greenfield, 
N.  Y.,  to  Wilton,  N.  Y. 

—Dr.  James  Clyne  (A.  M.  C,  1886),  is  in  practice  at  Joliet,  111. 

—Dr.  Joseph  S.  Parent  (A.  M.  C,  1886)  has  moved  from  Birchton, 
N.  Y.  to  Ballston  Spa.,  N.  Y. 

— Dr.  William  B.  Campbell  (A.  M.  C,  1886)  is  practicing  at  Edmeston, 
Otsego  county,  N.  Y. 

—Dr.  Ira  D.  Hasbrouck  (A.  M.  C,  1896)  has  moved  from  Providence, 
R.  I.,  to  Washington,  R.  I. 

—Dr.  George  E.  Beilby  (A.  M.  C,  1899)  has  moved  from  No.  12  Wash- 
ington avenue,  Albany,  N.  Y.,  to  No.  247  State  street,  Albany,  N.  Y. 

— Dr.  Gerald  Griffin  (A.  M.  C,  1901)  has  moved  from  No.  114  Grand 
street,  Albany,  N.  Y.,  to  No.  140  Washington  avenue,  Albany,  N.  Y. 

— Dr.  Roscoe  C.  Waterbury  (A.  M.  C,  1905)  is  practicing  at  Averill 
Park,  N.  Y. 

— Dr.  Lemuel  R.  Hurlbut  (A.  M.  C,  1905)  is  in  the  State  Hospital  at 
Binghamton,  N.  Y. 

— Dr.  Edward  J.  Bedell  (A.  M.  C,  1893)  has  moved  from  Beckers 
Corners,  N.  Y.,  to  Delmar,  N.  Y. 

— Dr.  Wilfred  S.  Hale  (A.  M.  C,  1894)  has  returned  from  Europe. 

—Dr.  James  N.  Vander  Veer  (A.  M.  C,  1903)  has  returned  from 
Europe  where  he  has  been  doing  post-graduate  work  for  the  last  year. 

— Dr.  James  F.  Rooney  (A.  M.  C,  1899)  has  removed  from  123  Grand 
street  to  295  Madison  avenue,  Albany. 

— Dr.  Albert  Vander  Veer  (1862)  has  returned  from  the  International 
Congress  held  at  Lisbon,  Portugal,  in  April. 

— Dr.  Chas.  L.  Bailey  has  moved  from  No.  281  Clinton  avenue  to  No. 
293  Clinton  avenue,  Albany,  N.  Y. 


Albany  Medical  Annals,  June,  iqo6 


IN  MEMORIAM 


461 


Deaths. — Dr.  James  Carr  (A.  M.  C,  1886)  of  No.  36  Piatt  street, 
New  York  City,  died  in  December,  1905,  from  pneumonia. 

—Dr.  John  Campbell  (A.  M.  C,  1843)  died  at  his  home  in  Cold  Spring, 
N.  Y.,  December  25,  1905,  aged  84.  He  was  a  member  of  the  medical 
department  of  the  United  States  Army  from  1847,  when  he  joined  as 
lieutenant,  until  1886  when  he  retired  as  colonel,  receiving  in  April,  1904, 
the  rank  of  brigadier  general,  retired.  He  was  lieutenant-colonel  and 
medical  inspector  U.  S.  V.  during  the  Civil  War;  a  veteran  of  the 
Mexican  War  and  in  several  Indian  campaigns. 

— Dr.  E.  Collins  Blaispell  (A.  M.  C,  1858)  died  at  his  home  in  Quincy, 
III,  December  22,  1905,  from  paralysis. 

— Dr.  Israel  I.  Buckbee  (A.  M.  C,  1841),  aged  86,  died  at  his  home 
in  Fonda,  N.  Y.,  April  25,  1906. 

— Dr.  Tames  E.  Kelley  (A.  M.  C,  1901),  of  Saratoga  Springs,  N.  Y., 
died  May  14,  1906. 

— Dr.  Luther  B.  Newton  (A.  M.  C,  1874)  died  at  North  Bennington, 
Vt,  May  2,  1906. 


Hn  flDemortam 

Israel  I.  Buckbee,  M.  D. 

Dr.  Israel  I.  Buckbee,  the  last  survivor  of  the  class  of  1841  of  the 
Albany  Medical  College,  and  during  a  long  life  a  most  respected  prac- 
titioner of  the  Mohawk  Valley,  died  at  his  home  in  Fonda,  N.  Y., 
April  25,  1906. 

Dr.  Buckbee  was  born  on  the  12th  of  February,  1821,  in  Dutchess 
county,  N.  Y.  He  was  the  son  of  Gilbert  I.  and  Mary  Buckbee  and 
the  representative  of  the  fourth  generation  to  bear  the  name,  Israel 
Buckbee,  in  this  county.  His  grandfather,  Jeremiah  Buckbee,  was  one  of 
seven  sons,  five  of  whom  fought  bravely  in  the  Revolutionary  war.  He 
was  of  English  origin  and  a  prominent  farmer  in  Dutchess  county,  where 
he  owned  a  valuable  tract  of  land.  He  also  owned  a  tract  of  land  in 
Warren  county,  mostly  uncleared,  and  there  the  Doctor's  parents  went 
as  pioneers  in  1822.  Gilbert  I.  Buckbee,  father  of  the  subject  of  this 
sketch,  was  born  in  1794  and  died  in  Fonda  in  1878  at  the  age  of  84  years. 
Three  years  later  his  wife  died  in  the  same  place,  aged  85.  On  the 
home  farm  in  Warren  count)',  in  what  was  almost  a  wilderness,  Dr. 
Buckbee's  boyhood  was  passed  until  his  father  purchased  another  farm 
near  the  village  of  Glens  Falls.  The  family  and  their  ancestors  were 
Quakers.  At  the  age  of  17  years  the  young  man  began  the  study  of 
medicine  with  Drs.  Clark  and  Peck  of  Glens  Falls  and  later  he  studied 
with  Dr.  Littlefield,  his  uncle.  This  was  followed  by  one  year's  course 
in  the  Vermont  Medical  College  and  two  more  in  the  Albany  Medical 


IN  MEMORIAM 


College,  from  which  he  was  graduated  in   1841.    He  spent  one  year 
with  Dr.  Snow  of  Root,  Montgomery  county,  and  aftefward  located  in 
Fonda.    He  was  a  member  of  the  Medical  Society  of  the  County  of 
Montgomery  and  had  been  a  member  of  the  Medical  Society  of  the 
State  of  New  York  since  1866.    On  the  10th  of  September,  1890,  Dr. 
Buckbee  completed  a  period  of  practice  of  fifty  years'  duration,  and  the 
occasion  was  honored  by  a  meeting  of  his  professional  brethren  in  the 
county  society  and  others,  which  was  held  at  his  residence  in  this  village. 
On  that  occasion  some  indication  of  the  esteem  in  which  Dr.  Buckbee 
was  held  by  his  colleagues  and  by  the  citizens  of  his  town  was  voiced 
by  Dr.  Charles  Stover,  who  said  in  part:    "If  the  mind  is  allowed  to 
run  back  fifty  years  and  recall  the  scanty  equipment  that  the  period 
allowed  the  medical  student  to  be  provided  with  when  he  launched  into 
practice;  if  one  will  recall  the  lack  of  clinical  instruction,  the  paucity 
of  instruments  of  precision,  the  labyrinthine  maze  of  rooted  superstitions 
and  venerated   errors   that  preceded   the  application  of  the  inductive 
method  to  medicine,  and  then  reflect  that  our  associate  whom  we  are 
here  to  honor  tonight  has  kept  even  pace  with  the  march  of  medical 
progress  that  the  mellow  experience  of  his  life  has  been  so  blended 
with  latter  day  science  that  we  are  all  content  to  sit  at  his  feet  and  be 
taught,  we  must  award  to  him  proved  qualities  of  industry  and  courage. 
I  hope  we  may  hear  from  his  own  lips  to  what  conditions  and  to  what 
circumstances  may  be  attributed  his   signal  success.    For  it  is  success 
for  fifty  years  to  have  gone  in  and  out  amid  the  families  of  the  community 
and  to  have  sympathized  with  them  in  their  sorrow  and  rejoiced  with 
them  in  their  joy,  to  have  given  comfort  to  the  afflicted,  to  have  buoyed 
them  up  with  hope  when  hope  seemed  dead,  to  have  protected  family 
honor  and  have  been  able  to  shield  the  innocent  and  the  weak  while 
presenting  no  barrier  to  offend  justice.    It  is  success  for  fifty  years  to 
have  done  one's  duty  as  an  honest  citizen  at  the  caucuses  and  the  polls, 
while  touching  the  community  at  so  many  points  as  only  the  physician 
may;  it  is  success  to  have  merited  and  held  the  esteem  of  one's  pro- 
fessional associates,  to  have  been  in  sympathy  with  the  enthusiastic 
aspirations  of  youth,  to  have  borne  the  friction  of  laudable  strife  without 
sacrifice  of  one's  manliness." 

Dr.  Buckbee  married  on  the  14th  day  of  February,  1844,  Anna  C, 
daughter  of  Thomas  and  Elizabeth  Bunn  of  Amsterdam.  They  had  one 
child,  Luella  B.,  who  married  Ferguson  Jansen  of  this  village.  The  surviv- 
ing members  of  the  family  are  two  grandsons,  Dr.  F.  I.  Jansen  of  Fonda, 
and  Romeyn  B.  Jansen  of  Seattle,  Wash.,  a  son-in-law,  Ferguson  Jansen 
and  a  sister,  Miss  Jane  A.  Buckbee  of  Saratoga  county. 

At  the  time  of  the  Civil  War  Dr.  Buckbee  was  appointed  a  surgeon 
for  the  153rd  Regiment  and  he  made  Dr.  Snow  his  assistant,  but  when 
it  came  time  for  this  regiment  to  leave  for  active  service  his  wife  was 
seriously  ill  with  typhoid  fever,  detaining  him,  and  Dr.  Snow  took  his 
place.  In  addition  to  his  professional  life  of  business  he  has  taken 
much  interest  in  agriculture.  He  was  also  a  director  of  the  National 
Mohawk  River  Bank  of  Fonda,  his  connection  with  the  bank  dating 
back  to  its  organization. 


Vol.  xxvii 


JULY,  1906 


No  7. 


ALBANY 
MEDICAL  ANNALS 


®rlGtnal  Communications 

THE  SANITARY  DEPARTMENT  OF  ARMIES  AND  THE 
MILITARY  MEDICAL  OFFICER.* 

By  JOHN  VAN  RENSSELAER  HOFF,  A.  M.,  M.  D., 

Colonel,  Assistant  Surgeon  General,  U.  S.  Army. 

"History  draped  in  her  ceremonial  robes,  describes  decisive 
victories  and  the  ultimate  results  of  campaigns,  but  does  not 
mention  the  cost  in  blood  and  tears  by  which  they  were  won, 
nor  enter  into  the  familiar  details  which  make  all  men  akin." 

History  of  Military  Medical  Organization. 

Exactly  when  military  sanitary  organization  first  began  to 
take  form  is  impossible  to  say.  Probably  in  the  very  beginning 
of  human  existence  rude  attempts  were  made  to  alleviate  the 
sufferings  of  those  injured  in  the  conflicts  of  that  day.  Certainly, 
military  medicine  dates  from  the  dawn  of  history.  "Aescu- 
lapius, who  sailed  with  Jason  in  search  of  the  Golden  Fleece, 
and  Machaon,  who,  summoned  by  Agamemnon,  dressed  the 
wounds  of  Menelaus  'far  on  the  ringing  plains  of  windy  Troy,' 
were  prototypes  of  the  military  medical  officer  of  to-day." 

But  history  is  singularly  meager  in  details  of  this  most  interest- 
ing subject,  and  it  is  only  by  an  occasional  word  here  and  there 
that  we  are  enabled  to  form  any  idea  of  what  became  of  the 
ill  and  injured  of  ancient  armies.  Certainly  as  early  as  1 17  A.  D. 
Rome  had  military  hospitals,  and  there  was  an  organized  medical 
corps  in  the  Roman  army.  In  an  order  of  Aurelian  to  his  army 
occurs  the  following:  "Let  the  soldiers  be  cured  gratuitously 
by  the  physicians,  and  let  them  conduct  themselves  quietly  in 
the  hospitia,  and  he  who  would  raise  strife  let  him  be  lashed." 


*  Part  of  a  course  of  lectures  on  military  sanitation  delivered  before  the  Medical  School, 
University  of  Nebraska. 


464  THE  SANITARY  DEPARTMENT  OF  ARMIES 


But  nearly  seven  hundred  years  before  this  Xenophon  notes  the 
presence  of  medical  officers  with  his  army. 

In  the  endless  conflicts  of  the  Dark  Ages,  soldiers,  if  captured, 
were  promptly  hung  or  butchered;  if  sick,  they  were  abandoned; 
and,  except  for  the  glimmering  taper  held  by  the  Hospitaler 
Knights  of  Saint  John,  it  would  seem  as  though  the  light  of 
humanity  had  been  quenched.  The  entire  neglect  of  the 
medical  care  of  soldiers  during  this  period  is  shown  by  the  fact 
that  scarcely  any  mention  is  made  of  it  between  the  fall  of 
Rome  and  the  sixteenth  century.  Fronsperger  (1555)  was  the 
first  to  formulate  and  publish  systematic  regulations  for  the 
sanitary  service,  which  are  said  to  be  the  basis  of  the  present 
German  army  Sanitatsordnung. 

It  was  only  after  the  establishment  of  well-organized  standing 
armies  that  any  systematic  methods  were  provided  for  the  care 
of  troops,  and  even  then  the  medical  organization  was  very 
crude,  being  limited  to  the  company  infirmary.  From  the  fall 
of  Rome  until  almost  the  beginning  of  the  seventeenth  century 
no  account  is  found  of  the  establishment  of  a  field  hospital, 
the  first  one  being  organized  at  the  siege  of  Rouen,  in  1591,  and 
the  second  at  Amiens,  in  1597. 

From  this  time,  it  would  appear  that  the  greatest  advances 
in  military  organization  were  made  by  the  French,  who,  in  the 
language  of  Sully,  "had  pursued  no  other  trade  than  that  of 
arms."  To  be  sure,  the  advance  was  with  halting  step.  In 
1630  medical  officers  were  first  given  a  distinctive  military 
title;  the  Hotel  des  Invalides  was  founded  in  1659;  a  permanent 
medical  corps  was  organized  in  1708;  an  army  and  navy  medical 
school  was  established  in  1718;  competitive  examinations  for 
the  appointment  of  medical  officers  were  inaugurated  in  1761; 
and  the  first  military  medical  journal  was  publisehd  in  1780. 

The  Napoleonic  era  produced  the  remarkable  medico-military 
administrators  Percy  and  Larry,  who  disputed  the  honor  of 
having  perfected  the  field  sanitary  organization  of  the  French 
army  to  a  degree  never  before  equalled.  After  Waterloo  there 
was  some  progress,  but  the  advance  was  faltering,  and  not  until 
the  Franco-Prussian  war  brought  a  rude  awakening  did  the 
medical  department  of  the  French  army  reach  the  ideal  organiza- 
tion it  now  has. 

The  sanitary  service  of  other  armies  has  been  of  even  slower 
growth.    Gore  says,  the  British  custom  up  to  the  sixteenth 


JOHN  VAN  RENSSELAER  HOFF 


465 


century  was  to  discharge  the  wounded  with  a  small  gratuity 
"to  find  their  way  home  as  best  they  might."  A  permanent 
medical  department  was  organized  in  that  army  during  the 
Stuart  period,  but  it  was  not  until  the  campaigns  of  Marlborough 
that  this  department  became  prominent  under  the  clever  admin- 
istration and  boundless  courage  of  its  senior  officer,  Sir  John 
Pringle.  It  was  this  distinguished  ofhcer  who  suggested  and 
pushed  to  a  finality  the  articles  of  agreement  between  Lord 
Stair,  representing  Great  Britain,  and  the  Duke  de  Noailles, 
the  French,  neutralizing  the  wounded  and  medical  personnel  in 
the  campaign  of  1743.  This  was  the  beginning  of  the  altruistic 
movement  which  culminated  in  1864  in  the  adoption  of  the 
articles  of  the  Geneva  convention.  To  Sir  John  Pringle  is  due 
the  organization  of  regimental,  field  and  general  hospitals  in 
the  British  army,  and  this  able  officer  may  be  said  to  be  the 
progenitor  of  the  Medical  Department  of  the  United  States  army, 
since  it  was  his  scheme  of  sanitary  organization  that  this  nation 
adopted  when  they  separated  from  the  mother  country  and 
adhered  to  for  the  most  part  for  over  a  hundred  years,  long  after 
the  British  army  had  developed  it  to  a  much  higher  state  of 
efficiency. 

But  this  development  on  their  part  was  by  no  means  rapid. 
During  the  Peninsular  war  the  hospital  personnel  was  detailed 
from  the  line,  and  that  war  resulted  in  no  improvement  in 
organization.  In  1812  a  transport  corps,  called  the  "Royal 
Waggon  Train,"  was  organized,  part  of  the  function  of  which 
was  to  man  the  ambulances,  but  after  twenty  years'  trial,  not 
proving  satisfactory,  it  was  disbanded. 

The  outbreak  of  the  Crimean  war  found  this  army  without 
an  enlisted  personnel  for  its  medical  department.  A  so-called 
Hospital  Conveyance  Corps  was  hastily  organized,  and  proved 
hopelessly  inefficient.  Of  this  it  is  stated,  it  "failed,  owing, 
amongst  other  reasons,  to  the  total  want  of  training  of  the  men 
composing  the  corps.  They  were  not  accustomed  to  such 
varied  service,  nor  to  work  together;  further,  they  were  advanced 
in  years,  and  generally  drunken  and  disorderly  in  habits." 
In  1855  the  first  medical  staff  corps  appeared,  the  function  of 
which  was  the  performance  of  all  hospital  duties.  This  came  to 
an  untimely  end  in  three  months,  due,  it  is  said,  to  a  lack  of 
proper  military  organization,  and  was  succeeded  by  the  Army 
Hospital  Corps. 


466  THE  SANITARY  DEPARTMENT  OF  ARMIES 


After  the  Crimean  war,  following  the  custom  of  that  country, 
a  royal  commission  was  appointed  to  inquire  into  the  sanitary 
organization  and  regulations  affecting  the  British  army.  As 
the  result  of  this,  an  army  medical  school  was  established,  and 
the  medical  department  was  for  the  first  time  placed  on  a  military 
basis;  but  it  was  not  until  1873  that  the  regimental  system  was 
abolished  and  the  medical  officers  consolidated  into  a  corps. 

The  same  year  a  Hospital  Corps  was  organized,  and  regimental 
hospitals  were  substituted  by  general,  station  and  field  hospitals. 
Four  years  after  medical  officers  were  for  the  first  time  authorized 
to  command  their  own  department,  the  sick  and  soldiers  attached. 
In  1884  the  designation  of  the  Hospital  Corps  was  changed  to 
the  Medical  Staff  Corps,  and  in  1891  medical  officers  were  given 
army  rank,  with  substantive  titles,  surgeon  colonel,  etc.,  which 
in  1902  were  changed  by  eliminating  "surgeon;"  in  a  word, 
the  medical  officer  of  the  British  army  was  then  for  the  first 
time  placed  on  the  same  plane  with  other  so-called  staff  officers. 

The  history  of  the  Medical  Department  of  the  United  States 
army  begins  in  1775,  when  they  naturally  adopted  Sir  John 
Pringle's  scheme  of  organization,  and,  as  previously  stated,  in 
large  measure  adhered  to  it  for  quite  a  hundred  years.  The 
War  of  the  Revolution,  fought  as  it  was  for  the  most  part  by 
raw  levies  from  the  people,  destitute  of  almost  every  material 
thing,  even  arms  and  ammunition,  added  little  to  the  advance- 
ment of  military  sanitation.  The  Medical  Department  was  as 
a  rule  poorly  officered  and  badly  equipped,  and  the  sick  were 
crowded  into  wretched  huts  or  makeshift  hospitals. 

The  war  of  181 2  again  found  this  country  without  sanitary 
organization.  The  lessons  taught  by  the  wars  of  the  Directory 
and  Empire,  in  which  Percy  and  Larry  gained  such  distinction, 
had  apparently  made  little  or  no  impression  upon  the  people  or 
their  medical  profession,  for  the  military  sanitary  department  was 
in  no  respect  an  advance  beyond  that  of  the  Revolutionary 
army.  Nothing  apparently  had  been  learned  from  "the  vexa- 
tious controversies  and  sad  failures  of  that  war." 

Fortunately,  however,  the  hospitals  were  abundantly  supplied 
with  everything  necessary  for  the  comfort  of  the  sick,  and  the 
essential  fault  lay  in  the  lack  of  proper  organization.  With 
the  close  of  the  war  the  Surgeon  General  was  retired  to  private 
life,  and  the  Medical  Department,  as  a  corps,  ceased  to  exist. 

In  1 81 4  the  duties  of  medical  officers  were  first  clearly  defined 


JOHN  VAN  RENSSELAER  HOFF 


467 


in  regulations.  These  have  been  variously  modified  from  time  to 
time  and  are  even  now  undergoing  still  further  modifica- 
tion, which  must  ultimately  result  in  a  very  perfect  code. 

The  act  of  181 8  which  provided  for  the  permanent  appointment 
of  a  Surgeon  General  marks  the  beginning  of  the  history  of  the 
Medical  Department  of  the  United  States  army  as  a  permanent 
organization,  though  it  was  not  until  after  the  enactment  of 
the  law  of  1821  that  it  assurned  the  form  which  it  retained  up 
to  the  reorganization  in  1901. 

Examinations  for  appointment  as  medical  officers,  ostensibly 
required  as  early  as  the  Revolutionary  war,  became  really 
operative  in  1832,  nnd  this  law  has  been  rigidly  observed  since 
that  time. 

The  medical  history  of  the  Mexican  war  is  full  of  interest, 
and  the  work  done  there  reflected  great  credit  upon  the  medical 
officers,  not  only  as  sanitarians,  but  as  soldiers  as  well.  Never- 
theless there  was  little  or  no  advance  in  organization,  for  they 
still  adhered  to  the  then  antiquated  methods  of  Sir  John  Pringle, 
and  failed  to  avail  themselves  of  the  improved  methods  developed 
in  the  Napoleonic  wars.  The  good  work  accomplished  was 
not  because  of  the  system,  but  in  spite  of  it.  By  the  act  of 
February  nth,  1847,  medical  officers  were  for  the  first  time 
given  actual  rank. 

From  the  conclusion  of  the  Mexican  war  until  1861  each  year 
there  was  a  gain,  always  slow  and  sometimes  imperceptible, 
but  nevertheless  a  gain.  Especially  the  personnel  was  so 
improved  through  the  high  standard  demanded  by  the  examin- 
ing boards,  that  the  officers  of  the  Medical  Department  of  the 
army  were  quite  on  a  plane  with  the  best  talent  the  country 
afforded. 

The  outbreak  of  the  war  of  Secession  again  found  the  United 
States  without  any  definite  scheme  of  sanitary  organization. 
The  Medical  Department  was  still  an  aggregation  of  most 
excellent  practitioners,  with  few  medical  officers. 

But  the  logic  of  events  soon  pointed  out  the  place,  function 
and  responsibility  of  the  sanitary  service,  and,  though  all  through 
that  war,  as  in  every  other,  the  department  had  to  contend 
strenuously  for  everything  necessary  to  its  efficiency,  yet  as 
time  rolled  on  these  things  were  conceded,  grudgingly  indeed, 
but  nevertheless  conceded  in  one  form  or  another. 

Medical   inspectors   were   appointed;  the   department  was 


468  THE  SANITARY  DEPARTMENT  OF  ARMIES 

given  control  of  its  hospitals;  and  an  efficient,  though  impro- 
vised, ambulance  corps  was  organized  in  the  army  of  the  Potomac 
in  1862,  its  personnel  being  detailed  from  the  line  and  at  the 
expense  of  the  fighting  effective;  regimental  dispensaries  and 
field  hospitals  (organized  in  the  perfecting  of  the  sanitary 
service)  were  manned  from  the  same  source. 

This  improvised  organization  was  rendered  necessary  not 
because  the  Surgeon  General  failed  to  recommend  the  establish- 
ment of  an  independent  hospital  corps,  but  because  General 
Halleck  disapproved  his  recommendations  and  the  Secretary  of 
War  sustained  him.  It  was  not  until  1864,  and  then  only  through 
an  act  of  Congress,  that  a  uniform  ambulance  organization  was 
established  throughout  the  army. 

The  accomplishments  of  the  Medical  Department  in  this  war 
were  stupendous,  and  are  deserving  of  the  magnificent  testi- 
monial to  it  found  in  the  medical  history  of  that  unequalled 
conflict,  and  the  museum  and  library,  enduring  monuments  to 
the  medical  officers  of  that  period.  But  with  the  close  of  the 
war  the  army  apparently  straightway  endeavored  to  forget 
its  dearly-bought  experience,  and  resumed  its  old  status  and 
organization. 

During  the  succeeding  generation  such  experience  as  came  to 
the  military  establishment  was  from  the  little  Indian  wars,  in 
which  the  medical  arrangements  were  necessarily  more  or  less 
primitive.  The  most  important  law  enacted  during  this  period 
was  that  of  March  1st,  1887,  organizing  the  Hospital  Corps. 
Loosely  drawn  and  elastic  as  is  this  law,  no  act  of  Congress  since 
that  of  1847  is  more  important  to  the  present  efficiency  and 
future  usefulness  of  the  Medical  Department.  The  growth  of 
this  organization  progressed  tentatively.  Post  detachments 
were  first  organized,  and  then  in  1891  companies  of  instruction. 
At  this  time  an  unsuccessful  effort  was  made  to  obtain  a  more 
detailed  organization.  An  Army  Medical  School  was  established 
in  1893. 

The  declaration  of  war  with  Spain  found  the  Medical  Depart- 
ment without  any  organization  for  active  service,  and  such  as 
was  had  during  that  war  was  evolved  while  the  army  was  actually 
assembling.  This  organization  was  based  upon  the  experience 
gained  in  1861-65  and  the  methods  adopted  in  the  best  foreign 
armies.  The  army  corps  was  made  the  administrative  unit. 
Each  corps  had  a  reserve  field  hospital  and  ambulance  company ; 


JOHN  VAN  RENSSELAER  HOFF 


469 


each  division  had  a  field  hospital  and  ambulance  company;  and 
each  regiment,  a  regimental  dispensary.  The  personnel  of  the 
Hospital  Corps  was  in  the  beginning  transferred,  vi  et  arrnis, 
from  the  volunteers  into  the  regular  establishment  (necessitated 
by  the  fact  that  Congress  had  made  no  provision  for  a  volunteer 
hospital  corps),  and  was  afterwards  maintained  by  regular 
recruitment.  The  war  did  Viot  last  long  enough  to  test  the 
efficiency  of  this  organization,  for  no  organization  can  be  pro- 
ficient until  its  personnel  is  trained,  but  theoretically  it  was  up 
to  the  best  standards,  except  in  being  under-manned  both  as 
to  officers  and  soldiers. 

Base  hospitals  were  organized  at  various  points,  but  not  in 
sufficient  number,  or  else  the  division  hospitals  would  not  have 
been  overcrowded  and  immobilized.  Since  the  Spanish-Ameri- 
can war  a  complete  sanitary  organization  for  active  service 
has  been  adopted  and  promulgated  in  regulations. 

General  Considerations. 

The  personnel  of  the  medical  department  of  armies  has  grown 
up  from  the  most  humble  origin,  for,  while  occasionally  we  see 
some  name  renowned  in  ancient  legend  mentioned  in  connection 
with  military  sanitation,  and,  mayhap,  the  medical  officer  did 
attain  rank,  position  and  influence  in  olden  times,  nevertheless 
the  line  leads  back  to  the  slave,  to  the  camp  follower,  to  the 
barber  of  the  Dark  Ages,  and  it  was  only  when  the  healing  art 
grew  into  and  was  recognized  as  a  learned  profession  that  its 
followers  attained  the  status  that  education  always  gives,  and 
the  medical  man  became  a  medical  officer. 

It  might  be  asked  why  the  perfecting  of  the  sanitary  service 
has  progressed  so  slowly  and  apparently  with  so  much  opposition 
on  the  part  of  other  branches  of  the  service,  which  are  really 
those  most  interested  in  it  ?  The  reasons  for  this  are  both  psycho- 
logical and  sociological.  The  average  man  dislikes  to  contem- 
plate the  possibility  of  a  disagreeable  occurrence,  no  matter 
how  very  probable  that  occurrence  may  be.  Formerly  more 
than  now  the  idea  prevailed  that  to  have  one's  life  insured 
was  to  invite  disaster,  and  the  making  of  one's  will  is  generally 
approached  with  a  dread  and  solemnity  akin  to  that  of  the 
final  act  of  dissolution.  So,  too,  the  idea  of  sickness  is  abhorrent 
to  the  healthy,  and  to  many  of  them  preparation  for  such  an 
eventuality  is  looked  upon  as  an  invitation  to  disease;  moreover, 


470 


THE  SANITARY  DEPARTMENT  OF  ARMIES 


since  the  days  of  Marlborough  it  has  been  considered  effeminate 
to  be  ill,  so  that  the  medical  department  has  been  forced  to  rely 
upon  the  ten  per  cent,  sick  to  justify  it  against  the  ninety  per 
cent.  well.  Sometimes  the  majority  is  with  it,  though  rarely; 
hence  medical  departments  have  existed  rather  through  suffer- 
ance than  by  actual  recognition,  and  their  present  well-defined 
position  has  been  won  after  endless  struggle  for  the  benefit  of 
the  very  people  who  have  opposed  them. 

Sociological  conditions  have  also  cut  a  large  figure  in  the 
development  of  the  military  sanitary  department.  As  pre- 
viously stated,  the  origin  of  the  medical  officer  was  of  the  hum- 
blest, as  was  that  of  his  art.  Among  the  classes  of  the  older 
countries  the  profession  of  medicine  was  considered  an  ignoble 
occupation,  while  that  of  war  was  practically  the  only  trade 
open  to  the  more  or  less  impecunious  scions  of  noble  houses. 
Even  to-day  in  Continental  armies  they  differentiate  between 
officers  and  military  physicians,  and  that  medical  officers  have 
any  social  standing  there  is  simply  because  they  have  forced  it 
through  their  splendid  ability  and  broad  education. 

In  the  United  States  it  is  of  course  quite  different.  As  Weir 
Mitchell  remarks,  "in  new  lands,  peopled  by  the  self-selection 
of  the  fittest,  by  those  who  have  the  courage  of  enterprise  and 
the  mental  and  moral  outfit  to  win  for  it  success,  the  physician 
is  sure  to  take  and  keep  the  highest  places."  Here  there  are 
no  artificial  class-distinctions.  If  one  man  is  larger,  stronger 
and  brighter  than  another,  it  is  because  God  has  made  him  so, 
and  he  takes  his  place  accordingly.  The  officers  of  the  United 
States  Army  Medical  Department  have  from  the  beginning 
measured  well  up  to  the  standard  of  those  of  any  other  part  of  that 
army,  and  they  have  always  been  able  to  get  what  they  required 
whenever  they  have  really  made  up  their  collective  mind  such 
was  necessary  or  desirable.  If  that  medical  department  is  not 
the  very  best  in  all  respects,  it  is  the  fault  of  its  own  officers, 
and  it  behooves  them  to  make  it  the  best,  for  they  can  have 
for  the  united  asking  what  others  have  struggled  for  through 
the  ages  and  only  won  through  military  necessity. 

It  may  be  said  that  military  medical  organization  is  prac- 
tically identical  in  principle  everywhere,  but  the  details  vary 
with  circumstances  and  the  genius  of  the  people.  In  France, 
Germany,  Austria,  Italy,  Russia,  Switzerland,  Great  Britain 
and  the  United  States  every  military  unit  (regiment,  battalion 


JOHN  VAN  RENSSELAER  HOFF 


471 


or  battery)  has  its  own  medical  officers.  In  all  modern  armies 
the  medical  officers  interchangeably  do  regimental  and  depart- 
mental work — in  a  word,  they  belong  to  a  distinct  military 
department,  or  so-called  staff  corps. 

In  the  matter  of  interior  economy,  strength  and  management 
of  personnel,  etc.,  there  are  wide  differences.  In  the  Russian 
army,  for  example,  the  vrdich  is  a  physician  with  practically  no 
other  function,  while  in  France,  Great  Britain  and  the  United 
States  the  medical  officer  has  command  over  his  department 
in  all  respects.  The  development  in  all  armies  is  essentially 
in  the  direction  of  that  of  France,  which  stands  for  autonomy, 
and  away  from  Russia,  where  the  medical  officer,  as  such,  cuts 
but  a  small  figure. 

All  armies  exist  for  but  one  purpose,  war;  and  by  far  the 
larger  part  of  their  work  is  in  preparation  for  the  supreme  event. 
It  often  happens  that  generations  of  soldiers  must  be  trained 
that  one  may  fight.  Since  Germany  fought  her  last  battle, 
she  has  trained  nearly  ten  million  of  soldiers,  scarcely  any  of 
whom  will  ever  hear  a  hostile  bullet. 

Thus  it  will  be  seen  that  soldiers  live  under  two  quite  distinct 
conditions,  those  of  peace  and  war,  and  that  their  functions  are 
rehearsal  and  performance.  The  combatant  soldier  passes  his 
life  in  an  atmosphere  of  imagination,  constantly  doing  things  to 
the  discomfiture  of  a  hypothetical  enemy,  who  may  never  become 
a  reality  to  him  but  surely  will  to  some  other  soldier. 

With  the  supply  and  medical  departments,  which  must  pro- 
vide and  prescribe  for  the  fighting  man,  there  is  no  imaginary 
existence,  for,  though  the  soldier's  enemy  is  mostly  hypothetical, 
he  himself  is  very  real,  and  must  be  fed,  clothed,  housed,  and 
when  ill  or  injured,  cared  for  just  the  same,  be  it  peace  or  war- 
times. Nevertheless  none  of  these  departments,  in  the  very 
nature  of  things,  can  be  at  all  times  fully  prepared  for  war,  nor 
can  their  personnel  have  any  more  or  less  active  service  than  the 
combatant  soldier. 

From  the  foregoing  it  will  be  seen  that  the  sanitary  department 
of  an  army  must  be  organized  to  meet  two  widely  different 
conditions — that  of  peace,  by  far  the  greater  in  point  of  time; 
and  that  of  war,  of  infinite  importance  and  the  only  raison 
d'etre  for  an  army.  Hence  such  an  organization  must  be  a 
compromise  between  what  would  be  best  for  each  condition, 
and  the  medical  officer  can  never  lose  sight  of  both  his  functions 
if  he  expects  satisfactory  results. 


472  THE  SANITARY  DEPARTMENT  OF  ARMIES 

The  medical  regulations  of  modern  armies  substantially 
agree.  Paragraph  141 3,  General  Regulations,  U.  S.  army, 
reads:  "The  Medical  Department  under  the  Secretary  of  War 
is  charged  with  the  duty  of  investigating  the  sanitary  condition 
of  the  army  and  making  recommendations  in  reference  thereto; 
of  advising  with  reference  to  the  location  of  permanent  camps 
and  posts ;  the  adoption  of  systems  of  water  supply  and  purifica- 
tion; and  the  disposal  of  wastes;  with  the  duty  of  caring  for  the 
sick  and  wounded;  making  physical  examinations  of  officers 
and  enlisted  men;  the  management  and  control  of  military 
hospitals;  the  recruitment,  instruction  and  control  of  the  Hos- 
pital Corps,  and  of  the  Army  Nurse  Corps  (female) ;  and  fur- 
nishing all  medical  and  hospital  supplies,  except  for  public 
animals." 

The  duties  of  the  medical  staff  officer  of  the  British  army 
are  thus  described :  "The  general  treatment  of  the  sick,  officers, 
men,  women,  and  children;  careful  observation  and  regulation 
of  the  sanitary  surroundings  of  the  soldiers,  bearing  in  mind  the 
various  conditions  of  service  in  climates  of  widely  varying 
character;  prevention  as  well  as  treatment  of  disease;  examina- 
tion and  passing  of  recruits  for  the  army ;  invaliding  of  men  who 
are  physically  unfit  for  further  service ;  management  and  control 
of  the  various  classes  of  hospitals,  general  hospitals,  station 
hospitals,  hospitals  on  board  ships,  lunatic  hospitals,  hospitals 
for  women  and  children;  supervision  and  control  of  all  officers 
and  men,  both  patients  and  those  doing  duty  in  these  various 
hospitals;  the  command,  discipline  and  interior  economy  of 
the  Medical  Staff  Corps." 

Personnel. 

But  what  manner  of  man  is  he  who  must  do  all  these  things? 
and  what  are  the  conditions  under  which  they  are  to  be  accom- 
plished? 

It  has  been  said  that  the  soul  of  an  army  is  its  officers,  for 
"the  best  possible  troops  under  bad  officers  are  at  best  very 
deficient,"  while  indifferent  but  well-led  men  often  accomplish 
surprisingly  good  results.  The  officer  should  be  educated, 
for  the  profession  of  arms  is  a  profession,  and  moreover  "educa- 
tion is  the  superstructure  of  noble  and  moral  qualities,  the  basis 
of  which  is  character."  In  devoting  himself  to  his  country's 
service  he  foregoes  opportunities  for  wealth  and  the  prizes  of 


JOHN  VAN  RENSSELAER  HOFF  473 

civil  life  and  sacrifices  personal  advantages  to  great  public  ends. 
"He  becomes  a  member  of  a  class  in  which  there  is  absolute 
social  equality,  community  of  interest  and  common  duties, 
which  make  the  whole  body  responsible  for  each  of  its  members, 
a  class  in  which  the  gradations  of  rank  and  official  relationship 
are  clearly  defined  and  should  be  firmly  maintained." 

All  officers  are  necessarily  specialists,  except  those  who,  as 
indicated  by  their  tftle — general  officers, — have,  through  superior 
ability,  education  and  opportunity,  obtained  a  comprehensive 
knowledge  of  all  branches  of  the  service,  and  have  thereby 
fitted  themselves  to  be  directors.  Cavalry,  artillery,  infantry, 
engineers,  signal,  medical, — indeed,  each  of  the  arms,  corps 
and  departments, — demands  special  knowledge  and  training, 
and  an  intimate  acquaintanceship  with  all  is  necessarily  possible 
to  but  few  officers. 

The  medical  officer,  like  other  officers,  is  a  military  specialist; 
his  duties  are  both  administrative  and  executive,  and  his  work 
demands  many  qualifications,  varied  knowledge,  and  especially 
in  active  service  an  exact  military  training. 

The  executive  medical  officer  has  been  thus  described.  He 
must  be  prepared  to  practice  all  branches  of  the  medical  pro- 
fession; and  he  must  in  addition  possess  a  variety  of  other 
knowledge  peculiar  to  army  conditions  in  order  to  be  a  thoroughly 
efficient  officer.  He  should  be  acquainted  with  the  science  and 
application  of  hygiene  as  regards  bodies  of  men  in  all  climates; 
the  preparation  of  various  technical  returns  and  reports;  and 
the  nature  and  uses  of  all  the  armamentaria  of  the  medical 
department,  not  only  of  fixed  hospitals,  but  of  the  lines  of  assist- 
ance in  active  service.  He  must  know  the  regulations  bearing 
upon  the  management  of  the  sick,  and  his  own  relations  to 
other  parts  of  the  military  service.  He  must  be  familiar  with 
the  duties  and  responsibilities  which  devolve  upon  him  as  the 
commander  of  the  various  medical  units,  and  be  capable  of 
undertaking  the  management  and  instruction  of  the  hospital 
corps  and  the  nurses'  corps.  Such  a  man  must  necessarily  be 
of  robust  constitution  to  enable  him  to  resist  the  exposures 
and  vicissitudes  of  active  service,  during  which  his  duties  are 
particularly  arduous,  and  he  should  possess  high  moral  quali- 
ties, which  will  command  the  respect  of  those  with  whom  he 
is  associated,  and  the  esteem  and  confidence  of  his  patients. 

The  administrative  medical  officer  is  developed  from  the 


474 


THE  SANITARY  DEPARTMENT  OF  ARMIES 


executive  officer,  in  which  latter  position  he  should  have  had 
large  experience  and  demonstrated  his  fitness  for  administrative 
duties.  He  must  be  prudent,  sagacious,  ready  in  emergency, 
prompt,  and  thoroughly  imbued  with  habits  of  military  discipline 
and  the  importance  of  his  department. 

It  is  equally  true  of  the  medical  as  of  the  combatant  officers 
that  those  who  have  conducted  themselves  best  in  subordinate 
positions  will  almost  always  prove  successful  in  superior  places, 
for  such  will  usually  possess  circumspection  and  judgment  in 
control,  the  ability  and  decision  of  character  which  will  impress 
their  commanders  with  respect  for  their  opinions  and  advice, 
the  professional  knowledge  and  administrative  tact  which  will 
procure  willing  obedience  and  excite  zeal  among  their  officers 
and  men, — these  are  the  qualities  which  Longmore  well  says 
mark  the  successful  administrative  medical  officers. 

Surely  it  must  be  apparent  from  the  foregoing  that  the  medical 
officer  can  only  result  from  special  training  and  experience, 
and  that  his  functions  are  essentially  military,  though  not  mili- 
tant. Speaking  of  this  fact,  a  distinguished  medical  officer  of 
the  British  army  in  unmistakable  language  invites  his  brothe 
officers  and  the  world  to  an  appreciation  of  the  vast  difference 
between  the  work  of  the  civil  and  military  physician.  He 
says:  "However  attractive  and  charming  may  be  the  life  of 
the  civil  physician,  who  enters  the  home  of  his  patient  and  simply 
orders  a  treatment  to  be  carried  out  by  affectionate  relatives, 
the  duties  and  life-work  of  the  soldier-surgeon  must  be  com- 
pletely and  entirely  different.  *  *  *  *  Trained, 
it  may  be,  in  the  same  medical  college,  the  lives  of  the  two  men 
are  absolutely  divergent,  and  the  common  title  of  'doctor'  given 
to  each  is  wholly  misleading  in  the  case  of  the  military  officer. 
Not  all  the  surgical  knowledge  of  a  Brodie  or  a  Ferguson  will 
take  a  convoy  of  200  wounded  soldiers  from  Kabul  over  the 
snowy  pass  of  Lataband  for  200  miles  to  Pishawar.  Not  all 
the  medical  science  of  a  Jenner  or  a  Watson  will  insure  that  in 
the  great  base  hospitals  of  war  every  one  of  the  hundreds  of 
patients  is  seen  and  carefully  attended  to,  cleansed,  fed  and 
cared  for  on  a  hostile  shore,  and  shipped  to  England,  in  all  the 
confusion  and  turmoil,  and  oftentimes,  the  selfishness  of  the 
base  of  an  army  in  the  field.  My  dear  civil  brother  physician, 
it  is  true  I  was  at  the  same  school  of  medicine  with  you;  yes, 
but  it  never  taught  me  to  work  in  the  Soudan  square  and  see 


JOHN  VAN  RENSSELAER  HOFF 


475 


that  others  worked  under  me,  until  every  man  that  fell  was  not 
only  dressed,  but  fed  and  cared  for  and  carried  for  miles  off 
the  field  to  a  far-away  tent  hospital.  In  the  crowded  war  trans- 
port, in  the  Indian  camp,  in  the  torrid  heat  of  Suakim  deserts, 
or  in  the  steaming  tropical  depths  of  Malayan  forests  I  do  other, 
soldier,  work  for  England  than  you  who  serve  her  in  a  civil 
capacity  at  home,^,nd  I  do  it  far  away  and  alone,  often  unaided, 
and  far  from  sympathetic  help.  Energy,  courage,  self-sacrifice, 
devotion  to  duty,  a  soldier's  heart,  discipline  to  the  yielding  up 
of  one's  life  under  fire, — all  these  are  needed.  Life  with  the 
soldier  on  the  choking  march  in  the  burning  Soudan,  in  the 
drifting  snow  and  freezing  winds  of  Kabul  tablelands,  the  burn- 
ing tents  in  the  wide,  bare  Indian  plain, — all  these  things  shared 
with  the  soldier  separate  me  from  you  with  whom  I  learned  the 
physician's  art.  It  is  true  I  am  a  doctor  in  the  civil  sense, 
and  glory  in  the  fact,  but  I  am  a  soldier  of  England,  too,  and 
for  her  and  her  people  I  have  given  all  the  devotion  and  all  the 
self-sacrifice  she  demands  of  her  soldier-sons,  and  although  every 
man  in  the  army  denied  me  the  title  of  soldier,  from  the  chief  at 
the  head  to  the  last  recruit  that  joined  yesterday,  I  reply  you 
are  wrong,  and  you  are  wrong  because  you  do  not  know  and 
you  will  not  understand,  and  I  appeal  from  the  army  in  its 
prejudice,  to  England  and  her  people  to  do  justice  between  us, 
and  to  say  if  she  denies  me  the  title  I  have  so  justly  and,  I  hope, 
so  devotedly  earned  in  her  cause ;  for  the  army  does  not  belong 
to  the  army,  but  to  the  nation  that  lies  behind  it." 

The  enlisted  personnel  of  the  sanitary  service,  non- 
commissioned officers  and  men,  should  be  of  higher  intelligence 
than  that  of  other  branches  of  the  army;  their  remuneration  is 
more  liberal,  and  their  training  covers  a  wide  field,  embracing 
more  or  less  intimate  knowledge  of  most  of  the  general  require- 
ments of  the  medical  department.  The  sanitary  soldier  must 
possess  all  the  attributes  of  the  soldier — good  physique,  intel- 
ligence, obedience,  fortitude,  courage  and  soldierly  pride, — 
and  it  is  the  duty  of  the  medical  officers  to  so  far  as  possible 
impart  these  qualities  to  their  men. 

Sanitary  Duties. 

The  sanitary  duties  of  the  military  medical  officer  are  of 
great  importance  and  demand  on  his  part  a  broad  knowledge 
of  the  science  of  hygiene  and  the  art  of  sanitation.    But  as  the 


476 


THE  SANITARY  DEPARTMENT  OF  ARMIES 


medical  officer  must  from  the  nature  of  his  position  as  a  staff 
officer  be  an  advisor,  not  an  executor,  these  duties  also  demand 
some  knowledge  of  the  subject  on  the  part  of  the  officer  com- 
manding, that  the  recommendations  of  the  medical  officer  may 
be  intelligently  weighed  against  each  other  and  possibly  for  the 
moment  more  important  considerations,  and  a  proper  middle 
course  adopted. 

While  the  history  of  warfare  is  replete  with  instances  of 
disastrous  consequences  following  unsanitary  conditions,  such 
had  apparently  come  to  be  accepted  as  part  of  the  chances  of 
war,  and  it  was  not  until  the  horrors  of  the  Crimea  were  brought 
vividly  before  the  world  that  military  sanitation  began  to  be 
studied  scientifically.  Of  necessity  this  study,  appealing  most 
strongly  to  the  medical  officer,  has  been  developed  by  him, 
and,  strange  to  say,  has  come  to  be  regarded  as  his  special 
function,  with  the  result  that  a  scientific  knowledge  of  the 
"care  of  troops  "  has  not  yet  been  widely  diffused  among  line  offi- 
cers, who,  of  all,  should  be  most  familiar  with  it.  The  necessities  of 
the  war  of  Secession  prompted  the  enactment  of  the  law  of  1862 
appointing  medical  inspectors,  who  were  charged  with  the  duty 
of  "inspecting  the  sanitary  condition  of  transports,  quarters, 
and  camps,  of  field  and  general  hospitals  *  *  *  ** 
and  the  whole  subject  of  sanitation  gained  great  impetus  during 
that  war. 

The  return  of  peace  and  the  separation  of  the  army  of  the 
United  States  into  small  and  usually  healthy  garrisons  rendered 
unnecessary  the  enforcement  of  systematic  sanitary  inspections 
and  reports,  and  these,  with  other  important  military  subjects, 
were  permitted  to  drop  into  disuse,  only  an  annual,  historical 
sanitary  report  being  required.  In  1874  an  order  was  issued 
requiring  both  sanitary  inspections  and  reports,  which  order 
is  embodied  in  the  present  paragraph  141 4  of  the  General  Regu- 
lations, as  follows:  "The  surgeon,  under  the  direction  of  the 
commanding  officer,  will  supervise  the  hygiene  of  the  post  or 
command,  and  recommend  such  measures  as  he  may  deem 
necessary  to  prevent  or  diminish  disease.       *       *  * 

After  thirty  years'  experience  of  this  regulation,  commanding 
officers  are  but  now  beginning  to  accept  the  sanitary  report  as 
other  than  a  criticism  of  themselves,  and  the  scientific  "care 
of  troops"  is  slowly  beginning  to  be  recognized  as  an  important 
part  of  the  special  knowledge  of  the  line  officer.  Nevertheless 


JOHN  VAN  RENSSELAER  HOFF 


477 


the  United  States  army  had  no  medical  inspectors  with  specific 
power  to  control  sanitary  conditions,  authorized  by  law  during 
the  Spanish-American  war,  and  such  sanitary  recommendations 
as  were  made  by  medical  officers  could  not  be  enforced,  as  they 
were  without  legal  backing.  So  it  would  appear  that  military 
sanitation  had  actually  retrograded  in  that  service. 

The  medical  regulations  of  the  British  army  give  great  atten- 
tion to  sanitation,  and  prescribe  with  the  utmost  particularity 
the  sanitary  duties  of  the  various  medical  officers,  especially  in 
active  service,  while  practically  nothing  in  anywise  likely  to 
affect  the  health  of  a  command  appears  to  be  undertaken  without 
the  concurrence  of  the  sanitary  inspector. 

A  medical  officer  of  that  service  writes:  "In  these  days  of 
progress  and  improved  education,  knowledge  of  sanitary  science 
and  of  the  ordinary  rules  for  the  preservation  of  health  is  almost 
universal  among  all  classes;  the  duty,  consequently,  of  a  medical 
officer  in  advising  his  general  or  other  commanding  officer  upon 
sanitary  questions  is  much  lightened  and  facilitated.  Old 
prejudices  are  disappearing;  there  is  less  friction,  and  both  com- 
manding and  medical  officers  understand  each  other  on  these 
points  and  work  together  for  the  common  good  of  the  soldiers." 

The  Care  of  the  Sick  and  Wounded. 

The  care  of  the  invalid  was  formerly  the  only  function  of  the 
army  "surgeon,"  and  it  will  of  course  always  remain  the  most 
important  of  his  complex  duties.  The  military  medical  officer 
must  first  of  all  be  a  physician,  for  without  the  knowledge  this 
implies  he  cannot  satisfactorily  perform  any  of  the  multifarious 
and  apparently  incompatible  duties  which  fall  to  him. 

The  soldier-man  has  no  diseases  peculiarly  his  own,  but  the 
circumstances  of  his  environment  often  invite  to  a  wide  dissem- 
ination of  disease  germs  and  to  a  severe  manifestation  of  the 
infections  they  cause,  with  consequent  greater  mortality. 
"Preventable"  diseases  are  those  which  cause  the  most  part  of 
the  non-efficiency,  and  the  largest  death-rate  in  armies. 

In  peace-time  especially,  the  diseases  of  any  particular  com- 
mand are  those  of  the  neighborhood.  Statistics  show  that  in 
the  United  States  army  for  the  period  1886-95  diseases  ran  in 
frequency  in  the  following  order:  First,  infectious;  2nd,  diges- 
tive; 3d,  respiratory;  4th,  nervous;  5th,  cutaneous ;  etc.  m  Wounds 


4 


47^  THE  SAXITARY  DEPARTMENT  OF  ARMIES 


and  other  injuries  ranked  in  frequency  with  diseases  of  the 
respiratory  organs. 

The  professional  care  of  the  sick  is  the  one  point  of  contact 
between  the  physician  in  the  army  and  the  physician  in  civil 
practice.  They  meet  and  understand  each  other's  language 
at  the  bedside,  in  the  laboratory  and  the  operating  room;  they, 
too,  share  the  all-embracing  literature  of  the  noblest  of  profes- 
sions. Here  their  ways  part,  and  when  perchance  they  cross 
again  under  other  conditions,  the  civil  practitioner  finds  himself 
in  a  terra  incognita  the  speech  and  customs  of  whose  people  he 
knows  not. 

Recall  if  you  will  the  physician's  daily  routine  in  city  or  town, 
and  compare  it  with  the  experience  of  the  army  medical  officer. 
The  former  usually  finds  his  patient  comfortably  housed,  and 
resting  in  a  comfortable  bed.  After  the  usual  examination  and 
diagnosis,  he  writes  a  prescription,  which  is  to  be  filled  at  the 
neighboring  pharmacy,  and  if  necessary,  he  telegraphs  to  the 
nearest  agency  for  a  trained  nurse.  He  directs  a  dietary  which 
is  prepared  in  the  kitchen  of  the  patient's  house,  gives  such 
other  instructions  as  the  case  demands,  and  proceeds  to  his 
next  patient,  whom  he  sees  under  identical  conditions. 

The  medical  officer  sees  his  cases,  oftentimes  numbering 
hundreds  or  thousands,  under  the  stress  of  military  life,  unsur- 
rounded  by  any  of  the  comforts  of  home,  perhaps  lying  in  the 
mud  and  mire,  unprotected  from  storm  and  the  vicissitudes  of 
weather.  He  must  provide  the  house  in  which  his  patient  is 
to  be  treated ;  must  obtain  the  bed  upon  which  he  is  to  lie ;  must 
train  the  druggist  who  is  to  compound  the  prescription  he 
writes  for  drugs,  which  the  medical  officer  himself  must  procure; 
he  must  train  the  nurse  to  whose  care  the  patient  is  committed ; 
must  teach  the  cook  who  is  to  prepare  the  dietary;  in  fact,  he 
must  look  after  every  material  want  of  his  patient,  in  addition 
to  the  professional  care  he  is  required  to  give  him.  Moreover, 
he  must  take  charge  of  his  patient's  business  affairs,  must  keep 
his  accounts,  must  see  that  he  is  supplied  with  clothing,  is 
regularly  paid,  etc.  And  finally  he  must  give  detailed  reports 
of  all  his  doings  to  his  superior  officers. 

In  war  the  soldier  suffers,  besides,  from  an  epidemic  of  wounds 
and  injuries,  the  treatment  and  result  of  which  are  largely 
determined  by  his  environment.  This  treatment  is  often 
necessarily  a  departure  from  the  highest  standards,  standards 


JOHN  VAX  RENSSELAER  HOFF 


479 


which  are  made  in  the  perfectly  appointed  operating  rooms  of 
permanent  hospitals,  and  not  on  the  battle-field,  and  so  long 
as  war  continues  it  can  never  be  otherwise. 

Physical  Examinations  of  Officers  and  Enlisted  Men. 

The  physical  examination  of  recruits  is  one  of  the  most  im- 
portant functions  of  the  medical  department,  for  upon  its  proper 
performance  may  be  said  to  depend  the  fighting  efficiency  of 
the  command. 

The  governments  of  all  civilized  nations,  especially  those 
to  whom  large  standing  armies  have  become  a  necessity,  are 
fully  alive  to  the  great  value  of  the  judicious  and  careful  exam- 
ination of  recruits,  and  in  one,  Switzerland,  the  entire  matter 
of  recruitment  is  turned  over  to  the  Medical  Department.  The 
importance  of  this  examination  has  a  twofold  aspect,  military 
and  pecuniary. 

The  Austrian  regulations  say  that  "the  duty  of  inspecting 
conscripts  and  recruits  requires  the  utmost  skill,  impartiality, 
and  circumspection  on  the  part  of  the  medical  officer."  Prussian 
regulations  say  that  this  duty  is  one  of  the  most  difficult  and 
responsible  a  medical  officer  has  to  perform  and  requires  more 
knowledge  than  is  generally  supposed.  The  regulations  of  the 
Provost  Marshal's  Bureau,  U.  S.  Army,  required  that  the  exam- 
iner "must  bear  in  mind  that  it  is  the  number  of  bayonets  in 
the  field  and  not  the  number  of  names  on  the  rolls  that  deter- 
mines the  strength  of  an  army." 

The  method  of  examination  is  substantially  the  same  in  all 
armies,  and  the  regulations  governing  it  should  be  strictly 
observed.  The  inspection  must  be  made  by  daylight,  in  a  well- 
lighted  room,  sufficiently  large  to  move  about  in,  furnished  with 
table,  chair,  scales,  measuring  rod  and  tape,  vision  test-types, 
stethoscope,  etc.  The  candidate  is  to  be  examined  stripped; 
this  requirement  would  seem  to  go  without  saying,  but  its  neglect 
during  the  early  days  of  the  war  of  Secession  has  probably 
cost  the  United  States  millions  in  pensions.  A  report  by  a 
medical  officer  of  that  time  says,  that  early  in  the  war  it  hap- 
pened to  him  to  be  present  at  the  mustering  in  of  several  regi- 
ments of  volunteers,  and  to  make  a  so-called  physical  examina- 
tion of  the  men  comprising  them.  "My  duty  consisted  in  walk- 
ing through  the  ranks  with  the  commanding  officer,  to  point 
out  those  disqualified  for  military  duty.    I  was  not  permitted 


480 


THE  SANITARY  DEPARTMENT  OF  ARMIES 


to  examine  them  stripped.  During  the  progress  I  saw  not  a 
few  blind,  some  variously  deformed,  and  others  decrepit  from 
old  age,  and  found  it  necessary  to  reject  so  many  that  the 
commanding  officer  was  constrained  to  expostulate  with  me." 
One  reads  in  current  papers  stories  of  the  enrollment  even  of 
women  during  that  war,  which  certainly  would  indicate  that 
candidates  were  not  stripped  for  examination. 

The  person  of  the  recruit  should  be  washed  clean  before  he 
is  presented  for  inspection,  for,  says  Tripler,  "it  is  impossible 
for  the  medical  officer  to  ascertain  the  existence  of  certain 
defects  that  absolutely  disqualify,  when  concealed,  as  they 
effectually  may  be,  and  sometimes  are,  by  incrustations  of 
filth  a  month  old." 

The  candidate  should  be  carefully  inspected  front,  rear  and 
head  to  determine  any  superficial  defects,  and  thereafter  put 
through  a  course  of  physical  drill  to  determine  mobility  of  joints, 
etc.  The  mouth,  throat,  nose,  eyes,  ears,  testicles  and  arms 
are  then  examined,  the  superficial  lymphatic  glands  and  hernial 
openings  palpated,  the  state  of  lungs,  heart,  liver  and  spleen 
determined  by  percussion,  and  the  chest  auscultated. 

The  accurate  determination  of  vision  and  hearing  are  of 
great  importance  and  no  deviation  from  the  standard  should  be 
overlooked,  for  a  soldier  who  cannot  see,  cannot  shoot  straight, 
and  one  who  cannot  hear  is  useless  as  a  sentinel. 

In  all  armies  a  minimum  height  and  weight  are  fixed  by 
regulations,  which,  of  course,  vary  with  the  country  and  the 
conditions.  Experience  has  determined  a  physiological  relation 
between  height,  weight  and  chest  capacity,  which  in  the  United 
States  army  is  formulated  as  follows:  Between  64  and  67 
inches  in  height  the  circumference  of  chest  should  be  one  half, 
and  the  weight,  in  pounds,  twice  the  height;  between  67  and  72 
inches  add  one  half-inch  to  chest  measure,  and  above  72  inches 
one  inch.  When  the  height  exceeds  67  inches,  add  7  pounds 
for  each  inch  in  excess. 

Unfortunately  the  physiological  standard  has  been  departed 
from  in  recent  years,  with  a  result  that  is  but  too  plainly  apparent 
in  the  mental,  moral  and  physical  qualities  of  the  enlisted 
soldier  both  in  the  army  of  Great  Britain  and  that  of  the  United 
States.  A  distinguished  naval  surgeon  says  of  this  that  "there 
seems  to  be  nothing  better  established  than  that  the  lowering 
of  the  physical  standard  is  invariably  followed  by  the  lowering 


JOHN  VAN  RENSSELAER  HOFF 


481 


of  the  moral  standard,"  and  he  further  says  that  such  lowering 
"in  order  to  increase  the  number  of  enlistments  does  not  add  to 
the  value,  the  strength,  or  the  efficiency  of  an  army  and  is  an 
unnecessary  waste  of  public  money." 

Upon  the  completion  of  the  examination  of  an  accepted 
recruit  he  is  vaccinated,  and  in  the  United  States  army  an 
outline  figure-card  is  made.  On  this  card,  bearing  an  outline 
of  the  human  figure,  front  and  rear,  every  mark  which  will 
serve  to  identify  a  deserter,  or  prevent  the  reenlistment  of  the 
dishonorably  discharged,  is  accurately  located  and  described. 
This  is,  I  understand,  soon  to  be  substituted  by  finger  marks 
and  photographs.  Each  peculiarity  or  deviation  from  the 
standard  is  to  be  noted  on  the  enlistment  papers,  for,  even 
though  it  is  considered  not  disqualifying  at  the  time  of  examina- 
tion, it  may  become  so  later,  in  which  event  it  will  almost  cer- 
tainly be  made  the  basis  of  a  claim  for  pension. 

The  United  States  army  regulations  for  the  examination  of 
cadets,  who  are,  of  course,  in  the  formative  physical  stage, 
while  they  follow  the  principles  laid  down  for  the  examination 
of  recruits,  differ  slightly  in  detail,  particularly  as  to  physical 
proportions  and  vision. 

It  would  seem  that  the  selection  of  soldiers  by  means  of  a 
physical  examination  as  now  practiced  in  armies  is  even  not 
yet  on  a  thoroughly  scientific  basis. 

No  regulations  are  prescribed  in  the  United  States  army  for 
the  examination  of  officers,  but  the  routine  followed  is  that  of  a 
recruit,  and  includes  an  examination  of  the  urine.  It  should 
be  thorough  in  every  detail. 

Soldiers  are  discharged  from  an  army  for  various  causes,  one 
being  physical  disability,  requiring  the  certificate  of  a  medical 
officer,  and  demanding  of  him  the  utmost  particularity.  During 
the  war  of  Secession,  from  April,  1861,  to  May,  1863,  the  aggre- 
gate of  discharges  on  surgeon's  certificate  reached  the  enormous 
number  of  nearly  200,000.  The  possibilities  of  this  function  of  a 
medical  officer  emphasize  the  necessity  for  a  conscientious 
performance  of  this  important  duty.  He  must  ever  have  in 
mind  that  his  first  duty  is  to  his  country,  whose  servant  he  is; 
his  second  duty  is  to  the  soldier. 

Before  giving  a  certificate  of  disability  for  discharge,  the 
officer  must  decide:  (1)  if  there  be  any  disability;  (2)  if  it  is 
permanent;  (3)  if  it  is  actually  disabling;  (4)  if  it  is  incident  to 


482 


INTERMITTENT  CLAUDICATION 


the  service  and  in  the  line  of  duty:  "malingering"  is  a  disease 
very  common  in  active  armies. 

The  question  of  the  origin  of  the  disability  is  apparently 
often  difficult  to  determine,  but  in  the  United  States  regulations, 
as  they  now  stand,  the  benefit  of  the  doubt  is  always  given  to 
the  soldier 

The  pecuniary  interest  involved  in  so  much  of  the  medical 
officer's  duties  as  are  embraced  in  physical  examinations  is 
found  in  the  fact  that  during  the  last  generation  the  United 
States  government  has  disbursed  for  pensions  over  three  billions 
of  dollars. 

{To  be  continued.) 


INTERMITTENT   CLAUDICATION,    DUE    TO  ANGIO- 
SCLEROSIS  OF  THE  EXTREMITIES. 

Read  at  a  Meeting  of  the  Medical  Society  of  the  County  of  Rensselaer, 
March  13,  iqo6. 

By  R.  H.  IRISH,  M.  D., 

Troy,  N.  Y. 

Among  the  many  and  varied  manifestations  of  angio-sclerosis, 
we  have  this  group  of  symptoms,  which  was  first  described  by 
Charcot  in  1858,  and  given  the  name  of  "intermittent  claudi- 
cation." 

This  term  was  used  to  describe  a  condition  characterized  by 
sudden  pain,  stiffness,  and  weakness  in  one  leg,  brought  on  by 
walking,  and  disappearing  after  a  few  minutes  rest  to  return 
when  walking  is  resumed. 

The  first  case  described  by  Charcot  was  found  to  be  due  to 
an  aneurism  of  the  right  ililac  artery,  the  vessel  having  been 
occluded  by  a  thrombus  for  a  short  distance  below.  He  also 
called  attention  to  the  resemblance  between  this  group  of 
symptoms  and  a  condition  described  by  veterinarians  and  com- 
monly known  as  "springhalt":  animals  suffering  from  this 
disease,  after  traveling  a  certain  distance  are  seized  with  a 
sudden  stiffness  and  weakness  in  the  hind  legs,  which  for  the 
time  become  absolutely  rigid.  After  a  short  rest  the  spasm 
relaxes  and  the  function  of  the  leg  is  restored. 

In  these  animals  evidences  of  arterio-sclerosis  were  found  in 


REUBEN  H.  IRISH 


483 


the  bifurcation  of  the  aorta  and  iliac  arteries,  interfering  with 
the  free  circulation  of  the  blood  in  the  parts  below  as  described 
by  Bouley,  1831;  Rademacher,  1838;  and  Bother  Bath,  1839, 
and  others. 

Charcot  further  contributed  to  this  subject  in  1886,  1887, 
1891  and  1892.  Other  communications  from  French  observ- 
ers appeared  in  1873  by  Sabourin;  1890,  Delounay;  1892, 
Magrez;  1894,  Seret,  and  Bourgeois,  in  1897. 

It  was  some  years  before  this  subject  received  attention  in 
other  countries. 

Elzholz  in  1892,  and  later  Goldflam,  recorded  cases  in  Ger- 
many. In  1898  Erb  gave  to  the  profession  what  was  probably 
the  most  masterly  contribution  on  this  subject  up  to  that  time 
and  indeed  to  the  present  time.  He  demonstrated  clearly  that 
in  the  greater  majority  of  cases,  this  condition  was  due  to  a 
sclerosis  and  consequent  obliteration  of  the  smaller  arterial 
branches  and  terminals,  while  by  Charcot  and  others  greater 
importance  had  been  attached  to  partial  or  complete  oblitera- 
tion of  the  larger  arteries. 

Following  this  contribution  of  Erb's  many  cases  were  reported 
in  Germany,  showing  the  relative  frequency  and  growing  im- 
portance of  this  affection.  Among  those  reporting  a  large 
number  of  cases  were  Higier  in  1900,  recording  23  cases;  Hagel- 
stam  in  1901,  recording  7  cases  and  Idelsohn  in  1903,  recording 
14  cases. 

In  the  United  States  the  first  report  of  a  case  was  made  by 
Putnam  of  Boston  in  1901.  Dana  in  1902  reported  a  case 
which  undoubtedly  belonged  to  this  class,  though  not  of  the 
ordinary  type.  In  his  case  the  left  leg  was  first  involved  and 
four  or  five  weeks  later  the  left  arm,  with  complete  absence  of 
pulsation  in  the  larger  arteries,  though  distinctly  present  in 
the  arm  and  leg  of  the  other  side.  The  diagnosis  was  a  stoppage 
of  the  large  arteries  of  these  extremities,  either  by  a  thrombus 
or  by  spasm  or  both. 

Other  contributors  of  cases  in  this  country  were  as  follows: 
Riesman,  1902;  Walton  and  Paul,  1902;  Levy,  1902;  Pateck, 
1904,  and  Burr,  1904.  In  January,  1905,  J.  Ramsay  Hunt 
read  a  most  interesting  paper  on  this  subject  before  the  New 
York  Society  of  Internal  Medicine.  This  paper  later  appeared 
in  the  Medical  Record  of  May  27,  1905.  In  this  paper  the 
author  gave  a  complete  review  of  the  literature  to  date,  with 


484 


INTERMITTENT  CLAUDICATION 


histories  of  four  typical  cases  which  had  come  under  his  per- 
sonal observation. 

As  his  handling  of  the  subject  was  exhaustive  and  his  descrip- 
tion of  the  condition  "clear  cut"  and  complete  I  have  taken 
the  liberty  of  quoting  freely  from  his  paper  in  my  presentation 
of  the  etiology,  pathology  and  symptomatology  of  this  disease. 

The  names  applied  to  this  condition  have  been  almost 
as  numerous  as  the  contributors  to  the  subject,  but  "inter- 
mittent claudication"  as  originally  suggested  by  Charcot  seems 
to  be  the  generally  accepted  term. 

Etiology. — The  condition  being  chiefly  dependent  on  arterio- 
sclerosis the  causes  favoring  the  development  of  that  condition 
would  naturally  occupy  first  place — advanced  life,  alcoholism, 
syphilis,  gout  and  excessive  use  of  tobacco.  Among  other 
causes  mentioned  are  diabetes,  and  local  exposure  to  extreme 
cold. 

Arterial  compression  by  aneurism  or  truss  as  in  cases  reported 
by  Charcot,  Barth  and  Mannaury.  Erb  who  recorded  57  cases 
attaches  greatest  importance  to  excessive  smoking  and  expo- 
sure to  excessive  cold.  Others,  among  whom  are  Oppenheim 
and  Goldflam,  attach  greatest  importance  to  the  neurotic 
temperament  as  a  factor  in  the  vaso-motor  irritability  and  spasm. 

As  with  arterio-sclerosis  in  general  this  condition  is  much 
more  frequent  in  men  than  women. 

Pathology. — In  the  study  of  amputated  extremities  and  five 
recorded  autopsies  the  findings  have  been  practically  uniform 
— same  sclerotic  change  in  the  arterial  wall  causing  a  diminu- 
tion in  the  caliber  of  the  vessel  and  consequent  interference 
in  the  circulation.  All  forms  of  arterial  change  have  been  met 
with,  such  as  obliterating  endarteritis  of  Friedlander,  senile 
calcif action,  the  arterio-sclerosis  of  Gull  and  Sutton,  and  the 
periarteritis  nodosa  of  Kussmaul  and  Maier.  These  conditions 
may  or  may  not  be  accompanied  by  thrombosis  or  obliteration. 

As  these  changes  in  the  arteries  are  frequently  present  with- 
out "intermittent  claudication,"  another  most  important  factor 
must  be  considered.  That  is  a  condition  of  vaso-motor  irrita- 
bility causing  spasm  of  the  arteries  of  the  extremities,  such  as 
is  familiar  to  us,  in  flushing  and  sudden  pallor  of  the  face  and 
coldness  of  hands  and  feet  due  to  sudden  emotion.  Another 
factor,  however,  must  not  be  lost  sight  of,  and  that  is  the  in- 
creased demand  upon  the  circulation  of  the  part  during  activity. 


REUBEN  H.  IRISH 


485 


Thus  the  pathology  might  be  summed  up  in  the  majority  of 
cases  in  a  few  words,  angio-sclerosis,  to  which  is  added  a  condi- 
tion of  vaso-motor  irritability  determining  this  particular  group 
of  symptoms. 

Charcot  attributed  the  trouble  more  to  disease  of  the  larger 
arterial  trunks,  but  Erb  demonstrated  quite  clearly  that  it  is 
usually  due  to  an  obliterative  arteritis  of  the  end  arteries,  and 
that  vaso-motor  spasm  is  an  important  element  in  causing  the 
attack. 

Symptomatology. — There  is  a  general  agreement  among  ob- 
servers as  to  the  symptoms  in  a  typical  case,  but  there  are 
many  variations  from  this  type  picture  which  undoubtedly 
come  under  this  same  head. 

The  patient  may  be  perfectly  comfortable  when  the  limbs 
are  at  rest,  though  they  often  complain  of  coldness  or  numb- 
ness of  the  extremity.  On  motion,  as  in  walking,  when  the 
legs  are  involved,  the  patient  may  start  off  all  right,  but  gradu- 
ally a  feeling  of  pain,  stiffness,  weakness  and  paresthesia  of  the 
affected  leg  comes  on  and  gradually  increases  in  severity  with 
continuance  of  exercise.  Finally  further  progress  becomes  dis- 
tressing or  even  quite  impossible.  After  a  period  of  rest  the 
patient  may  again  resume  the  walking,  but  with  a  gradual 
return  of  the  symptoms,  until  the  point  of  tolerance  is  again 
reached,  which  interval  may  vary  from  a  few  minutes  to  one- 
half  hour,  depending  upon  the  severity  of  the  case. 

At  the  beginning  of  one  of  these  attacks  the  patient  usually 
complains  of  a  sense  of  weight,  weakness  and  coldness  of  the 
affected  leg.  These  sensations  increase  and  are  accompanied 
by  a  sense  of  pain  which  gradually  becomes  more  severe  as 
muscular  activity  is  continued.  Painful  cramps  and  muscular 
spasm  follow,  as  in  the  case  of  the  horse  with  the  "spring  halts." 
Not  infrequently  in  these  cases  locomotion  becomes  quite  im- 
possible from  intense  pain  and  rigidity  of  the  muscles. 

While  the  above  is  the  usual  history  of  a  paroxysm,  quite 
different  symptoms  have  been  complained  of  in  individual  cases, 
as  "a  sensation  of  water  rushing  through  the  leg,"  "scalding 
and  burning  sensation,"  "a  dull  ache,"  a  "bursting  feeling  in 
the  calf  of  the  leg,"  etc.,  but  the  characteristic  feature  is  the 
intermittent  character  of  the  symptoms,  subsiding  during  rest 
and  increased  upon  muscular  activity. 

Inspection  of  the  feet  and  legs  especially  after  prolonged 


486 


INTERMITTENT  CLAUDICATION 


muscular  effort  usually  reveals  evidence  of  circulatory  disturb- 
ance. They  are  usually  cold  to  the  touch  and  frequently  con- 
gested and  swollen,  with  evidence  of  mottling  or  cyanosis.  In 
the  more  advanced  cases  of  approaching  gangrene  there  may  be 
intense  burning  pain  in  the  toes,  which  may  be  glossy  red  or 
purple. 

Objective  changes  in  the  pulsation  of  the  arteries  of  the  foot 
are  of  great  importance.  In  most  cases  the  pulsation  in  the 
posterior  tibial  and  dorsalis  pedis,  one  or  both,  is  absent  or 
weaker  than  normal.  Absence  of  pulsation  even  in  the  pop- 
liteal has  been  frequently  reported  in  these  cases  and  by  some 
observers  is  considered  to  be  of  the  greatest  diagnostic  value. 

To  determine  the  constancy  of  the  pulsation  of  these  arteries 
in  other  conditions  not  presenting  this  group  of  symptoms  Erb 
examined  750  cases  of  all  ages  and  suffering  from  various  ail- 
ments, with  a  positive  result  of  ninety-nine  per  cent.  Other 
observers  have  carried  out  similar  investigations  on  a  smaller 
number  of  cases  with  practically  the  same  results. 

With  the  same  object  in  view  I  have,  through  the  courtesy 
of  the  attending  physicians  of  the  Leonard  and  Samaritan  hos- 
pitals and  a  few  cases  taken  from  private  practice,  examined 
the  foot  pulse  (posterior  tibial  and  dorsalis  pedis)  in  both  the 
right  and  left  foot  in  eighty  cases,  forty  males  and  forty  females. 
These  cases  were  all  of  ages  from  fifteen  months  to  seventy-eight 
years.  Twenty  of  them  were  cases  of  arterio-sclerosis,  the  other 
sixty  included  a  variety  of  other  medical  and  surgical  cases. 
When  the  pulsation  was  in  doubt  it  was  each  time  verified  by 
some  one  taking  the  pulse  at  the  wrist  while  I  counted  aloud 
the  pulse  at  the  foot.  In  the  cases  in  which  the  pulsation  was 
absent,  this  fact  was  verified  by  another  physician,  Dr.  Hull  or 
Dr.  Sprague. 

In  the  sixty  cases  exclusive  of  those  in  which  there  were 
other  evidences  of  arterio-sclerosis  I  obtained  a  positive  result 
of  100  per  cent. 

In  the  twenty  cases  of  pronounced  arterio-sclerosis  the  results 
were  quite  different.  In  ten  of  these  cases  the  pulsation  was 
absent  in  one  or  both  of  these  arteries.  In  other  words,  in 
these  cases  I  obtained  a  positive  result  in  only  fifty  per  cent. 
In  four  cases  there  was  absence  of  pulsation  in  one  posterior 
tibial  or  a  positive  result  in  the  posterior  tibials  of  eighty  per 
cent  of  cases. 


REUBEN   H.  IRISH 


487 


In  eight  of  these  cases  the  pulsation  in  the  dorsalis  pedis  of 
one  or  both  sides  was  absent  or  a  positive  result  of  sixty  per 
cent. 

These  cases  were  too  few  to  draw  any  positive  conclusion 
from  them. 

I  believe  that  in  cases  exclusively  of  arterio-sclerosis  the  foot 
pulses  may  be  regarded  as  fixed  and  constant — but  I  also 
believe  that  absence  of  pulsation  in  one  or  both  of  these  arteries 
in  cases  of  general  arterio-sclerosis,  is  not  such  an  infrequent 
symptom  as  the  reports  of  some  observers  would  indicate. 

Diagnosis. — The  absence  of  pulsation  in  these  vessels  is  not 
so  frequent  that  this  symptom  is  not  of  diagnostic  value  when 
found  in  connection  with  the  above  mentioned  group  of  symp- 
toms, namely  pain,  stiffness,  weakness  and  paresthesia  of  the 
leg  due  to  muscular  effort  and  disappearing  with  rest.  The 
intermittent  character  of  the  symptoms,  increased  with  muscu- 
lar effort  and  associated  with  arterial  changes  and  circulating 
disturbances  are  the  chief  diagnostic  points. 

Prognosis. — Unfavorable  as  regards  complete  recovery,  but 
the  symptoms  frequently  remain  stationary  or  improve  for  a 
time  under  proper  treatment. 

Treatment. — Rest  is  frequently  the  most  important  element. 
The  patient  should  never  exceed  the  time  limit,  that  is  the  time 
when  symptoms  of  claudication  first  appear  after  beginning 
exercise  as  in  walking. 

In  a  severe  case  complete  rest  in  bed  for  a  few  weeks  has  been 
found  to  be  of  decided  benefit. 

Of  internal  remedies  sodium  and  potassium  iodide  occupy  first 
place  as  in  other  conditions  of  arterio-sclerosis. 

Nitro-glycerine  is  also  used  in  this  condition,  but  from  my 
personal  experience  with  its  use  in  other  conditions  of  arterio- 
sclerosis, I  would  consider  it  of  doubtful  value. 

In  the  presence  of  other  neurotic  symptoms  bromides  are 
indicated. 

Of  local  measures  the  following  are  most  important:  keeping 
the  parts  well  protected  from  the  cold,  local  hot  salt  water 
baths  and  galvanism. 

Report  of  Case. 

The  patient  is  a  male,  89  years  of  age  and  has  a  remarkable  strong 
constitution  for  a  man  of  his  age.  He  comes  of  a  very  long  lived  family, 
his  mother  living  to  be  over  100  years  of  age.    I  was  able  to  obtain 


488 


INTERMITTENT  CLAUDICATION 


no  family  history  of  gout,  rheumatism  or  grave  mental  or  nervous 
disease. 

Patient  has  always  enjoyed  exceptionally  good  health,  and  has  been 
temperate  in  all  his  habits.  He  has  drunk  one  glass  of  hot  Scotch  whiskey 
at  bed  time  for  13  years,  what  he  calls  his  "night  cap."  Never  used 
tobacco  in  any  form  and  there  is  no  specific  history.  His  temperament 
is  sanguine.  For  the  past  four  or  five  years  has  had  a  chronic  bronchitis, 
with  acute  exacerbations  from  time  to  time,  which  confine  him  to  his 
bed  or  room  for  three  or  four  weeks  at  a  time.  Also  in  later  years  has  had 
some  trouble  from  intestinal  indigestion  and  flatulency  in  the  lower 
bowel.  Has  been  troubled  for  years  with  coldness  of  the  legs  or,  as  he 
himself  describes,  his  "shins  would  get  cold."  For  this  reason  he  has 
worn  woolen  leggings  summer  and  winter  for  the  past  ten  or  fifteen  years. 
Has  frequently  had  painful  cramps  in  the  muscles  of  the  calves  of  the 
legs,  which  would  awaken  him  from  his  sleep  and  would  often  be  so  severe 
that  he  would  jump  out  of  bed  and  rub  the  muscles  and  walk  about, 
when  cramps  would  soon  disappear. 

Present  trouble.  About  May  1st,  1905,  first  noticed  what  he  described 
as  "an  aching  sensation"  and  numbness  in  the  muscles  of  the  front 
of  the  thigh  and  calf  of  the  left  leg,  which  would  come 
on  after  walking  a  short  distance  and  especially  in  climbing  stairs. 
After  rest  it  would  disappear  to  again  return  upon  exertion.  At  first 
he  only  noticed  it  in  climbing  stairs  when  the  last  two  or  three  stairs 
were  reached.  It  continued  to  grow  worse  until  it  would  come  on  after 
climbing  two  or  three  stairs  and  grow  quite  painful  before  top  of  the 
stairs  was  reached.  In  walking  on  the  level  at  first  it  only  came  on 
when  taking  long  walks,  but  later  would  begin  to  trouble  him  after 
walking  less  than  one-half  block.  After  resting  he  could  start  off  all 
right,  and  would  feel  as  well  and  strong  as  ever,  but  if  walking  was  con- 
tinued the  aching  sensation  would  gradually  come  on  and  grow  more  severe. 

He  first  consulted  me  about  July  1  regarding  this  trouble.  When 
asked  to  describe  the  pain,  he  said  it  was  like  what  was  called  "growing 
pains ' '  when  he  was  a  boy. 

He  also  complained  of  a  sensation  of  numbness  of  three  toes,  begin- 
ning with  great  toe  of  left  foot,  with  painful  contraction  of  the  extensor 
tendon  of  this  toe  at  times. 

There  was  also  numbness  of  the  two  larger  toes  of  the  right  foot  and 
for  past  two  weeks  had  noticed  what  he  described  as  "a  slight  aching 
sensation"  in  muscles  of  the  calf  of  the  right  leg  on  exertion. 

Physical  examination. — Heart  sounds  normal,  no  murmurs;  pulse 
varies  from  60  to  70,  full,  strong  and  readily  compressible;  slight 
thickening  in  radial  and  temporal  arteries,  no  calcarious  deposits.  Exam- 
ination of  nervous  system  negative  except  for  diminished  knee  jerk  on 
both  sides,  though  still  present.  Sensation  over  lower  extremities  is 
normal.  Examination  of  urine  negative.  No  apparent  muscular  weak- 
ness. No  apparent  muscular  atrophy  or  muscle  quivering.  Leg  marked 
with  areas  of  discoloration  due  to  dilatation  of  capillary  veins.  Feet 
and  legs  cold  to  the  touch,  left  being  perceptibly  colder  than  right.  No 
oedema. 


OSTEOMYELITIS  OP  THE  FEMUR 


489 


Pedal  arteries. — Pulsation  in  posterior  tibials  present  on  both  sides, 
but  the  left  is  appreciably  weaker  than  the  right,  and  is  detected  with 
difficulty.    Popliteal  pulsation  also  weaker  on  left  side. 

Dor  satis  pedis. — Right,  weak  pulsation,  detected  with  difficulty.  Left, 
pulsation  absent,  though  examined  on  several  occasions. 

Patient  was  instructed  never  to  exceed  painless  limit  in  walking. 
Given  potassium  iodide  grs.  xv.  t.  i.  d.  Massage  and  galvanism  were 
tried,  but  apparently  without  result.  The  hot  salt  water  foot  baths 
seemed  to  be  of  service. 

July  2gth. — Up  to  two  days  previous  to  this  time  trouble  had  seemed 
to  improve.  Two  days  ago  did  more  walking  than  usual  and  since 
that  time  "aching  sensation"  came  on  more  frequently  and  after  only 
moderate  exertion. 

Pulsation  of  pedal  arteries  same  as  before  except  that  right  dorsalis 
pedis  was  also  absent. 

November  1st. — Decided  improvement.  Can  again  climb  stairs  quite  com- 
fortably, the  old  aching  sensation  only  coming  on  when  the  last  stair 
or  two  have  been  reached  and  then  not  severe.  Can  walk  five  or  six 
blocks  with  comfort.  But  if  he  exceeds  his  limit  for  a  day  or  two 
trouble  returns  as  severe  as  before. 

Left  post  tibial  still  weaker  than  right.  Dorsalis  pedis  absent  in  left 
leg;  present  in  right.  Complains  of  what  seems  to  be  a  neuritis  of  the 
right  upper  arm  which  condition  is  also  present  in  a  lesser  degree  in  the 
left  arm.  No  difference  in  radial  pulsation  of  two  sides.  No  other 
evidence  of  circulatory  disturbance  in  hand  or  arm. 

January  1st. — Condition  of  legs  remained  about  the  same  as  in  Novem- 
ber. Condition  of  arms  unimproved,  though  I  had  tried  various  external 
and  internal  remedies. 

Remarks. — The  etiological  factor  in  this  case  was  undoubtedly  the  ad- 
vanced age  of  the  patient.  The  diagnosis  was  based  upon  the  inter- 
mittent character  of  the  symptoms — increased  upon  motion  and  dis- 
appearing with  rest;  the  changes  and  absence  of  pulsation  observed 
in  the  toot  arteries  with  coldness,  numbness  and  other  evidence  of  local 
circulating  disturbances. 

While  a  cure  could  not  be  expected  the  condition  has  improved  under 
treatment. 

OSTEOMYELITIS  OF  THE  FEMUR. 
Read  before  the  Medical  Society  of  the  County  of  Albany,  December  13,  IQ05. 
By  GEORGE  GUSTAVE  LEMPE,  M.  D., 

Instructor  of  Anatomy,  Albany  Medical  College. 

The  patient,  M.  H.,  aged  33,  presented  the  picture  of  a  well 
nourished  robust  young  woman,  about  five  feet  seven  inches  in 
height  and  about  165  pounds  in  weight.  She  had  been  treated 
for  rheumatism  of  the  right  knee  for  three  days  before  I  saw  her. 
There  was  a  slight  tenderness  around  the  knee  joint.    The  color 


49° 


OSTEOMYELITIS  OF  THE  FEMUR 


of  the  skin  was  normal  and  no  swelling  or  enlargement  of  the 
joint  was  apparent.  She  had  been  unable  to  walk  for  three  days 
on  account  of  pain  in  the  joint.  Her  pulse  was  slightly  above 
normal  and  her  temperature  was  990  F.  Urine  normal.  The 
patient  was  very  nervous  and  hysterical  at  times.  Her  previous 
history,  excepting  an  attack  of  typhoid,  twelve  years  ago,  was 
negative.  Her  condition  remained  the  same  for  two  weeks,  ex- 
cepting occasional  attacks  of  severe  pain,  which  occurred  during 
the  day  or  night,  becoming  especially  intense  when  excited  or 
nervous  from  any  cause.  A  possibility  of  its  being  a  case  of 
neuromimesis  or  hysterical  simulation  of  joint  disease  came  to 
my  mind. 

At  the  end  of  the  third  week,  her  condition  being  the  same, 
I  requested  a  thorough  examination  of  the  knee  under  a  general 
anaesthetic,  which  was  not  granted.  Certain  bladder  symptoms, 
a  severe  vaginal  discharge,  and  an  enlarged  and  tender  ovary  or 
tube,  which  led  me  to  suspect  a  gonorrhoeal  infection  might  have 
been  cleared  up  if  patient  had  been  examined  under  an  anaes- 
thetic. About  the  middle  of  the  fourth  week  the  knee  began  to 
enlarge  and  grow  very  painful,  especially  above  the  patella. 
The  pain  extended  down  the  tibia  and  above  to  the  middle  of 
the  femur.  Temperature  and  pulse  were  slightly  above  normal 
during  the  day.  At  night  the  temperature  would  reach  101.80  F. 
and  the  pulse  varied  from  100  to  120.  Pain  was  more  severe  at 
night  than  during  the  day.  Hot  applications  of  any  kind  would 
increase  the  pain.  Leucocyte  count  gave  16.100.  The  leg  was 
held  in  a  slightly  flexed  position  and  any  movement  was  impossi- 
ble. The  skin  over  the  joint  became  red,  inflamed  and  oedema- 
tous,  and  fluctuation  in  the  joint  was  apparent.  The  oedems  ex- 
tended upward  as  far  as  the  hip.  I  advised  aspiration  with  a 
probable  subsequent  exploratory  incision,  but  the  patient  would 
not  consent.  The  next  day  I  called  Dr.  Neuman  to  see  the  patient. 
He  advised  aspiration  of  the  joint  and  examination  under  a  gen- 
eral anaesthetic  with  a  probable  subsequent  opening  of  the  joint. 
Aspiration  failed  to  reveal  any  fluid  although  palpation  appar- 
ently indicated  its  presence.  The  patient  was  removed  to  the 
hospital.  On  opening  the  joint  the  cartilages  were  found  en- 
larged and  the  joint  filled  with  large  gelatinous  masses;  the 
ligaments  were  torn  from  their  attachments  and  the  muscles 
were  dark  red,  almost  black  in  color.  The  lower  end  and  shaft 
of  the  femur  crumbled  under  slight  pressure  as  far  as  the  middle 


GEORGE  GUSTAVE  LEMPE 


4QI 


third  of  the  shaft.  The  head  of  the  tibia  was  in  the  same  con- 
dition. A  large  mass  of  gelatinous  material  was  found  back  of 
the  joint  in  the  poplitual  space.  Pockets  containing  from  three 
to  six  ounces  of  pus  were  found  in  the  soft  tissues  surrounding 
the  shaft  of  the  femur.  The  patella  was  loosened  from  its 
attachment.  The  leg  was  amputated  in  the  upper  third  of  the 
shaft  of  the  femur.  An  Esmarch  was  not  used  on  account  of 
oedema  of  the  thigh,  hemorrhage  being  controlled  by  digital 
compression.    The  patient  died  the  same  night. 

The  Bender  Laboratory  reported  as  follows:  Anatomical 
Diagnosis:  Osteomyelitis  of  the  femur,  involving  knee  joint  and 
tibia.    Microscopic  diagnosis:  Acute  osteomyelitis. 

Different  names  have  been  given  to  designate  the  onset  and 
course  of  acute  osteomyelitis  such  as  acute  spontaneous  osteo- 
myelitis; malignant  osteomyelitis;  acute  explosive  osteomy- 
elitis, etc.  In  acute  spontaneous  multiple  so-called  malignant 
osteomyelitis  the  changes  of  structures  are  very  rapid  and  de- 
structive and  may  occur  in  from  a  few  days  to  a  few  weeks.  The 
medulla  is  disintegrated  and  becomes  gangrenous.  The  neigh- 
boring joint  becoming  involved,  necrosis  of  a  large  portion  of  a 
bone  sometimes  of  the  whole  shaft  takes  place,  as  in  the  case  just 
recited.  Surrounding  parts  become  gangrenous,  the  veins  con- 
tain thrombi  and  pyemic  infection  and  abscesses  may  form  in 
different  parts  of  the  body.  The  infection  may  involve  the  lungs, 
kidneys,  pleura  and  pericardium.  In  cases  of  this  kind  death 
sets  in  after  a  few  weeks,  months,  or  even  in  a  few  days.  They 
almost  always  end  fatally.  This  form  of  osteomyelitis  affects  the 
femur  according  to  v.  Bruns  in  thirty -nine  per  cent,  of  all  cases 
of  acute  spontaneous  osteomyelitis,  the  lower  end  being  the  seat 
of  choice. 

Etiology.  The  direct  cause  of  acute  osteomyelitis  is  always  an 
infection  by  some  pyogenic  bacterium.  Most  frequently  found 
is  the  staphylococcus  pyogenes  aureus,  or  sometimes  the  staphy- 
lococcus albus  or  citreus.  In  a  few  cases  the  streptococcus 
pyogenes,  the  typhoid  bacillus  and  the  pneumococcus  were 
found  respectively.  In  others  we  have  a  mixed  infection. 
(Nichols).  The  point  of  entrance  is  either  a  small  suppurating 
wound,  acne  pustule,  furuncle,  felon,  eczema,  abscess  or  an 
abrasion  of  the  mucous  membrane  in  the  mouth  or  nose,  especially 
any  inflamed  spot  of  the  tonsil  or  the  nose.  A  few  cases  are 
supposed  to  have  received  their  infection  through  the  respiratory 


492 


OSTEOMYELITIS   OF  THE  FEMUR 


and  intestinal  tracts.  Ponfick  has  shown  that  infection  has 
been  carried  through  inflammation  of  the  mucous  membrane 
of  the  middle  ear.  I  might  mention  here  that  Fraenkel  has 
found  in  the  red  bone  marrow  in  the  various  infectious  diseases, 
bacteria  of  these  diseases.  The  negative  blood  findings  in 
these  cases  did  not  exclude  positive  marrow  findings.  The 
micro-organisms  may  lie  slumbering  for  months  or  years  in  the 
marrow  and  only  need  a  slight  stimulus,  such  as  a  slight  injury 
or  a  secondary  infection  from  the  nose,  throat  or  lungs,  to 
lead  to  a  typical  case  of  osteomyelitis.  This  may  explain  why 
in  so  many  cases  of  osteomyelitis  the  source  of  infection  could 
not  be  established  heretofore.  We  know  that  osteomyelitis 
may  be  recurrent  after  ten,  fifteen,  or  even  twenty-five  years. 
The  inflammatory  material  remains  latent  or  encapsulated, 
becoming  active  from  trauma  or  secondary  infection  of  some 
kind.  After  typhoid  fever  the  local  lesion  in  the  bone  seldom 
begins  until  months  or  even  years  after  the  infection.  The 
specific  bacillus  of  diphtheria  had  been  found  in  one  instance 
in  the  bone  marrow.  In  a  great  number  of  cases  the  strepto- 
coccus following  diphtheritic  invasions  of  the  throat  has  been 
found.  In  scarlet  fever  the  streptococcus  was  found  in  nine 
out  of  ten  cases.  In  three  cases  of  scarlet  fever  the  staphy- 
lococcus pyogenes  aureus  was  found  in  addition.  Two  cases 
have  been  reported  so  far  where  anaerobic  bacilli  were  found  in 
osteomyelitis.  Helferich  observed  in  141  cases  of  osteomyelitis 
the  following  order  of  frequency  of  occurrence:  tibia  sixty-six 
per  cent.;  femur,  forty-five  per  cent.;  humerus,  twenty  per 
cent.;  radius,  six  per  cent.;  fibula,  four  per  cent.  The  growth 
coefficient  has  been  established  by  v.  Langer  as  follows:  femur, 
4.38;  tibia,  4.32;  humerus,  3.97;  radius,  3.83;  etc.  This  would 
coincide  with  the  frequency  of  occurrence  of  osteomyelitis  in 
the  bones  mentioned,  except  that  of  the  tibia  which  may  be 
explained  by  the  fact  of  the  tibia,  being  subcutaneous,  it  is  thus 
more  exposed  to  injury.  In  seeking  a  cause  for  the  frequency 
with  which  one  bone  is  more  often  affected  than  another,  we 
find  that  in  the  rapidity  of  growth  and  the  strain  brought  to 
bear  on  the  bone.  Looking  at  the  place  or  portion  of  bone 
most  frequently  affected  we  find  in  one  hundred  and  forty-one 
cases  lower  end  of  femur,  .40;  upper  end  of  tibia,  .29;  middle  of 
tibia,  .19;  lower  end  of  tibia,  .18;  upper  end  of  femur,  .3;  mid- 
dle of  femur,  .2,  etc. 

Lexer,  in  working  out  the  circulation  of  the  bone,  claims 


GEORGE   GUSTAVE  LEMPE 


493 


that  he  can  state  the  cause  of  the  now  well-known  localization 
of  pyogenic  and  also  tuberculous  osteomyelitis.  (By  injecting 
an  emulsion  of  turpentine  and  mercury  into  the  large  arteries 
of  a  bone  in  its  fresh  state  the  various  arterial  trunks  in  the 
bone  are  filled,  and  an  X-ray  negative  may  be  taken  which 
gives  an  excellent  picture  of  the  arterial  circulation.)  He 
found  three  groups  of  arteries  in  the  long  bones  of  the  new  born 
and  in  children  the  diaphyseal,  the  metaphyseal  (on  both 
sides  of  the  epiphyseal  line),  and  the  epiphyseal,  the  bone  near 
the  epiphysis  receiving  branches  from  all  three  groups.  He 
found  that  the  older  the  bone  becomes  the  finer  are  the  arteries 
in  relation  to  the  size  of  the  bone.  These  three  groups  of  arteries 
are  found  up  to  the  termination  of  the  so-called  bony  growth, 
i.  e.,  adult  life.  In  adult  life  he  finds  the  diaphyseal  group  of 
arteries  growing  smaller  and  smaller.  The  epiphyseal  and 
metaphyseal  arteries  decrease  in  size  less  in  proportion,  whilst 
the  arterial  supply  of  the  joint  becomes  more  marked.  This 
would  explain  why  bone  lesions  are  most  frequently  found 
in  infancy  and  youth,  and  joint  lesions  in  the  adult.  The 
majority  of  pyogenic  osteomyelitic  foci  are  due  to  an  embolic 
process,  i.  e.,  clumps  of  bacteria  travel  from  the  primary  infected 
area  in  some  other  part  of  the  body,  and  are  carried  to  the  bone 
through  the  circulation.  If  the  embolus  is  large  it  blocks  the 
diaphyseal  artery,  if  small  it  is  carried  to  the  smaller  or  ter- 
minals of  this  artery  and  creates  a  focus  of  infection  near  the 
epiphysis.  When  the  embolus  plugs  an  epiphyseal  or  a  meta- 
physeal artery  the  focus  is  confined  to  the  area  supplied  by  the 
plugged  artery,  and  this  explains  the  frequently  observed  wedge- 
shaped  focus  in  the  early  stage  of  osteomyelitis  in  the  epiphysis. 
Osteomyelitis  of  the  femur  occurs  most  frequently  between 
the  eighth  and  seventeenth  year,  the  period  of  most  active 
growth,  and  is  rare  in  childhood  and  middle  life.  Men  are 
more  commonly  affected  than  women,  in  the  ratio  of  four  to 
one. 

The  symptoms  are  those  of  severe  septic  infection,  but  vary 
according  to  the  intensity  of  the  inflammatory  process.  Initial 
chill,  increasing  severe  pain,  swelling,  edema  and  diffused 
redness,  with  high  continuous  fever,  io2°-io4°  F.,  a.  m.  and 
io4°-io5.8°  F.,  p.  m.,  the  symptoms  often  pointing  to  disease 
of  the  bone. 

Differential  Diagnosis.  Diseases  most  frequently  mistaken  for 
acute  osteomyelitis  are  acute  tuberculosis  of  the  joints,  acute 


5 


494 


OSTEOMYELITIS  OF  THE  FEMUR 


articular  rheumatism  and  typhoid  fever.  Tuberculosis  of  the 
knee  is  not  infrequently  confused  with  acute  osteomyelitis,  but, 
as  a  rule,  the  course  of  the  disease  is  more  subacute.  The  diag- 
nosis often  can  be  made  only  at  the  operation.  Tuberculosis  of 
the  joint  usually  begins  in  the  epiphysis  of  the  long  bones,  whilst 
osteomyelitis  almost  always  begins  in  the  diaphysis  or  shaft. 
Cases  have  been  reported  recently  of  primary  tuberculosis  of  the 
diaphysis  (v.  Bergmann).  Acute  articular  rheumatism  affects 
as  a  rule  more  than  one  joint,  although  monarticular  rheumatism 
is  not  uncommon.  The  usual  early  marked  redness  and  oedema 
of  the  soft  parts  and  the  almost  constant  bone  tenderness  in 
osteomyelitis  may  allow  an  early  differentiation.  In  the  case 
reported  above  these  symptoms  did  not  appear  till  the  end  of  the 
third  week.  Gonorrheal  rheumatism  may  affect  one  joint,  and  the 
early  symptoms  being  severe  may  be  mistaken  for  acute  osteo- 
myelitis, especially  when  the  history  of  the  case  is  not  obtainable 
and  the  effusion  into  the  joint  is  of  a  purulent  nature.  We  know 
that  a  non-gonorrhoeal  synovitis  may  occur  during  gonorrhoea. 
Aspiration  in  gonorrhoeal  inflammation  of  the  knee  has  shown 
gonococci  in  about  sixty  per  cent,  of  cases  but  only  up  to  the 
sixth  day  of  the  disease.  Later  aspiration  failed  to  show  gon- 
ococci where  they  had  been  previously  shown.  In  some  cases 
gonococci  have  been  cultivated  from  the  fluid  in  the  joint. 

Acute  purulent  synovitis  may  be  confounded  with  osteomy- 
elitis or  may  accompany  osteomyelitis  of  the  epiphysis.  The 
clinical  picture  is  similar  to  acute  osteomyelitis  of  the  lower  end 
of  the  femur  and  upper  end  of  the  tibia. 

The  pain  and  local  symptoms,  the  high  leucocyte  count,  as  well 
as  the  very  sudden  onset,  and  the  absence  of  the  Widal  reaction, 
usually  allow  us  to  differentiate  between  typhoid  fever  and  acute 
osteomyelitis.  In  children  if  the  patient  is  in  a  complete  stupor, 
as  frequently  occurs  in  severe  cases  of  osteomyelitis,  it  may  be 
mistaken  for  typhoid.  The  differential  diagnosis  of  some  forms 
of  osteomyelitis  from  a  syphilitic  knee  is  often  as  difficult  in  in- 
dividual cases  as  from  tuberculous  or  rheumatic  arthritis. 

The  severest  cases  with  fever  like  that  of  typhoid  or  with 
symptoms  of  a  severe  infection  with  separation  of  the  epiphyses, 
suppuration  in  the  knee  joint  and  involvement  of  a  large  part  of 
the  entire  shaft  of  a  bone,  are  almost  always  fatal. 

Nichols  says :  ' '  Any  extreme  pain  in  the  bone  with  or  without 
swelling  should  always  lead  to  a  consideration  of  acute  osteo- 
myelitis." 


EDITORIAL 


495 


:£  tutorial 

The  winter  of  1881  was  a  peculiarly  hard  one,  and 
band  after  band  arrived  starving,  in  rags,  and  willing 
to  work  for  food,  for  clothes.  They  came  in  such  num- 
bers that  Bethel  could  not  keep  them  all, — the  most 
needy,  the  most  starving,  were  those  asked  to  stay. 
"  Would  to  God,"  said  a  hungry  vagrant  bitterly, 
"  Would  to  God  we  too  were  epileptic,  then  you 
would  keep  us ! "  That  went  to  the  pastor's  heart. 
"  I  will  try  and  keep  you — find  work  for  you,"  he  said, 
and  he  went  prospecting. 

A  Colony  of  Mercy.  Julie  Sutter. 

>h  % 

After  care  for  the  insane  which  has  so  long  been 
After  Care  of  systematically  carried  on  in  European  countries  has 
the  Insane  as  last  been  established  in  this  country  in  the  State  of 
New  York  by  the  State  Charities  Aid  Association  in 
co-operation  with  the  State  Commission  in  Lunacy 
and  the  managers  and  superintendents  of  the  State  hospitals. 
The  ultimate  aim  of  this  work  is  the  prevention  of  relapses  by 
assisting  patients  to  re-adjust  themselves  to  the  ordinary  con- 
ditions of  life  after  their  discharge  from  hospital  care.  It  is  felt 
that  a  systematic  effort  should  be  made  to  inquire  into  the  cir- 
cumstances and  home  surroundings  and  influences  of  patients 
leaving  hospitals  for  the  insane  and  endeavor  to  prevent  a  return 
to  the  conditions  which  have  brought  on  the  original  mental 
break-down,  and  are  likely  to  delay  or  prevent  a  complete  and  per- 
manent recovery.  Assistance  in  procuring  suitable  employ- 
ment, in  getting  into  normal  and  healthful  social  relations  with 
the  community  to  which  the  patient  returns,  and  such  other 
methods  of  friendly  aid  as  seem  to  be  required  by  the  individual 
patient,  are  offered  by  those  who  undertake  this  work.  The 
State  Charities  Aid  Association  visits  the  State  hospitals  for  the 
insane  throughout  the  State  and  its  visitors  have  an  opportunity 
to  acquaint  themselves  with  the  needs  of  the  patients  after 
leaving  the  hospital,  as  well  as  while  under  treatment.  The 
plan  of  organization  is  to  establish  an  After  Care  Committee  in 
each  hospital  district,  these  committees  co-operating  with  and 
working  under  the  direction  of  a  sub-committee  on  the  After  Care 
of  the  Insane,  appointed  by  the  Association's  Standing  Committee 
on  the  Insane.  The  Manhattan,  Willard  and  Hudson  River 
After  Care  Committees  have  already  been  organized,  and  the 
central  sub-committee,  which  has  charge  of  the  work,  employs 


496 


LITTLE  BIOGRAPHIES 


an  agent  to  assist  the  members  of  these  committees  in  visiting 
the  homes  of  patients  discharged,  recovered  or  about  to  be  dis- 
charged, and  in  assisting  them  to  secure  employment  or  in  other 
ways  in  which  help  or  counsel  may  seem  to  be  required.  This 
work  seems  likely  to  have  important  results  in  the  prophylaxis 
of  mental  disorders,  and  it  is  to  be  hoped  that  this  example 
established  in  the  State  of  New  York  may  be  followed  in  other 
states  by  the  organization  of  similar  societies. 

The  following  resolution  was  introduced  at  the  annual  meeting 
of  the  American  Medico-Psychological  Association  held  in  Bos- 
ton, June  1 2th  to  15th,  and  unanimously  adopted: 

Whereas,  The  State  Charities  Aid  Association  of  New  York 
has  recently  established  a  Committee  on  the  After  Care  of  the  In- 
sane to  work  in  co-operation  with  the  State  Hospitals  for  the  In- 
sane in  that  State,  and  to  provide  temporary  assistance,  em- 
ployment and  friendly  aid  and  counsel  for  needy  persons  dis- 
charged from  such  hospitals  as  recovered,  and 

Whereas,  In  the  opinion  of  the  American  Medico-Psycholog- 
ical Association,  it  is  very  desirable  that  there  should  be  carried 
on  in  connection  with  all  hospitals  for  the  insane  such  a  system  of 
after  care,  therefore, 

Resolved,  That  the  American  Medico-Psychological  Asso- 
ciation expresses  its  gratification  at  the  inauguration  of  this 
movement  in  the  State  of  New  York,  and  its  earnest  hope  that 
similar  work  may  be  undertaken  for  hospitals  for  the  insane 
generally. 

Xittle  JStoarapbtes 

VII.  FALLOPIUS,  1523-1563. 

GRABRIELLO   FALLOPIO,   usually  known  as  Fal- 
lopius,  was  not  only  one  of  the  most  distinguished 
anatomists  of  the  sixteenth  century,  but  also  together 
with  Vesalius  of  Brussels,  and  Eustachius  of  Rome, 
enjoyed  the  title  of  "  the  great  restorers  of  anatomy." 

The  exact  details  of  his  early  life  are  not  known  and  this 
accounts  for  the  contradictory  statements  found  in  the  different 
biographies.  He  was  descended  from  a  noble  Italian  family  of 
that  name  and  was  probably  born  about  the  year  1523  at  Modena, 
and  not  thirty-three  years  earlier  as  stated  by  several  biographers. 
He  died  at  the  early  age  of  forty  in  the  year  1563.  Hutchinson 


LITTLE  BIOGRAPHIES 


497 


describes  him  as  a  man  having  "  a  strong  and  vigorous  constitu- 
tion, with  vast  abilities  of  mind  which  he  cultivated  by  an  intense 
application  to  his  studies  in  philosophy,  physic,  botany  and 
anatomy/'  While  he  was  interested  in  all  branches  of  medicine, 
he  applied  himself  especially  to  the  study  of  anatomy  and  it  is 
the  work  in  this  subject  which  gave  him  his  greatest  reputation. 
He  studied  medicine  under  Antonio  Musa  Brasavola  at  Ferrara 
and  beside  traveled  extensively,  visiting  many  of  the  celebrated 
anatomists  of  that  time,  such  as  Madius,  Columbus,  Cananus, 
Ingrassias  and  others. 

Italy  honored  him  in  many  ways.  He  was  known  as  the 
"  yEsculapius  of  his  century."  The  University  of  Pisa  appointed 
him  professor  of  anatomy  in  the  year  1548,  and  three  years  later 
the  Senate  of  Venice  called  him  to  occupy  the  chair  of  surgery, 
anatomy  and  botany  at  Padua,  to  succeed  Vesalius ;  where  he 
remained  until  his  death  in  1563. 

Only  one  of  his  works  was  published  during  his  lifetime, 
viz.,  his  Observations  Anatomicse,  Venice,  8vo.,  1561.  Accord- 
ing to  Fisher  this  is  considered  one  of  his  most  valuable  works 
"  containing  as  it  does  most  of  his  discoveries  and  his  animad- 
numerous  corrections  of  the  errors  into  which  his  distinguished 
versions  on  the  words  of  other  anatomists  and  particularly  his 
predecessor  Vesalius  had  fallen."  His  collected  works  were  first 
published  at  Venice  in  the  year  1584,  and  later  editions  followed; 
the  1606  edition,  "  embraced  twenty-four  treatises  distributed 
in  three  folio  volumes,  containing  in  all  over  1,500  pages." 
(Fisher.) 

In  osteology,  he  was  the  first  to  describe  accurately  the  bony 
system  of  the  foetus  and  the  epiphyses  of  the  long  bones.  He 
also  understood  the  osseous  portion  of  the  ear  better  than  any 
of  his  predecessors  and  from  him  are  named  the  aqueductus  and 
hiatus  Fallopii. 

He  first  described  the  muscles  of  the  soft  palate,  and  the  liga- 
ment which  has  erroneously  been  attributed  to  the  French  anato- 
mist, Poupart.  His  contributions  in  angiology  and  neurology 
were  not  as  important  as  those  in  osteology,  myology  and  splanch- 
nology. 

He  first  described  the  villi  and  valvulae  conniventes  of  the  small 
intestine.  On  account  of  his  accurate  studies  of  the  female  pelvic 
organs  the  Fallopian  tubes  were  named  after  him,  but  unjustly 
for  they  had  been  previously  described  by  Herophilus  over  three 
hundred  years  before  Christ. 


498 


LITTLE  BIOGRAPHIES 


Hutchinson  states  that  "  He  practised  physic  with  great  suc- 
cess and  gained  the  character  of  one  of  the  ablest  physicians  of 
the  age."  Portal  claims  that  he  was  as  great  a  surgeon  as  he 
was  an  anatomist.  In  his  surgical  works  many  subjects  are  con- 
sidered ;  the  treatment  of  wounds  in  general  and  especially  those 
of  the  different  organs ;  the  use  of  ligatures ;  dislocations ;  ulcers, 
their  classification  and  treatment ;  the  various  surgical  opera- 
tions and  their  indications  and  contraindications.  He  has  described 
an  instrument  for  paracenthesis.  He  reported  a  case  of  anky- 
losis of  several  of  the  vertebra  and  another  of  a  fungoid  growth 
from  the  brain. 

Besides  being  Professor  of  Anatomy  and  Surgery  at  Padua, 
he  was  also  Professor  of  Botany  and  superintendent  of  the  botani- 
cal gardens  of  that  city  and  in  honor  of  him  as  a  botanist,  a  genus 
of  plants  (Fallopia)  has  been  named. 

Much  has  been  written  about  Fallopius  as  an  anatomist,  surgeon 
and  botanist,  but  little  about  him  as  a  man.  Portal  states  that 
he  was  amiable,  affable  and  in  no  way  presumptuous ;  he  pub- 
lished his  own  discoveries  in  a  very  modest  manner  and  treated 
the  mistakes  of  others  with  consideration.  He  always  had  the 
greatest  respect  for  Vesalius,  his  teacher.  In  fact  he  had  all  the 
good  qualities  one  desires  to  see  in  a  learned  man  and  which 
is  not  always  found. 

Quite  a  different  picture  of  Fallopius  has  been  portrayed  by 
others  as  shown  by  the  following  quotation  from  Willis  in  his 
life  of  Harvey  (referred  to  by  Fisher)  :  "  Fallopius  showed  him- 
self at  all  times  so  adverse  a  critic  of  Vesalius,  that  he  seems  to 
have  been  animated  by  something  like  personal  hostility  toward 
him.  Fallopius  had  for  many  years  been  engaged  obscurely,  but 
usefully,  as  presector  in  the  anatomical  theatre  at  Padua,  and 
probably  looked  to  the  professor's  chair  as  his  rightful  inherit- 
ance, when  Vesalius  was  appointed  over  his  head.  *  *  * 
Smothered  dislike  broke  out  at  length  into  open  emnity,  which 
is  unhappily  transmitted  to  us  in  the  writings  of  Fallopius." 
"  This  same  spirit  is  said  to  have  been  shown  toward  his  con- 
temporaries generally."  (Fisher.) 

John  A.  Sampson. 

REFERENCES. 

Fisher.  Gabriello  Fallopio.    Annals  of  Anatomy  and  Surgery,  1880,  ii, 

200-204. 

Portal.  Histoire  de  L'Anatomie  et  de  la  Chimrgie,  Paris,  1770,  i,  567- 

589. 

Hutchinson.  Biopraphia  Medica,  London,  1709,  i,  295-297. 

Michaud.  Biographie  Universclle,  Paris,  1842-65,  360-361. 

Gurlt  and  Hirsch.    Biographisches    Lexikon   der   hervorragende n   Artze.    Wien  & 
Leipzig,  1885,  ii,  335-336. 


SCIENTIFIC  REVIEW 


499 


Scientific  "Review 

THE  CEREBRO-SPINAL  FLUID  IN  HEALTH  AND 

DISEASE 

The    Diagnostic    and    Therapeutic    Value   of  Lumbar 

Puncture. 

(Concluded  from  Annals  of  June,  1906,  page  454.) 

Before  giving  the  indications  for  this  procedure,  it  may  be 
well  to  consider  first  the  immediate  and  remote  effects  of  lumbar 
puncture  on  the  general  condition  of  the  patient.  The  opera- 
tion is  perfectly  harmless  if  performed  properly  and  rarely 
causes  distressing  symptoms.  At  the  time  of  operation,  pa- 
tients may  complain  of  vertigo  and  sometimes  a  syncopal 
attack  may  be  observed. 

Later  there  may  be  an  intense  frontal  headache  lasting  even 
a  week,  vomiting  of  the  cerebral  type  and  constipation — a  triad 
which  may  suggest  meningitis. 

Usually  such  symptoms  do  not  occur;  at  most  do  we  hear 
of  slight  headache  and  nausea,  pains  in  the  legs  which  rapidly 
disappear.  In  the  great  majority  of  cases  no  symptoms  what- 
ever develop. 

Certain  authors  have  given  the  very  worst  picture  of  the 
after-effects  of  lumbar  puncture,  such  as  hemorrhage,  haema- 
tomyelia,  purulent  meningitis  and  even  death  in  cases  of  tumor, 
meningitis  and  uraemia. 

At  any  rate,  serious  manifestations  are  extremely  rare  and 
most  of  the  unpleasant  though  mild  symptoms  may  be  avoided 
by  keeping  in  mind  certain  facts:  Not  operate  on  elderly  per- 
sons and  the  least  possible  on  hysterical  women  (who  invari- 
ably complain  of  intolerable  headache  during  three  or  four 
weeks).  Patients  having  tabes  and  general  paresis  are  excel- 
lent subjects.  The  needle  should  be  of  fine  calibre,  so  as  to 
avoid  a  too  rapid  fall  in  the  intra-cranial  pressure.  The  fluid 
should  never  be  aspirated.  The  patient  should  remain  in  bed 
at  least  twenty-four  to  forty-eight  hours,  especially  if  symp- 
toms present  and  caffeine  and  other  cardiac  stimulants  may  be 
administered.  Particular  care  must  be  taken  in  cases  of  tumor 
and  especially  in  tumors  of  the  cerebellum,  where  strictest 
attention  should  be  paid  to  a  slow  removal  of  fluid,  so  as  to 
avoid  an  abrupt  relief  of  pressure  which  causes  intense  con- 


500  '  SCIENTIFIC  REVIEW 

gestion  ex-vacuo  with  subsequent  rapid  increase  of  intra- 
cranial tension  and  compression  of  the  nerve  centers.  In 
cerebral  abscess,  in  uraemia  and  in  cases  of  marked  arterio- 
sclerosis, the  same  precautions  should  be  taken. 

In  the  various  forms  of  meningitis,  but  especially  in  purulent 
meningitis,  lumbar  puncture  does  seem  beneficial  in  many- 
cases  and  good  results  have  been  reported  by  Rieken,  Jansen, 
Netter,  Nob^court  and  du  Pasquier,  Donath,  Cook,  Mathieu, 
Bauer  and  Mauban  and  many  others.  How  much  the  opera- 
tion accomplishes  in  effecting  a  cure  in  such  cases  and  might 
not  the  evolution  have  turned  favorably  without  intervention, 
are,  of  course,  legitimate  questions.  It  would  seem  that  in 
resistent  patients,  the  repeated  removal  of  moderate  quantities 
of  such  toxic  material,  would  appreciably  multiply  the  chances 
of  recovery.  The  procedure  is  least  valuable  in  tubercular 
meningitis.  Lumbar  puncture  should  certainly  be  resorted  to 
whenever  symptoms  of  compression  present  and  will  usually 
afford  relief.    This  palliative  effect  deserves  some  consideration. 

In  hydrocephalus,  lumbar  puncture  would  accomplish  more 
than  any  other  disease  according  to  many  authors  (Quincke, 
Ziemssen,  Lenhartz,  Goldscheider,  Peters,  Mya,  Concetti,  Chi- 
pault,  Oppenheim,  Brasch,  Henschen,  Seiffer,  Hirsch,  Gross, 
Pilcz,  etc.).  An  appreciable  and  even  a  lasting  amelioration 
has  been  observed.  It  relieves  the  headache,  gastric  disturb- 
ances and  convulsions  which  are  not  infrequent  and  is  particu- 
larly valuable  when  paralysis  of  the  ocular  muscles  and  visual 
disorders  due  to  an  optic  neuritis  are  present.  Under  such 
circumstances  the  operation  should  be  frequently  performed 
and  only  a  moderate  amount  of  fluid  removed  each  time. 

According  to  Milian,  lumbar  puncture  is  very  useful  in  the 
treatment  of  syphilitic  headache  and  is  particularly  effective  in 
the  headache  of  secondary  syphilis. 

In  inoperable  tumors  of  the  brain,  lumbar  puncture  often 
affords  much  relief  and  should  be  recommended  whenever  in- 
tense headache  and  visual  disturbances  occur.  It  is  well  known 
that  the  headache  of  cerebral  tumor  may  be  so  severe  as  to 
remain  uninfluenced  even  by  morphine  and  the  hypertension  of 
the  cerebro-spinal  fluid  invariably  present  can  be  considerably 
diminished  by  lumbar  puncture.  The  headache  will  then 
usually  disappear  at  least  in  great  part  and  the  chances  of  the 
optic  neuritis  and  atrophy  will  be  much  lessened. 


SCIENTIFIC  REVIEW 


These  facts  have  been  recently  brought  out  by  Babinski, 
Brissaud  and  Souques,  Widal  and  Digne  and  others.  In 
Widal's  case  the  tumor  was  situated  in  the  cerebellum  and  the 
results  of  the  puncture  were  most  satisfactory,  yet  it  cannot  be 
too  strongly  emphasized  that  of  all  tumors,  those  of  the  cere- 
bellum are  most  liable  to  cause  serious  accidents.  The  fourth 
ventricle  is  the  first  cerebral  cavity  affected  during  lumbar 
puncture  and  a  rapid  outflow  of  fluid  may  bring  about  the 
sudden  compression  of  the  vital  centers  beneath  its  floor  and 
lead  to  a  fatal  issue.  The  operation  rarely  presents  any  danger 
when  performed  for  the  relief  of  symptoms  caused  by  tumors 
situated  in  other  parts  of  the  brain. 

Charvet  and  Barcel  have  recently  reported  a  case  of  tumor 
of  the  frontal  lobe  in  which  visual  acuity  increased  fifty  per 
cent,  within  six  hours  after  the  removal  of  twenty  cubic  centi- 
meters of  the  fluid. 

The  nervous  complications  of  uraemia  have  been  materially 
helped  by  removing  fifteen  to  thirty  cubic  centimeters.  Deli- 
rium and  convulsions  disappeared  completely  after  two  lumbar 
punctures  in  the  case  published  by  Vigouroux. 

Merlin  and  Devaux  report  the  interesting  case  of  a  child  of 
four  years,  an  idiot  who  had  never  walked  and  who  suffered 
from  frequent  convulsive  seizures.  Lumbar  punctures  were 
performed,,  the  convulsions  gradually  disappeared  and  the 
child  has  begun  to  walk. 

Babinski  has  widely  used  lumbar  puncture  as  a  valuable 
therapeutic  procedure  in  diseases  of  the  ear,  especially  in  the 
treatment  of  vertigo. 

He  reports  the  following  results : 

(a)  Twenty-one  of  thirty-two  cases  of  vertigo  have  been 
greatly  improved  or  even  cured.  In  seven  cases  the  cure  had 
maintained  itself  six  months  later. 

(b)  Tinnitus  aurium  has  either  diminished  or  entirely  dis- 
appeared in  thirty  of  ninety  cases. 

(c)  Deafness  has  been  ameliorated  in  only  thirteen  cases  out 

of  IOO. 

Lumbar  puncture  acts  best  when  the  labyrinth  alone  is  in- 
volved. 

Lumineau,  Mignon  and  others  also  claim  to  have  obtained 
good  results. 

Bertolotti  reports  three  cases  of  whooping-cough  with  asso- 


502 


SCIENTIFIC  REVIEW 


ciated  nervous  manifestations  of  severe  type:  pupillary  inequal- 
ity, bradycardia,  and  violent  convulsions.  Lumbar  puncture 
brought  about  complete  cessation  of  the  symptoms  in  two  of 
the  three  cases. 

According  to  Devraigne,  the  removal  of  from  three  to  ten 
cubic  centimeters  of  cerebro-spinal  fluid  is  very  useful  in  the 
meningeal  hemorrhage  of  the  new-born. 

The  procedure  should  only  be  resorted  to  when  marked 
symptoms  occur,  such  as  cyanosis,  contracture,  convulsions 
and  coma.  The  operation  may  be  repeated  two  or  three  times 
if  necessary. 

Sub-arachnoidean  hemorrhage  is  also  an  indication  for  lum- 
bar puncture  and  very  good  results  have  been  obtained  by 
many  (Braillon). 

In  traumatism  and  fracture  of  the  skull,  lumbar  puncture 
has  acquired  much  vogue  in  Paris  within  the  last  three  years; 
it  has  been  extensively  employed  and  its  utility  has  been  recog- 
nized by  the  majority  of  French  surgeons. 

Quenu  has  reported  seven  cases  of  fracture  in  which  daily 
punctures  were  performed;  all  of  the  seven  cases  recovered. 
The  author  thinks  that  in  such  cases  the  hypertension  is  re- 
lieved and  the  amount  of  blood  re-absorbed  is  considerably 
diminished,  the  puncture  thus  doing  away  with  the  two  most 
important  factors  in  the  causation  of  coma  and  delirium. 
Potherat  has  also  reported  cases  where  a  cure  has  been  effected. 
Terrier,  Guinard,  Rochard,  Demoulin,  Boutier  and  many  others 
equally  approve  of  the  method  and  think  it  useful. 

La  Salle  Archambault. 


BIBLIOGRAPHY. 


Achard  et  Laubry. 
Bard. 


Bernheim  u.  Moser. 
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General  Considerations  and  Physical  Properties. 

Gazet.  hebdom.  de  med.  et  de  Chir.  April,  1902. 
Tonicity  du  liquide  c^phalo  rachidien.    Soc.  de  Biol., 

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Pouvoir  hdmolytique  du  liq.  c£ph.  rach.  Semaine 

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November  ix,  1903. 
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SCIENTIFIC  REVIEW 


503 


Charcot-Bouchard-Brissaud. 
Froin. 

Fuchs. 

Fuchs  u.  Rosenthal. 


Gaussel. 
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Leri. 

MlLIAN. 
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wollenberg. 
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Behring. 

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1902. 

Archives  de  Medecine,  April,  1902. 

Liquide  c6"ph.  rach.  hdmorrhagique.    Gazet.  hebd.  de 

mid.  et  de  Chir.,  August  7,  1902. 
Valeur  diagnostique  de  la  ponction  lombaire  dans  les 

heVnorrhagies  du  neVraxe,  Thise  de  Paris,  1902 
Ponction  lombaire  dans  tumeurs  c^rebrales.    Thise  de 

Lyon,  1904. 

Sulla  perdita  di  liquido  c^ph.  rach.,  etc.  Clinica 

Moderna,  April,  1904. 
Lehrbuch  der  Nervenkrankheiten,  Berlin,  1905. 
Practice  of  Medicine,  1905. 

Ueber  Lumbalpunction  in  Die  deutsche  Klinik,  etc., 

Vienna,  1902. 
Deutsch.  Archiv.  f.  Klinische  Med.  Bd.  LVI,  1895. 
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Chromo  diagnostic  du  liq.  cep>h.  rach.    Soc.  d.  Biol. 

November,  1901. 
Chromo  diagnostic  du  liq.  ceph.  rach.    Presse  med., 

January  25,  1902. 
Le  liquide  c^phalo  rachidien,  Paris,  1902. 
Clinical  Diagnosis. 

Technique  de  la  ponction  lombaire  dans  les  hemor- 
rhagies  rachidiennes.    Pres.  mid.,  March  5,  1902. 

Le  diagnostic  de  l'he'morrh.  me'ningee,  Pres.  mid., 
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August  20,  1900. 
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Chemistry. 

Choline :  A  new  method  of  testing  for  its  presence  in 
the  blood  and  cerebro  spinal  fluid.  Journ.  of 
Physiology,  Vol.  30,  1904. 

Allegmeine  Therapie  der  infect.  Krankheiten,  1900. 

Variations  du  sucre  du  sang  et  du  liq.  ceph.  rach. 
Soc.  de  Biol.,  February  13,  1904. 

Ueber  cerebro  spinale  Flussigkeit.  Ergebnisse  der 
Physiologee  Erste  Abteil.,  Weisbaden,  1902. 

Centralblatt  fur  Physiologie,  1900. 

La  clinica  medicale  italiana,  No.  38. 

The  chemical  findings  in  the  cerebro  spinal  fluid,  etc. 
American  Journ.  of  Insanity,  No.  4,  1904. 

Valeur  de  permeability  meningee  en  neurologie  in- 
fantile.   Reunion  biol.  de  Bordeaux,  December,  1904. 

Revue  de  Midecine.  1896. 

Chlorures  du  liq.  ceph.  rach.    Thise  de  Paris,  1901. 
Choline  in  der  Cerebro    spinalflussigkeit,    etc.,  in 

Hoppe-Seyler's  Zeitschr.  f.  Chemie,  Vol.  39,  1903. 

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Also  Medical  News,  New  York,  January  21  1905. 


So4 


SCIENTIFIC  REVIEW 


DONATH. 

Ducrot  et  Gautrelet. 

Geoghegan. 

Gilbert  et  Castaigne. 

GlLLARD. 

Garnier. 

Guillain  et  Parant. 
gumprecht. 

Griffon. 

Heubner. 
Jacob. 

v.  Jaksch. 
Kraus. 

Lannois  et  Boulud. 
v.  Leyden. 

v.  Leyden  u.  Blumenthal. 

Lewandowski. 

Milian  et  Legros. 

MONGOUR. 

Mott  and  Halliburton. 

Nawratzki. 
Nobecourt  et  Voisin. 

Pfaundler. 

Plott  and  Halliburton. 
Quincke. 

rosenfeld. 
schultze. 
Sicard  et  Brecy. 

SlCARD. 


Skoczynsky. 
Stintzing. 

TONELLO. 

Widal,  Sicard  et  Ravaut. 

Widal,  Sicard  et  Monod. 

Widal  et  Froin. 

Wilson. 

Wolf. 
Zambelli. 


Preuve  de  l'existence  de  la  choline  a  l'aide  du  micro- 
scope polarisant.    Rev.  Neurol.  No.  4,  1906. 

Le  liq.  ceph.  rach.  au  cours  de  l'ictere  experimental. 
Reunion  biol.  de  Bordeaux,  January,  1905. 

Zeutschr.  f.  physiol.  Chemie.  1-330. 

Pigments  biliares  dans  le  liq.  ceph.  rach.  Soc.  de 
Biol.,  August  20,  1900. 

"Le  sucre  rachidien."  Annates  mtdico-chirurgicales 
du  Centre.    November,  1904. 

Recherche  de  la  lipase  dans  le  liq.  ceph.  rach.  Reunion 
biol.  de  Nancy,  November,  1904. 

Rev.  Neurologique ,  April,  1903. 

Choline  in  der  normalen  u.  patholog.  Cerebrospinal 
Flussigkeit,  etc.  Verhandl.  d.  Kong.  f.  in.  Medizin, 
1900. 

Impermeability  des  meninges  a  l'iodure  de  potassium, 

etc.    Soc.  de  Biol.    March,  1901. 
Deutsche  med.  Wochenschr.  No.  47,  1899. 
Berliner  Klinische  Wochen.  No.  21,  1898. 
Deutsch.  med.  Wochen.  No.  3-4,  1900. 
Klinische  Diagnostik  in  Krankheiten,  5th  Edition. 
Zeitschr.  f.  Klinische  Medizin,  1900. 
Sur  la  teneur  en  sucre  du  liq.  ceph.  rach.  Rev- 

Neurol.  No.  10,  1904. 
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Biol.  March,  1901. 
Teneur  du  liq.  ceph.  rach.  en  pigments  biliaries. 

Reunion  biol.  de  Bordeaux,  November,  1904. 
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Les  chlorures  du  liq.  ceph.  rach.,  etc.  Rev.  Neurol- 
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Jahrbuch  f.  Kinderheilkunde ,  1899. 

Journ.  of  Physiology,  No.  22. 

Kongres.  f.  in.  Medizin,  Wiesbaden,  1891. 

Berlin  Klin.  Wochenschr.    1891  and  1895. 

Versamm.  d.  siid-west  deutsch.  Irrenaerzte,  1904. 

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Permeability  m^ning^e.    Soc.  mid.  hop.,  April,  1901., 

Perm^abilite"  m^ning^e.    Soc.  de  Biol,  December,  1902. 

Glycometrie  du  liq.  ceph.  rach.  Acad,  de  Medicine 
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Chemische  untersuchung  der  Spinal  flussigkeit.  Neurol 
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Mitteil.  aus  den  Crenzgebieten  der  Medizin  und  Chir- 
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1900. 

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SCIENTIFIC  REVIEW 


505 


Balfour. 

Brucb. 

Cook. 

Charcot-Bouchard-Brissard. 
Councilman,  Mallory  and  Wright 


Freyhan. 
furbringer. 


Gordon. 
Griffon. 

Griffon  et  Bezancon. 


GOnther. 
Guinon  et  Simon. 


Hartmann. 

Hautefeuille  et  Thery. 


Henkel. 
Heubner. 


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Jemma. 

Jaeger. 

Josias  et  Netter. 
Kronig. 

Labbe. 
Laederich. 

Lenhartz. 

LlCHTHEIM. 

Mya. 
Netter. 


NOBECOURT  et'DUPASQUIER. 

Oppenheim. 

OSLER. 

Park. 
Parkinson. 


Bacteriology. 

Trypanosomiasis   in   the   Anglo-Egyptian  Soudan. 

British  Medical  Journal,  November  26,  1904. 
Trypanosomes  and  Sleeping  Sickness  in  Uganda. 

Liverpool  Biol.  Soc,  February  12,  1904. 
Lumbar  puncture,  diagnostic  and  therapeutic  value 

New  York  Med.  Journal,  February  22,  1905. 
TraitS  de  Midecine,  Paris,  1904. 

"Epidemic  cerebro-spinal  meningitis  and  its  relation 

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Caracte"res  distinctifs  entre  le  meningocoque  et  le 
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Einfuhrung  in  das  Studium  der  Bacteriologie,  1898. 

Cyto  diagnostic  des  meningites,  Soc.  de  Pediatrie, 
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Wiener  Klinische  Wochenschr.  May,  1902. 

M^ningite  suppuree  causee  par  le  Micrococcus  tetra- 
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Ein  Fall  v.  geheilt.  meningites  tubercul.  Munch, 
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Zur  Aetiologie  und  Diagnose  der  epidem.  cerebro- 
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Rivista  di  clinica  pediatrica.    June,  1903. 

Epidem.  und  Bakteriologische  su  cer.  spin.  Meningitis. 
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Soc.  m6d.  d.  hopiteaux,  May  5,  1899. 

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XVII  Cong.  f.  in  Medizin,  Wiesbaden,  1899. 

La  m^ningite  ceVebro  spin.  Epidem.    Gaz.  d.  hop.,  1900. 

Leucocytose  c^ph.  rach.  tardive  dans  un  cas  de 
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Ueber  den  diag.  und  therap.  Werth  der  Lumbal- 
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Berline  Klinishe  Wochenschr.  No.  13,  1895. 

XIII  Cong,  internat.  de  Medecine,  Paris,  August,  1900. 

Diagnostic  de  la  mening.  cer£bro-spin.  Sem.  med., 
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Intervention  du  diplococcus  intracellularis,  etc.,  dans 
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XIII  Cong,  internat.  de  MSdecine,  Paris,  August,  1900. 

Soc.  de  Pidiatrie,  December  18,  1902. 

Lehrbuch  der  Nervenkrank.    Berlin,  1905. 

The  etiology  and  diagnosis  of  cerebro-spinal  menin- 
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Pathogenic  Bacteria,  etc.,  Philadelphia,  1905. 

A  case  of  post  basal  meningitis  due  to  the  Pneumo- 
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506 


SCIENTIFIC  REVIEW 


SacquEpee  et  Peltier. 
Schwarz. 

Stadelmann. 

Simon. 

Thursfield. 

Za.mbelli. 

ACHARD. 

Belin  et  Bauer. 

Brissaud  et  Sicard. 

Bernard. 

Brandbis. 

Chevasse  et  Mahu. 

Chaufpard  et  Froin. 

Clergier. 

Dana. 

Devaux. 

DOPTER. 

DUFLOS. 
DUFOUR. 

Dupr£  et  Devaux. 
Faure-Beaulieu. 

GOGGIA. 

Griffon. 

Guinon  et  Simon. 
Joffroy  et  Mercier. 

JOFFROY. 

de  Lapersonne. 

Laederich. 

Loeper  et  Crouzon. 

Maillard. 
Marie  et  Duflos. 

M  IL  IAN. 


Archiv.  gen.  de  Midecine,  May,  1901. 
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Verein  f.  in  Medizin,  Berlin,  1897. 
Ueber  spor.  epidem.  eitrige  Cerebro  spinal  menin. 

Zeitschr.  f.  Klinische  Med..  1899. 
Clinical  Diagnosis. 

Posterior  basilar  Meningitis.  Lancet,  February,  1901. 
77  Morgagni.    September,  1904. 

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No.  19,  1904. 
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Cytologic  du  liq.  c£ph.  rach.  dans  4  cas  de  zona. 
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Ponction  lombaire  dans  complications  endocraniennes 
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Reaction  m£ningee  dans  le  zona.  Soc.  mid.  hop., 
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Ponction  lombaire  chez  les  paralytiques  g^neYaux. 
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Cytodiagnosis.  Journal  of  nervous  and  mental  dis- 
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Lumbalpunction  u.  Cytodiagnose.    Centralbl.  f.  Ner- 

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1904. 

La  ponction  lombaire  en  psychiatric  Thise  de  Paris, 
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Soc.  midicale  des  hopitaux,  October  11,  1901. 
Meningite     sarcomateuse ;     cytologic     positive  et 

sp^ciale  du  liq.  ceph.  rach.    Rev.  Neurol.  No.  a, 

1904. 

Cytodiagnostic  dans  les  maladies  mentales.  Soc. 
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Gazetta  degli  ospedali  et  delle  Cliniche,  No.  13,  1905. 

Cytodiagnostic  des  m^ningites.  Soc.  d.  Biol.,  Janu- 
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Cytodiagnostic  des  meningites.  Soc.  de  Pediatrie, 
April,  1902. 

"De  l'utilite-  de  la  ponction  lombaire  pour  le  diag- 
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Grenoble,  1902. 

Soc.  mid.  d.  hdpitaux,  January,  1903. 

Examen  cytologique  dans  la  syphilis  oculaire,  Soc. 
de  Biol.,  January,  1903. 

Leucotytose  cephale-rachidienne  tardive,  etc.  Gazet. 
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Sarcomatose  du  liq.  c£ph.  rach.  Clinique  mid.  dt 
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Thise  de  Bordeaux,  1902. 

Congres  di  Grenoble,  1902. 

C^phalee  syphilitique  et  ponction  lombaire.  Tribune 
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SCIENTIFIC  REVIEW 


507 


MoiNDROT. 
MO  NOD. 

Nageotte. 

PlTRES. 

Ralliou. 
Ravaut. 

Ravaut  et  Darre. 
Salraz£s  et  Muratet. 

Seglas  et  Nageotte. 

SEPET. 
SlCARD. 

Sicard  et  Bouchaud. 

SlCARD. 
SlGXORELLI. 

schoenborn. 

Tremolieres. 

Voulcoff. 

Wentworth. 
Widal  et  Ravaut. 
Widal,  Sicard  et  Ravaut. 

Widal,  Sicard  et  Ravaut. 

Widal  et  Lemierr*. 

Widal  et  Lemierrb. 

Widal  et  Ravaut. 

Zambelli. 
Zambiresco. 


Le  liquide  ceph.  rach.  des  tabetiques.    Annales  de 

dermatologie ,  No.  7,  1903. 
Ponction  lombaire  dans  tumeurs  cerebrales.  Thise 

de  Lyon,  1904. 
Les  elements  figures  du  liq.  ceph.  rach.,  etc.  Soc. 

mid.  d.  hop.,  January,  1901. 
Remarque  sur  les  lesions  meningees,  etc.    Soc.  mid. 

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Lymphocitose  du  liq.  ceph.    rach.    dans  3  cas  de 

nevralgie  du  trijumeau.    Reunion  biol.  d.  Bordeaux, 

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De  la  lymphocytose  dans  le  zona.    These  de  Paris, 

1904. 

Le  liq.  ceph.  rach.  des  syphilitiques,    en  periode 

tertiaire    Annales  de  Dermatologie ,  No.  12,  1904. 
Le  liq.  ceph.  rach.  des  syphilitiques  en  periode  secon- 

daire.    Annales  de  Dermatologie,  No.  7,  1903. 
Contribution   a  l'etude   des   herpes   genitaux  etc. 

Annales  de  Dermatologie,  No.  6,  1904. 
Corps  granuleux  et  cellules  hematomacrophages  du 

liq.  c6ph.  rach.    Rev.  Neurol,  No.  21,  1904. 
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16,  1905. 

Cytodiagnostic  du  liq.  ceph.  rach.  dans  les  maladies 
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Cyto  et  Sero  diagnostic  d'une  meningite  guerie.  Mar- 
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Le  liquide  cephalo-rachidien,  Paris,  1902. 

Syphilides  zoniformes  tertiaires,  etc.  Soc.  mid.  d. 
hop,  Oct.,  1003. 

Nevralgie  du  trijumeau  et  ponction  lombaire.  Soc. 
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Un  cas  d'oreillons  avec  zona  du  triiumeau,  etc. 
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Archives  latines  de  Mid.  et  de  Biol.  Madrid,  October, 
1903. 

Die  Diagnose  des  liquors  Cerebro  Spinalis.  Archiv. 

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Le   diagnostic  de  la  meningite   tuberculeuse,  etc. 

Gaz.  d.  hops,  November,  1903. 
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paralysie  generale.    Thise  de  Montpellier,  1904. 
Boston  Medical  and  Surgical  Journal,  No.  7,  1896. 
Congris  internat.  de  Paris,  August,  1900. 
Cytodiagnostic   de  la  meningite  tuberculeuse.  Soc. 

de  Biol,  October  13.  1900. 
Histologic  du  liq.  c£ph.  rach.  au  cours  des  proces. 

meninges  chroniques.    Soc.  mid.  d.  hop.,  January, 

1901. 

Cytologic  du  liq.,  ceph.  rach.  cours  des  poussees 

congestives  de  la  paralysie  generale.    Soc.  mid.  d. 

hap,  July,  1902. 
Lymphocitose  dans  l'hemiplegie  syphilitique.  ~  Soc. 

mid.  d.  hop.  May,  1903- 
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Pathol,  gen.  de  Bouchard,  Vol.  6,  1903. 
//  Morgagni,  September,  190a. 

Liq.  ceph.  rach.  dans  2  cas  de  zona.  Soc.  d  Scienct 
med.  de  Bucarest,  1904. 


5o8 


SCIENTIFIC  REVIEW 


Abadie. 

Agatson. 


Babinski. 


Bier. 

BOKEY. 
BOUTIER. 

Braun. 
Bertolotti. 
Clergier. 

Charcot,  Bouchard  et  Brissaud 
Charvet  et  Barcel. 

Chauffard  et  Boidin. 

Chipault. 

Concetti. 

Cook. 

Chevasse  et  Mahu. 
Devraigne. 


Donath. 

GOLDON. 

Goldscheider. 
Jaboulay. 

KOHTS. 

Legrain  et  Guyard. 
Lenhartz: 

Legendre. 
V.  Leyden. 

LlCHTHEIM. 

Lumineau. 

Marfan. 
Marian. 

Marie  et  Guillain. 
Masing. 


Therapeutic  indications  for  lumbar  puncture. 

Semaine  Midicale,  December,  1902. 

Case  of  cerebro-spinal   meningitis,   etc;  recovery. 

N.  Y.  Med.  Journal,  February  4,  1905. 
Sur  la  ponction  lombaire  contre  la  c^phalee"  des 

Brightiques.    Soc.  mid.  d.  hop,  1901. 
Annales  des  maladies  de  I'oreille,  February,  1902. 
Traitement  des  affections  auriculaires,  etc.    Soc.  m. 

hdp,  April  24,  1903. 
Sur  le  traitement  des  affections  de  I'oreille  et  en 
particulier    du    vertige    auriculaire.    Annales  d. 
mal.  de  I'oreille,  February,  1904. 
Weitere  Mitteilungen  uber  Ruckenmark  Anaesthesie. 

Archiv.  f.    Klin.  Chirurgie,  Bd.  64,  1901. 
Ueber   den   iWerth    der    Systematischen  Lumbal 
punction    bei     Hydrocephalus,     etc.    Jahrb.  f. 
Kinderhilk,  1903. 
Sur  la  valeur  de  la  ponction  lombaire  dans  le  diag- 
nostic, le  pronostic  et  le  traitement  des  fractures  de 
la  base  du  crane.    These  de  Paris,  March.  1902. 
Die  locale  Anaesthesie,  etc.    Leipzig,  1905. 
Gazetta  medica  italiana.    An.  LVI,  No.  7,  1905. 
Ponction  lombaire  chez  les  paralytiques  geneYaux. 

These  de  Paris,  1905. 
Traiti  de  Medecine,  Paris,  1904. 

Gliome   volumnieaux   du  lobe   frontal,   etc.  Lyon 

Medical,  April  10,  1904. 
Ponction  lombaire  dans  un  service  hospitalier.  Gaz. 

d.  hdp.  June  28,  1904. 
La  ponction  lombosacr^e;    utility  diag.  et  therap. 

Acad.  d.  Mid.,  April,  1897. 
La  ponction  lombaire  dans  la  pratique  infantile, 
Paris,  1899. 

Lumbar  puncture;   value  in  diagnosis,  etc.    N.  Y. 

Med.  Jour.,  February,  1905. 
Ponction  lombaire  dans  le  traitement  des  complica- 
tions   endocraniennes    des    otites.    Presse  mid., 
No.  4,  1903- 

Valeur  diagnotique,  pronostique  et  therapeutique  de 
ponction   lombaire   chez   le    norneau-ne\  Press 
med.,  No.  65,  1905. 
Wiener  med.  Wochenschr,  No.  49,  1903. 
American  Medicine,  1902. 
Cong.  f.  in.  Medizin,  Wiesbaden,  1896. 
Injections  m^dicinales  dans  le  liq.  c£ph.  rach.  Lyon 

Medical,  August  4,  1901. 
Ueber    Lumbal    punction    bei    Kindern.  Therap. 

Monatschr,  No.  n,  1900. 
Progris  Medical,  October,  1903. 

Ueber  den  diag.  u  therap.  Werth  der  Lumbal  punct. 

Cong.  f.  in.  Medizin,  Wiesbaden,  1896. 
Soc.  med.  d.  hdpitaux.    May,  1901. 
Gesel.  der  Chariie  Aerzte,  January,  1900. 
Deutsche  med.  Wochenschr,  1893. 

De  la  ponction  lombaire  dans  le  traitement  des  troubles 

auditifs.    These  de  Paris,  1903. 
Presse  medicale,  September  8,  1895. 
Chirurgie  du  Systeme  merveux,  Paris,  1905. 
Soc.  med.  d.  hdpitaux,  May,  1901. 

Zur  Anvendung  der  Lumbal  punction  bei  Hirntu- 
moren.    St.  Petersburgh  med.  Wochen,  No.  1,  1904. 


SCIENTIFIC  REVIEW 


509 


Mathibu. 

Merlin  et  Devaux. 
Mignon. 

MlLIAN. 

Mikulicz. 
Maystre. 
Netter. 

Oppenheim. 
Parkinson. 

PlLLAGOT. 

Potherat. 

Quenu. 

Quincke. 

ROCHARD. 

Seiffert. 

SlCARD. 

Thursfield. 
Tretrop. 

Tuffier-Hallion. 

VlGOUROUX. 


Wertheimer. 

WlDAL  et  DlGNE. 


Ziemssen. 


Contribution  a  l'^tude  de  la  ponction  lombaire  dans 
les  differents  proces,  m^ning^s.  These  de  Lyon, 
1904. 

Ponction  lombaire  dans  un  cas  d'idiotie,  etc.  Gazet. 

d.  hop.,  No.  57.  May  18,  1905. 
Contribution   a  l'etude   des  affections  auriculaires 

traitees    par    la    ponction    lombaire.    Thtse  dt 

Bordeaux,  1904. 
Le   liq.    c^ph.    rach.    des   tab^tiques.    Annales  de 

Dermatologie ,  etc.,  No.  7.  1903- 
C^phalee  Syphilitique  et  ponction  lombaire.  Tribune 

mid.,  November,  1903 • 
Methoden  der  Smerz-Betaubung.    Deutsche  Gesell.  f. 

Chirurgie,  Bd.  II,  1901. 
Des  accidents  de  la  ponction  lombaire.    Thise  de 

Montpellier,  July,  1903. 
Meningite  cerebro-spinale  prolonged ;  bons  effets  de  la 

ponction  lomb.  Soc.  we'd.  d.  hop.,  August,  1899. 
Curabilite  de  la  meningite  cerebro-spinale  suppuree 

etc.    Soc.  mid.  d.  hop.,  1900. 
Lehrbuch  der  Ncrvenkrankheiten,  Berlin,  1905. 
Post-basal  meningitis,  etc;   recovery.    British  Jour- 
nal of  Children's  Disease,  Vol.  I,  1904. 
Resultats  therapeutiques  obtenus  par   la  ponction 

lombaire.    Thise  de  Paris,  1900. 
Sur  la  valeur  therapeutique  de  la  ponction  lombaire 

dans  les  fractures  du  crane.    Soc.  de  Chirurgie, 

November,  1905. 
De  la  valeur  theVap.  de  la  ponct.  lomb.  dans  les 

fractures  du  crane.    Soc.  de  Chirurgie,  October, 

1905- 

Ueber  Hydrocephalus.  X.  Cong.  f.  in.  Med.,  Wies- 
baden, 1891. 

Ueber  Meningitis  Serosa.  |(a)  Samml.  Klin.  Vortr., 
No.  67,  1893;  (b)  Deutsche  Zeitsche  f.  Nervenheilk, 
1896.  Die  Technik  der  Lumbal  ponction,  Vienna, 
1902. 

De  la  ponction  lombaire  comme  moyen  de  traitement 

des  accidents  cons^cutifs  aux  fractures  du  crane. 

Presse  med.,  April,  1902. 
Anvendung    der     Lumbalpunction    bei  Uraemie. 

Munchener  med.  Wochen,  No.  10.  1904. 
Les   injections   sous  arachnoidiennes   et   le  liquide 

c^phalo-rachidien.    Thise  de  Paris,  1900. 
Posterior  basilar  meningitis.    Lancet,  February,  1901. 
Resultats  personnels  du  traitement  des  vertiges,  etc. 

Assemblee  des  Specialistes  Beiges,  Bruxelles,  1904. 
L'Analgesie  Chirurgicale  par  voie  rachidienne.  Paris, 

1901. 

Delire  hallucinatoire  survenu  chez  un  Brightique 
am&iore'  par  des  ponctions  lombaires.  Annales 
medico-psychologiques,  November,  1903. 

Munchener  med.  Wochen,  June,  1904. 

Tumeur  du  cervelet,  symptoms  d'hypertension 
calmed  par  les  ponctions  lombaires.  Revue  Neurol, 
No.  21,  1904. 

Ueber  den  diag.  u.  therap.  Werth  der  Punktion  de- 
Wirbelkanals.  XII.  Cong.  f.  in.  Med.  Wiess 
baden,  1893. 


6 


PUBLIC  HEALTH 


Public  fbealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 


Department 

of  Health — City 

OF  AL 

BANY,  N. 

Y. 

Abstract 

of  Vital  Statistics,  May,  1906. 

Deaths. 

1902 

1906 

20 

18 

2 1 

18 

Typhoid  fever  

2 

0 

0 

Measles  

0 

O 

A 

4 

7 

I 

O 

0 

2 

I 

O 

0 

Diphtheria  and  Croup.  . 

  5 

3 

O 

3 

0 

7 

I 

0 

0 

i5 

18 

10 

8 

3 

3 

r 

7 

  8 

10 

16 

5 

19 

Apoplexy  

  8 

9 

2 

8 

1 2 

Cancer  

  9 

7 

7 

6 

14 

Accidents  and  violence. . 

  13 

5 

13 

1 1 

3 

Seventy  years  and  over. 

  24 

28 

23 

25 

32 

10 

13 

8 

12 

  166 

i5i 

144 

146 

i59 

  19-53 

17.77 

16.94  16.31 

18.71 

16.00  15.04 

16.94 

Deaths  in  Institutions. 

1902  1903         1904  1906  1906 


Resi- 

Non- 
resi- 

Resi- 

Non- 
resi- 

Resi- 

Non- 
resi- 

Resi- 

Non- 
resi- 

Resi- 

Non- 
resi- 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

dent 

8 

6 

6 

2 

6 

8 

1  r 

5 

1 1 

9 

Albany  Orphan  Asylum  

I 

0 

2 

0 

I 

O 

1 

2 

0 

0 

Child's  Hospital  

0 

0 

O 

0 

I 

O 

2 

0 

0 

0 

County  House  

3 

0 

3 

0 

5 

O 

4 

0 

5 

2 

0 

0 

2 

0 

1 

O 

0 

0 

0 

0 

Friendless  Home  

0 

0 

1 

0 

0 

O 

3 

1 

1 

0 

Homeopathic  Hospital  

2 

0 

1 

2 

0 

O 

0 

0 

1 

1 

Hospital  for  Incurables  

0 

1 

0 

O 

0 

O 

1 

0 

0 

0 

Little  Sisters  of  the  Poor  

0 

1 

0 

I 

1 

O 

0 

0 

3 

0 

0 

0 

0 

0 

0 

O 

0 

0 

0 

0 

St.  Margaret's  Home  

0 

0 

1 

0 

2 

O 

1 

2 

0 

0 

St.  Peter's  Hospital  

0 

0 

0 

0 

2 

O 

5 

2 

3 

3 

St.  Frances  De  Sayles  Or- 

1 

1 

0 

0 

0 

O 

1 

0 

0 

0 

4 

0 

0 

0 

0 

O 

0 

0 

0 

0 

PUBLIC  HEALTH  511 

Births..   46 

Marriages   28 

Stillbirths   8 

Premature  births  ,   3 

Bureau  of  Contagious  Diseases. 
Cases  Reported. 

1902  1903  1904  1905  1906 

Typhoid  fever                                                    7        2        1        1  3 

Scarlet  fever                                                    10      13      15       8  19 

Diphtheria  and  croup                                        22      23        1       8  18 

Chicken  pox                                                        22      19        3        2  o 

Measles                                                            29    168      21    129  3 

Whooping-cough                                                2        1       o       o  3 

Consumption                                                     1        2       4       o  3 

Total                                                        93    228      45    140  49 


Contagious  Disease  in  Relation  to  Public  Schools. 

Reported  Deaths 
D.    S.  P.  D  SP 

Public  School  No.  1   7 

Public  School  No.  2   1 

Public  School  No.  5   1 

Public  School  No.  7  

Public  School  No.  11  

Public  School  No.  15   1 

Public  School  No.  17  

Public  School  No.  21  

Public  School  No.  22   1 

High  School  

St.  John's  School   2 

Miss  Cooper's   1 

Fumigations : 

Houses                                    3    Rooms   64 

Cases  of  diphtheria  reported   18 

Cases  of  diphtheria  in  which  antitoxin  was  used   15 

Cases  in  which  antitoxin  was  not  used   3 

Deaths  after  use  of  antitoxin   o 

Bureau  of  Plumbing,  Drainage  and  Ventilation. 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  two 
hundred  thirty-nine  inspections  made  of  which  one  hundred  ninety-one 
were  of  old  buildings  and  forty-eight  of  new  buildings.  There  were  fifty- 
three  iron  drains  laid,  eighteen  connections  with  street  sewers,  twenty-one 
tile  drains,  thirteen  urinals,  forty-three  cesspools,  one  hundred  twenty-five 


SOCIETY  PROCEEDINGS 


wash  basins,  seventy-eight  sinks,  ninety-six  bath  tubs,  fifty-seven  wash 
trays,  ten  trap  hoppers  in  yard,  one  hundred  fifty-five  tank  closets,  one 
slop  hopper,  one  stable  wash  stand,  one  shower  bath.  There  were  one 
hundred  thirty-six  permits  issued,  of  which  ninety-seven  were  for  plumb- 
ing and  thirty-nine  for  building  purposes.  There  were  twenty-eight 
plans  submitted  of  which  eleven  were  of  old  buildings  and  seventeen  of 
new  buildings.  There  were  four  houses  tested  on  complaint,  two  with  the 
blue,  red  and  two  with  peppermint.  There  were  ten  water  tests  made 
and  there  were  forty-two  houses  examined  on  complaint.  There  were 
one  hundred  twenty-three  reinspections  of  the  same  and  twenty-four  com- 
plaints were  found  to  be  valid  and  eighteen  were  without  cause. 


Society  proceeMngs 

Medical  Society  of  the  County  of  Albany. 

A  regular  meeting  of  the  Medical  Society  of  the  County  of  Albany  was 
held  in  the  Albany  Medical  College,  April  n,  1906.  The  meeting  was 
called  to  order  by  the  president  at  8.55  p.  m.  There  were  present  Doctors 
Bedell,  Bielby,  Baldauf,  Curtis,  Cook,  George,  Hinman,  Jenkins,  Laird, 
Lempe,  Lomax,  Moore,  C.  H.,  O'Leary,  Papen,  Sr.,  Rooney  and  Wiltse. 

Dr.  Curtis  read  the  report  of  the  Committee  on  Revision  of  the  By- 
Laws. 

Dr.  Rooney  moved  that  the  by-laws  be  presented  to  the  annual  meeting 
for  adoption.    Seconded  and  carried. 

The  Secretary  read  the  applications  for  membership  of  Doctors  Vines, 
Filkins  and  Silcocks,  which  were  ordered  referred  to  the  Board  of  Censors. 

Dr.  Hinman  then  read  his  paper  upon  the  Diagnosis  of  Adenoids,  which 
will  be  published  in  the  Annals. 

Dr.  Jenkins  said  that  he  had  been  surprised  at  the  frequent  presence 
of  adenoids  in  young  children.  He  said  that  he  knew  of  nothing  worse 
than  a  child  with  this  condition.  He  said  that  these  cases  were  those  in 
which  brilliant  results  might  be  frequently  obtained  by  prompt  operative 
intervention.  He  felt  that  the  subject  was  one  which  demanded  the 
very  careful  attention  of  the  general  practitioner. 

Dr.  Wiltse  said  that  he  knew  of  no  other  operation  which  gave  better 
results  than  this  operation  for  adenoids ;  he  had  seen  the  whole  character 
of  a  child  changed  remarkably  in  this  manner. 

Dr.  Curtis  said  that  he  hoped  it  would  not  seem  to  the  writer  of  the 
paper  that  the  society  did  not  appreciate  the  importance  of  his  contribu- 
tion because  of  the  slightness  of  discussion.  He  felt  that  it  was  simply 
due  to  the  fact  that  the  field  had  been  so  thoroughly  covered  by  the  writer 
that  the  matter  practically  precluded  discussion. 

Dr.  Rooney  then  read  his  paper  on  Enteroptosis  with  a  summary  of  one 
hundred  and  eighty-two  cases. 


SOCIETY  PROCEEDINGS 


513 


Dr.  Lempe  said  he  had  had  quite  a  little  experience  in  women  with 
enteroptosis ;  the  symptoms  were  in  many  cases  very  deceptive  and  the 
disease  very  rebellious  to  treatment. 

Dr.  Lomax  questioned  the  manner  in  which  perineal  lacerations  would 
prove  to  be  a  factor  in  the  causation  of  enteroptosis.  It  seemed  to  him, 
from  study  of  the  abdominal  cavity,  that  the  point  of  pressure  was  rather 
against  the  anterior  abdominal  wall  than  in  the  perinaeum  and  at  the 
same  time,  the  pelvic  cavity  being  so  completely  filled  with  the  genital 
apparatus  in  women  prevented  the  displacement  of  the  abdominal 
organs  simply  by  a  weakening  of  the  pelvic  floor. 

Dr.  Cook  said  that  one  of  the  most  interesting  things  that  he  had  heard 
at  a  recent  medical  society  meeting  was,  that  these  different  displacements 
were  caused  by  relaxation  of  the  perineal  musculature. 

Dr.  Beilby  said  that  it  had  seemed  to  him  that  the  condition  of  lacerated 
perinaeum  might  be  explained  by  the  descent  of  the  pelvic  viscera,  giving 
place  to  the  abdominal  viscera.  When  the  pelvic  viscera  are  displaced, 
the  abdominal  organs  prolapse.  He  referred  to  the  treatment  of  gastrop- 
tosis  by  the  operation  of  gastroplication. 

On  motion  the  society  adjourned. 

James  F.  Roon'ey,  Secretary. 


The  annual  meeting  of  the  Medical  Society  of  the  County  of  Albany 
was  held  in  the  Albany  Medical  College,  May  8,  1906,  at  8.30  p.  if.;  the 
president  in  the  chair.  Present:  Doctors  Adt,  Baldauf,  Bristol,  Bedell, 
Ball,  Blair,  Blessing,  Craig,  Curtis,  Cox,  J.,  Capron,  Carroll,  Classen, 
Cook,  Davis,  C.  E.,  Dawes,  Devoe,  Filkins,  George,  W.  H.,  Giffen, 
Gutman,  Griffin,  E.  G.,  Hale,  W.  S.,  Happel,  Hinman,  Holding,  Hacker, 
Jenkins,  Joslin,  Keens,  Lempe,  Laird,  Lewi,  Lochner,  Lomax,  Lipes, 
Lanahan,  J.  A..  Leavy,  Moston,  Mosher,  Mereness,  Moore,  C.  H.,  McGar- 
rahan,  McHarg,  McKenna,  Munson,  Neuman,  O'Leary,  Jr.,  Perry, 
Papen,  Sr.,  Root,  Rooney,  Sabin,  Sampson,  Sautter,  Schutter,  Sheldon, 
Steenberg,  Stevenson,  Stillman,  Theisen,  Traver,  Trego,  Vander  Veer, 
E.  A.  Van  Rensselaer,  Van  Slyke,  Vines,  Ward,  Winne,  C.  K., 
Winne,  L.  B.  Washburn,  Wiltse. 

Dr.  Lipes  moved  that  the  reading  of  the  minutes  be  dispensed  with. 
Seconded  and  carried. 

Dr.  Curtis  made  the  final  report  of  the  Committee  on  Revision  of  the 
By-Laws. 

Dr.  Ward  moved  that  the  report  of  the  committee  be  received  and 
accepted  and  the  committee  discharged.    Seconded  and  carried. 

Dr.  Ball  moved  to  amend  Chapter  2,  §  3,  of  the  recently  adopted 
by-laws,  to  read  as  follows:  "Initaition  fee  shall  be  three  dollars,  which 
shall  cover  the  county  dues  for  the  current  year."  Seconded. 

Dr.  Neuman-  said  that  it  seemed  to  him  that  the  initiation  fee  should 
not  be  reduced  from  five  dollars  to  two  dollars ;  if  we  cut  down  our  receipts 
it  would  be  impossible  to  give  any  social  character  to  the  future  meetings 


5M 


SOCIETY  PROCEEDINGS 


of  the  society,  as  had  been  anticipated.  It  seemed  to  him  that  this  subject 
should  be  very  carefully  considered. 

Dr.  Ball  then  moved  that  the  by-laws  as  revised  by  the  committee  be 
adopted  by  the  society,  with  the  exception  that  the  chapter  which  he  had 
moved  to  amend,  making  the  initiation  fee  three  dollars,  be  changed  to 
read:  "The  initiation  fee  shall  be  five  dollars,  which  shall  cover  the  state 
dues  for  the  current  year,"  at  the  same  time  withdrawing  his  former 
amendment.    Seconded  and  carried. 

Dr.  Root  reported  on  behalf  of  the  Legislative  Committee.  He  felt 
that  it  might  be  known  to  many  of  the  members  present  what  a  difficult 
year  this  had  been  concerning  legislation  on  medical  subjects;  but  he  also 
felt  that  many  of  the  members  did  not  and  could  not  appreciate  the 
amount  of  work  which  was  necessitated  by  every  local  committee  and  also 
by  the  committee  from  the  State  Society.  The  year  had  been  one  of 
the  most  trying  in  the  eleven  years  that  he  had  served  upon  the  legislative 
committee;  the  crop  of  special  bills,  legislating  into  the  profession  men 
entirely  unfitted  for  its  duties;  special  bills  for  the  licensing  of  men  in 
special  subjects  which  were  purely  medical,  and  bills  to  endeavor  to 
destroy  the  present  enactments,  had  been  large.  Two  of  these  bills  very 
narrowly  failed  of  passage.  It  was  thought  that  last  year's  fight  against 
the  osteopaths  was  a  serious  one,  when  the  bill  failed  of  passage  in  the 
senate  by  only  one  vote.  This  year  the  bill  actually  passed  the  senate 
and  in  the  assembly  was  referred  to  the  committee  on  public  health  where, 
fortunately  and  with  much  labor,  it  was  kept  until  the  end  of  the  term. 
At  the  end  of  the  term,  all  bills  lying  in  special  committees  are  referred  to 
the  committe  on  rules  and  here  this  bill  remained  until  the  session  was 
closed.  The  optometry  bill  was  only  at  one  time  in  danger  of  passing  and 
this  danger  was  caused  by  the  inactivity  of  the  profession  throughout  the 
state.  In  fact ;  the  greatest  danger  which  we  meet  is  the  passiveness  of  the 
the  profession  in  matters  which  directly  interest  it.  If  from  all  parts  of 
the  State  physicians  manifest  their  opposition  to  any  measure,  that  opposi- 
tion will  be  completely  effective. 

One  bill  was  reported  from  the  committee  on  public  health  which  would 
solve  the  entire  difficulty.  This  bill  gives  the  most  explicit,  concise  and 
exclusive  definition  of  the  practice  of  medicine  and,  at  the  same  time, 
provides  for  one  State  board  of  examiners,  who  are  to  be  appointed  by  the 
Regents,  which  shall  be  composed  of  nine  members,  and  before  this  State 
board  shall  come  all  applicants  for  medical  licensure,  whether  regular, 
homeopathic  or  eclectic.  This  bill  also  failed  of  passage  because  of  the 
inactivity  of  professional  support  and  at  the  same  time  because  of  opposi- 
tion on  the  part  of  the  homeopaths  and  eclectics.  The  bill,  however, 
will  be  re-introduced  at  the  next  session  and  it  is  trusted  that  the  profes- 
sion will  become  sufficiently  alive  to  the  importance  of  this  matter,  and  by 
their  support  secure  its  enactment.  He  also  recommended  that  this 
society  place  itself  on  record  in  favor  of  this  bill  and  advocating  its  passage. 

Dr.  Ball  moved  the  adoption  of  Dr.  Root's  report  and  also  the  adoption 
of  his  recommendation.    Seconded  and  carried.  |§g 


SOCIETY  PROCEEDINGS 


515 


The  Secretary  reported  that  the  Board  of  Censors  had  favorably  con- 
sidered the  applications  of  Doctors  Silcocks,  Vines,  Filkins  and  Devoe. 

Dr.  Cook  moved  that  the  secretary  cast  one  ballot  for  the  election  of 
these  men  as  members  of  the  society.    Seconded  and  carried. 

The  Secretary  declared  the  ballot  cast  and  the  president  declared 
Doctors  Silcocks,  Vines,  Filkins  and  Devoe  elected  members. 

Dr.  Cook  moved  that  the  city  make  some  provision  for  bacteriological 
examinations  of  material  from  patients  too  poor  to  pay  the  cost  of  such 
examinations.  He  said  that  other  cities  did  this,  and  he  didn't  know  why 
Albany  should  not  do  the  same. 

Dr.  Craig  said  that,  for  some  time  past,  the  city  had  given  the  profes- 
sion the  privilege  of  sending  sputum  from  suspected  cases  of  tuberculosis 
to  the  laboratory  for  examination,  the  cost  of  which  was  a  city  charge. 
He  felt,  also,  that  a  large  number  of  the  profession  were  aware  of  this  and 
he  knew  that  many  had  taken  advantage  of  it. 

Dr.  Cook  said  that  he,  for  one,  did  not  know  this  and,  in  fact,  in  several 
instances  had  received  bills  from  the  laboratory  for  examinations  of  this 
sort,  which  he  himself  had  paid. 

Dr.  Laird  said  that,  although  not  now  officially  connected  with  the 
laboratory,  he  knew  that  in  Dr.  Blumer's  time  the  city  had  made  provision 
for  sputum  examinations  and  the  reason  that  Dr.  Cook  received  the  bills 
was,  that  it  was  customary  for  the  laboratory  to  send  out  bills  in  all  in- 
stances and  only  when  the  physician  reported  inability  to  pay  was  the  bill 
made  a  city  charge. 

Dr.  Ward  moved  that  the  matter  be  referred  to  a  committee  of  three, 
of  which  Dr.  Craig  and  Dr.  Cook  should  be  two.    Seconded  and  carried. 

The  President  named  Dr.  Ball  as  the  third  member  of  this  committee. 

Dr.  Ball  moved  that  five  hundred  copies  of  the  revised  by-laws  be 
printed,  for  the  use  of  the  members  of  the  society.  Seconded. 

Dr.  MacFarlane  moved  to  amend,  that  the  secretary  be  directed  to 
mail  a  copy  to  each  member  of  the  society.  The  amendment  was  accepted 
and  the  motion  carried  as  amended. 

Dr.  Mosher  moved  that  a  committee  of  five  be  appointed  to  consider 
the  expediency  of  changing  the  mode  of  electing  officers.  It  seemed  to 
him  that  nominations  should  be  made  in  advance;  so  that  the  society 
could  contemplate  carefully  the  men  who  were  to  be  elected.  He  also 
moved  that  all  elections  should  be  had  by  printed  ballot,  mailed  in  ad- 
vance of  the  annual  meeting  to  each  member,  who  could  then  return  the 
marked  ballot,  to  be  deposited  at  the  poll.  The  motion  was  seconded 
and  carried. 

The  President  appointed  on  such  committee  Doctors  Mosher,  Ward, 
Craig,  E.  A.  Vander  Veer  and  Curtis. 

The  Secretary  read  a  communication  from  the  Kings  County  Medical 
Society  in  reference  to  their  means  of  raising  funds  for  the  men  in  the  pro- 
fession_who  had  lost  everything  in  San  Francisco. 


SOCIETY  PROCEEDINGS 


Dr.  Theisen  moved  that  the  society  start  a  subscription  for  the  mem- 
bers of  our  profession  who  have  suffered  loss  in  the  disaster.  Seconded. 

Dr.  MacFarlane  said  that  several  former  members  of  our  society  had 
suffered,  among  whom  he  mentioned  Dr.  Blumer  and  Dr.  Lartigau,  who 
had  lost  everything. 

Dr.  Rooney  moved  that  the  secretary  send  out  subscription  blanks 
to  each  member  of  the  society  and  that  the  treasurer  be  empowered  to 
receive  contributions,  which  should  be  forwarded  to  the  treasurer  of  the 
San  Francisco  County  Society.    Seconded  and  carried. 

The  President  then  read  his  annual  address. 

Dr.  MacFarlane  moved  that  the  thanks  of  the  society  be  extended  to 
Dr.  Wiltse  and  that  a  copy  of  his  address  be  requested  for  publication  in 
the  Annals.    Seconded  and  carried. 

Dr.  Rooney  moved  that  a  committee  of  three  be  appointed  to  audit 
the  treasurer's  report.    Seconded  and  carried. 

The  President  appointed  as  such  committee  Dr.  Washburn,  Dr.  L.  B. 
Winne  and  Dr.  C.  E.  Davis. 

Dr.  Curtis  spoke  of  the  conflicting  interests  of  some  of  the  private 
societies  in  detracting  from  the  attendance  at  the  meetings  of  the  county 
society.  While  he  felt  that  these  were  advisable  and  necessary,  it  seemed 
to  him,  however,  that  they  should  be  subsidiary  to  the  county  society. 
He  felt  that  much  was  needed  to  stimulate  interest  in  the  meetings  of  the 
county  society  and  that  the  burden  of  this  would  better  fall  on  one  of  the 
younger  men.  For  this  reason,  he  took  great  pleasure  in  nominating  for 
president  of  the  society  Dr.  G.  G.  Lempe.    Nomination  seconded. 

Dr.  Mosher  said  that  there  was  one  member  of  the  society  who  was 
one  of  the  older  members  and  who  had  not  yet  served  in  the  office  of  presi- 
dent. He  felt  that  the  older  men  should  at  least  have  the  opportunity  of 
enjoying  the  presidency  of  the  society.  He  then  presented  the  name  of 
Dr.  Case,  of  Slingerlands,  which  was  seconded. 

The  Secretary  moved  that  the  President  appoint  two  tellers  to  conduct 
the  ballot.    Seconded  and  carried. 

The  President  appointed  Doctors  Mosher  and  Craig. 

Balloting  was  then  had  and  the  tellers  announced  the  result  of  the  bal- 
lot; Dr.  Lempe,  35;  Dr.  Case,  19. 

The  President  then  declared  Dr.  Lempe  elected  president  for  the  ensuing 
year. 

Dr.  Neuman  nominated  for  the  office  of  Vice-President  Dr.  Montmarquet 
of  Cohoes.    Nomination  seconded.    Nominations  closed. 

Dr.  Craig  moved  that  the  secretary  cast  one  ballot  for  Dr.  Montmarquet 
for  Vice-President.    Seconded  and  carried. 

The  Secretary  declared  the  ballot  cast  and  the  president  declared  Dr. 
Montmarquet  elected  Vice-President  for  the  ensuing  year. 

Dr.  Traver  proposed  for  the  office  of  Secretary  the  present  incumbent. 

Dr.  Rooney  declined. 


MEDICAL  NEWS 


517 


Dr.  Rooney  then  proposed  the  name  of  Dr.  A.  T.  Laird  for  Secretary. 
Nomination  seconded.    Nominations  closed. 

Dr.  George  moved  that  the  Secretary  cast  one  ballot  for  Dr.  Laird  for 
Secretary.    Seconded  and  carried. 

The  Secretary  declared  the  ballot  so  cast  and  the  president  declared 
Dr.  A.  T.  Laird  elected  secretary  for  the  ensuing  year. 

Dr.  Root  proposed  for  treasurer  the  name  of  Dr.  W.  H.  George.  Nom- 
ination seconded.    Nominations  closed. 

Dr.  Neuman  moved  that  the  secretary  cast  one  ballot  with  the  name 
of  Dr.  George  for  treasurer.    Seconded  and  carried. 

The  Secretary  declared  the  ballot  so  cast  and  the  president  declared 
Dr.  W.  H.  George  elected  treasurer  for  the  ensuing  year. 

For  censors  there  were  nominated  Dr.  S.  B.  Ward,  Dr.  H.  E.  Mereness, 
Dr.  A.  Vander  Veer,  Dr.  Hinman,  Dr.  Craig,  Dr.  Neuman,  who  declined, 
Dr.  Curtis,  Dr.  Traver.  Dr.  Archambault,  Dr.  Lomax,  Dr.  Moston,  Dr. 
Mosher  and  Dr.  Carroll.  . 

The  tellers  reported  as  the  result  of  the  ballot  that  the  five  highest 
number  of  ballots  cast  were  for  Doctors  Ward,  Curtis,  Craig,  Vander 
Veer  and  Mereness  and  they  were  declared  elected. 

The  committee  appointed  to  audit  the  treasurer's  report  reported  the 
accounts  correct. 

The  Secretary  moved  that  the  report  of  the  committee  be  accepted 
and  the  committee  discharged.    Seconded  and  carried. 

On  motion  the  society  adjourned. 

James  F.  Rooney,  Secretary. 


/fceMcal  "Hews 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick. — Statistics  for  May, 
1906.  Numberof  new  cases,  104;  Classified  as  follows :  Dispensary  patients 
receiving  home  care,  1 ;  district  cases  reported  by  the  health  physicians,  7  ; 
charity  cases  reported  by  other  physicians,  64 ;  patients  of  limited  means, 
32;  old  cases  still  under  treatment,  49;  total  number  of  patients  under 
nursing  care  during  the  month,  153.  Classification  of  diseases  (new  cases) : 
Medical,  21 ;  surgical,  8;  gynecological,  3.  Obstetrical  work  of  the  Guild 
— 33  mothers  and  32  infants  under  professional  care;  eye  and  ear,  1; 
skin,  2. 

Special  Obstetrical  Department. — Number  of  obstetricians  in  charge  of 
cases,  2;  attending  obstetricians,  1;  medical  students  in  attendance,  4; 
Guild  nurses,  6;  patients,  3;  number  of  visits  by  head  obstetrician,  20; 
by  attending  obstetricians,  1 ;  by  the  medical  students,  9 ;  by  the  Guild 
nurses,  30.    Total  number  of  visits  for  this  department,  60. 


Si8 


MEDICAL  NEWS 


Visits  of  Guild  Nurses  (all  departments) :  Number  of  visits  with  nursing 
treatment,  1,019;  for  professional  supervision  of  convalescents,  180; 
total  number  of  visits,  1,199.  Six  graduate  nurses  and  6  assistant  nurses 
were  on  duty.  Cases  were  reported  to  the  Guild  by  three  of  the  health 
physicians  and  by  35  other  physicians  and  by  1  dentist. 

Examination  for  the  Medical  Corps  of  the  Army  —  A 
preliminary  examination  of  applicants  for  appointment  in  the 
Medical  Corps  of  the  Army  will  be  held  at  various  military  posts  through- 
out the  United  States  on  July  31,  1906.  Full  information  in  regard 
thereto  may  be  obtained  from  the  Surgeon  General  of  the  Army,  and 
applications  must  be  filed  prior  to  June  30.  Thirty  years  is  the  pre- 
scribed maximum  age,  and  persons  whose  age  exceeds  that  limit  are  not 
eligible  for  examination. 

United  StatesCivil  Service  Examination — Hospital  Interne  (Male). 
Examination  for  Panama  Canal.  The  United  States  Civil  Service  Com- 
mission announces  an  examination  on  July  5-6,  1906,  to  secure 
eligibles  from  which  to  make  certification  to  fill  vacancies  in  the  posi- 
tion of  hospital  interne  (male)  under  the  Isthmian  Canal  Commission,  on 
the  Isthmus  of  Panama,  as  they  may  occur. 

As  an  insufficient  number  of  eligibles  to  meet  the  needs  of  the  service 
resulted  from  the  examination  held  on  December  6-7,  1905,  for  this  posi- 
tion, qualified  persons  are  urged  to  enter  this  examination. 

Men  only  will  be  admitted  to  this  examination,  for  which  two  days 
will  be  required. 

Each  applicant  for  the  Isthmian  Canal  Service  will  be  required  to 
submit  to  the  examiner,  on  the  day  he  is  examined,  a  recent  photograph 
of  himself,  taken  within  three  years,  which  will  be  filed  with  his  examina- 
tion papers,  as  a  means  of  identification  in  case  he  receives  appointment. 

An  unmounted  photograph  is  preferred.  The  date,  place,  and  name  of 
examination,  the  examination  number,  the  competitor's  name,  and  the 
year  in  which  the  photograph  was  taken  should  be  indicated  on  the 
photograph. 

Age  limit,  20  to  30  years  on  the  date  of  the  examination;  salary,  $100 
per  month,  with  quarters,  but  without  board  and  washing. 

Only  graduates  of  reputable  medical  schools  having  not  less  than  a 
three  years'  course  will  be  admitted  to  this  examination. 

The  examination  will  consist  of  the  subjects  mentioned  below,  weighted 
as  indicated: 

1  Letter-writing  (the  subject-matter  on  a  topic  relative  to  the  practice 
of  medicine) ,  5  ;  2  Anatomy  and  physiology  (general  questions  on  anatomy 
and  physiology,  and  histologic  or  minute  anatomy),  10;  3  Chemistry, 
materia  medica,  and  therapeutics  (elementary  questions  in  inorganic 
and  organic  chemistry;  the  physiological  action  and  therapeutic  uses 
and  doses  of  drugs),  15;  4  Surgery  and  surgical  pathology  (general 
surgery,  surgical  diagnosis;  the  pathology  of  surgical  diseases),  20;  5 
General  pathology  and  practice  (the  symptomatology,  etiology,  diagnosis, 
pathology,  and  treatment  of  disease),  25;  6  Bacteriology  and  hygiene 
(bacteriologic  methods,  especially  those  relating  to  diagnosis;  the  appli- 


MEDICAL  NEWS  519 

cation  of  hygienic  methods  and  prophylaxis  and  treatment),  15;  7 
Obstetrics  and  gynecology  (the  general  practice  of  obstetrics;  diseases  of 
women,  their  pathology,  diagnosis,  symptoms,  and  treatment,  medical 
and  surgical),  10.    Total,  100. 

This  examination  is  open  to  all  male  citizens  of  the  United  States 
who  comply  with  the  requirements. 

.  The  county  officer's  certificate  in  the  application  form  need  not  be 
executed.  No  person  will  be  appointed  for  service  on  the  Isthmus  who 
is  not  physically  sound  and  in  good  health.  Persons  appointed  to  posi- 
tions under  the  Isthmian  Canal  Commission  will  be  expected  to  proceed 
promptly  to  the  Isthmus.  Persons  examined  for  positions  under  the 
Commission  will  not  be  eligible,  as  the  result  of  such  examination,  to 
positions  in  the  United  States  or  Philippine  services. 

Applicants  should  at  once  apply  either  to  the  United  States  Civil 
Service  Commission,  Washington,  D.  C,  or  to  the  secretary  of  the  board 
of  examiners  at  anyplace  mentioned  in  the  accompanying  list, for  applica- 
tion Form  13 1 2.  The  medical  certificate  in  form  13 12  must  be  filled 
in  by  a  reputable  practicing  physician.  No  application  will  be  accepted 
unless  properly  executed  and  filed  with  the  Commission  at  Washington. 
In  applying  for  this  examination  the  exact  title  as  given  at  the  head  of 
this  announcement  should  be  used  in  the  application. 

As  examination  papers  are  shipped  direct  from  the  Commission  to 
the  places  of  examination,  it  is  necessary  that  applications  be  received 
in  ample  time  to  arrange  for  the  examination  desired  at  the  place  indi- 
cated by  the  applicant.  The  Commission  will  therefore  arrange  to  ex- 
amine any  applicant  whose  application  is  received  in  time  to  permit  the 
shipment  of  the  necessary  papers. 

The  United  States  Civil  Service  Commission  announces  the  post- 
ponement to  July  5-6,  1906  (in  view  of  the  small  number  of  applications 
filed),  of  the  examination  scheduled  for  June  6-7,  to  secure  eligibles 
from  which  to  make  certification  to  fill  at  least  two  vacancies,  at  $600 
per  annum  each,  with  maintenance,  in  the  position  of  medical  interne, 
Government  Hospital  for  the  Insane,  Washington,  D.  C,  and  vacancies 
as  they  may  occur  in  any  branch  of  the  service  requiring  similar  quali- 
fications. 

The  Department  states  that  it  reserves  the  right  to  continue  or  terminate 
appointment  at  the  end  of  one  year,  or  to  promote  the  appointee  at  the 
expiration  of  that  length  of  service. 

The  examination  will  consist  of  the  subjects  mentioned  below,  weighted 
as  indicated : 

1  Letter-writing  (the  subject-matter  on  a  topic  relative  to  the  practice 
of  medicine),  5  ;  2  anatomy  and  physiology  (general  questions  on  anatomy 
and  physiology,  and  histologic  or  minute  anatomy),  15;  3  Chemistry, 
materia  medica,  and  therapeutics  (elementary  questions  in  inorganic  and 
organic  chemistry ;  the  physiological  action  and  therapeutic  uses  and 
doses  of  drugs),  10;  4  Surgery  and  surgical  pathology  (general  surgery, 
surgical  diagnosis;  the  pathology  of  surgical  diseases),  20;  5  General 
pathology  and  practice  (the  symptomatology,  etiology,  diagnosis,  path- 


520 


MEDICAL  NEWS 


ology,  and  treatment  of  disease),  25;  6  Bacteriology  and  hygiene  (bac- 
teriologic  methods,  especially  those  relating  to  diagnosis;  the  application 
of  hygienic  methods  and  phrophylaxis  and  treatment),  10;  7  Obstetrics 
and  gynecology  (the  general  practice  of  obstetrics;  diseases  of  women, 
their  pathology,  diagnosis,  symptoms,  and  treatment,  medical  and 
surgical),  15.    Total,  100. 

Two  days  will  be  required  for  this  examination.  Men  only  will  be 
admitted. 

Age  limit,  20  years  or  over  on  the  date  of  the  examination. 

This  examination  is  open  to  all  male  citizens  of  the  United  States  who 
comply  with  the  requirements. 

Applicants  must  indicate  in  answer  to  question  15  of  the  application 
form,  that  they  are  graduates  of  reputable  medical  colleges. 

Applicants  should  at  once  apply  either  to  the  United  States  Civil 
Service  Commission,  Washington,  D.  C,  or  to  the  secretary  of  the  board 
of  examiners  at  any  place  mentioned  in  the  accompanying  list,  for  applica- 
tion Form  1 3 1 2 .  No  application  will  be  accepted  unless  properly  executed 
and  filed  with  the  Commission  at  Washington.  In  applying  for  this 
examination  the  exact  title  as  given  at  the  head  of  this  announcement 
should  be  used  in  the  application. 

As  examination  papers  are  shipped  direct  from  the  Commission  to  the 
places  of  examination,  it  is  necessary  that  applications  be  received  in 
ample  time  to  arrange  for  the  examination  desired  at  the  place  indicated 
by  the  applicant.  The  Commission  will  therefore  arrange  to  examine  any 
applicant  whose  application  is  received  in  time  to  permit  the  shipment  of 
the  necessary  papers. 

The  New  Harvard  Medical  School — Invitations  have  been  issued 
by  the  president  and  fellows  of  Harvard  College  and  the  Faculty  of 
Medicine  to  the  dedication  of  the  new  buildings  of  the  Harvard  Medical 
School  on  Tuesday  afternoon  and  Wednesday  morning,  September  25th, 
and  26th,  1906. 

The  Quarterly  Journal  of  Inebriety — The  office  of  publication 
of  the  Journal  of  Inebriety,  of  which  Dr.  T.  D.  Crothers  is  editor  and 
secretary,  has  been  transferred  from  Hartford  to  Boston,  at  194  Boylston 
street. 

Personal. — Dr.  George  S.  Munson  (A.  M.  C,  1880)  announces  that 
his  office  is  closed  from  June  20th  to  September  15,  1906,  owing  to  his 
absence  in  Europe. 

— Dr.  Whittlesey  D.  Lester  (A.  M.  C,  1899)  is  in  practice  at  Indian 
Fields,  Albany  County,  N.  Y. 

— Dr.  John  E.  Canfield  (A.  M.  C,  1903)  is  in  practice  at  Herkimer, 
N.  Y. 


Death. — Dr.  George  W.  Draper  (A.  M.  C,  1858)  died  at  Syracuse, 
N.  Y.,  June  8,  1906,  aged  seventy-three  years. 


IN   MEMORI AM  521 


In  flDemoriam 

Isaac  G.  Wheeler,  M.  D. 

Dr.  Isaac  G.  Wheeler,  one  of  the  oldest  physicians  of  Buffalo,  died  at  his 
home,  346  Fargo  avenue,  May  22,  1906,  at  theageof  seventy-three  years. 
Dr.  Wheeler  was  active  in  his  practice  until  a  week  before  his  death,  when 
he  was  seized  with  his  last  illness. 

Isaac  G.  Wheeler  was  born  in  Buffalo  in  1832.  His  father  was  Isaac 
Wheeler,  one  of  the  early  settlers  in  that  vicinity,  and  both  father  and  son 
spent  the  greater  part  of  their  lives  in  this  city.  As  a  young  man  Dr. 
Wheeler  chose  the  profession  with  which  he  was  always  identified,  'and 
graduated  from  the  Albany  Medical  College  with  the  class  of  1874.  He 
returned  to  his  home  and  built  up  an  extensive  practice.  Of  late  years 
he  had  not  been  as  active  as  formerly  on  account  of  failing  health,  but  he 
had  always  kept  his  office  and  continued  his  work. 

Dr.  Wheeler  was  at  one  time  active  among  the  Masonic  orders  of  Buffalo 
and  was  also  a  member  of  the  A.  O.  U.  W. 

Beside  his  immediate  family  Dr.  Wheeler  is  survived  by  two  brothers, 
William  F.  and  Alger  M.  Wheeler,  and  a  sister,  Mrs.  Frank  Catlin  of  Ore- 
gon. His  wife,  now  deceased,  was  Cornelia  B.  Noye,  who  was  also  of  one  of 
the  old  families  of  Buffalo. 

James  E.  Kelley,  M.  D. 

Dr.  James  E.  Kelley,  one  of  the  active  physicians  of  Saratoga,  died  at 
his  home  in  that  village  on  May  14,  1906.  Death  resulted  from  a  com- 
plication of  diseases  and  followed  an  illness  of  five  months.  Dr.  Kelley 
was  first  stricken  in  the  winter,  but  recovered  from  that  illness  partially. 
The  improvement  was  only  temporary,  and  for  the  last  two  weeks  of  his 
life  he  failed  rapidly.    He  was  forty-two  years  of  age. 

Dr.  Kelley  was  a  man  of  varied  talents.  After  his  graduation  from  the 
Schuylerville  High  school,  he  studied  law  in  the  office  of  Delcour  S.  Potter, 
and  was  admitted  to  the  bar.  He  also  was  at  one  time  a  student  at  Union 
College.  Instead  of  continuing  in  the  legal  profession,  Mr.  Kelley  taught 
school  for  a  while,  then  began  the  study  of  medicine  and  graduated  from 
the  Albany  Medical  College  in  190 1.  He  began  practice  in  Schuylerville 
and  returned  to  Saratoga  about  three  years  before  his  death. 

Besides  his  widow  and  two  children,  Dr.  Kelley  is  survived  by  his 
mother,  Mrs.  Ann  Kelley  of  Schuylerville;  two  sisters  and  one  brother, 
Dr.  C.  D.  Kelley  of  Mt.  Vernon,  N.  Y. 


522 


CURRENT   MEDICAL  LITERATURE 


Current  ADeDlcal  Xlteraturc 

REVIEWS  AITD  NOTICES  OP  BOOKS 

A  Treatise  on  Surgery.  In  two  volumes.  By  George  R.  Fowler,  M.  D., 
Examiner  in  Surgery,  Board  of  Medical  Examiners  of  the  Regents  of 
the  University  of  the  State  of  New  York;  Emeritus  Professor  of 
Surgery  in  the  New  York  Polyclinic,  etc.  Two  imperial  octavos  of 
725  pages  each,  with  888  text  illustrations  and  4  colored  plates,  all 
original.  Philadelphia  and  London:  W.  B.  Saunders  Company, 
1906.    Per  set:  Cloth,  $15.00  net;  half  morocco,  $17.00  net. 

"In  presenting  anew  work  on  surgery  the  author  has  endeavored  to 
bring  together  the  most  recent  and  improved  methods  of  surgical  practice 
and  with  the  aid  of  numerous  cross  references,  to  arrange  these  in  a  form 
readily  available  to  the  student  and  practitioner.  As  a  necessary  pre- 
liminary to  this,  the  so-called  art  of  surgery,  the  effort  has  been  made  to 
set  forth  the  fundamental  principles  underlying  what  is  known  as  the 
science  of  surgery  in  both  an  interesting  and  instructive  manner.  "  The 
above  is  the  opening  paragraph  to  the  preface  of  Dr.  Fowler's  "A  Treatise 
on  Surgery. ' ' 

The  work  is  in  two  volumes  and  is  divided  into  two  parts.  Part  I  is 
devoted  to  General  Surgery  and  Part  II  to  Regional  Surgery. 

In  common  with  most  works  on  Surgery  the  first  subject  to  be  con- 
sidered is  that  of  Inflammation,  but  the  arrangement  of  the  topics  dis- 
cussed under  that  head  differs  from  that  of  the  usual  text-book  in 
such  a  manner  as  to  merit  special  attention. 

Inflammation,  as  viewed  from  the  surgical  standpoint,  is  that  series  of 
changes  in  the  tissues  which  takes  place  as  the  result  of  injury  plus  in- 
fection. In  the  absence  of  infection  and  during  the  repair  of  an  injury, 
however,  the  processes  considered  are  histologically  identical  with  those 
concerned  in  inflammation.  But  the  differences  in  degree  and  extent  are 
such  as  to  stamp  the  one  as  a  pathologic  process  and  the  other  as  a  physio- 
logic process.  The  study  of  the  phenomena  will  therefore  naturally  com- 
mence with  the  injury  itself.  The  first  topic  to  be  taken  up  is,  therefore, 
Wounds. 

Writing  of  the  symptoms  of  wounds  the  author  says :"  Contused  wounds 
are  the  most  painful  of  injuries.  Individual  temperament  may  also 
modify  the  amount  of  pain.  Courageous  persons  and  those  in  a  ferocious 
rage,  on  the  one  hand,  and  those  exercising  a  quiet  self-control  on  the  other, 
suffer  the  least,  for  these  conditions  act  as  restraining  influences  on  the 
sensory  cortical  centers." 

Healing  by  primary  and  secondary  intention  are  described,  after  which 
the  Histology  of  the  Healing  Process  is  discussed  at  some  length. 

Inflammation  in  General  is  the  next  general  topic.  Here  the  various 
forms  of  inflammation  such  as  exudative,  suppurative  and  gangrenous, 
phlegmonous  and  granulating  are  discussed.  This  is  followed  by  the 
Etiology  of  Inflammation,  under  which  head  the  subject  of  Surgical 
Bacteriology  is  taken  up. 

General  Diagnosis  of  Inflammation,  Termination  and  Prognosis  of 


CURRENT  MEDICAL  LITERATURE 


523 


Inflammation  and  Surgical  Fever,  are  the  next  topics  to  be  considered  and 
in  the  order  named.  The  last  topic  in  the  section  is  the  Treatment  of 
Inflammation  and  here,  very  appropriately,  under  the  head  of  Preventive 
Treatment,  are  discussed  the  various  methods  of  modern  aseptic  operative 
technic. 

Section  II  treats  of  the  Injuries  and  Diseases  of  Separate  Tissues. 

Section  III,  Gunshot  Injuries,  is  up  to  date  and  is  profusely  illustrated 
with  photographs  of  cases  observed  in  the  Russian-Japanese  war. 

Section  IV  discusses  Acute  Wound  Diseases  such  as  septicaemia, 
pyemia,  tetanus,  hydrophobia,  etc. 

Section  V  takes  up  the  Chronic  Surgical  Infections,  syphilis,  tubercu- 
losis, etc.  In  the  treatment  of  tuberculosis  of  the  extremities,  mention 
is  made  of  Bier's  method  of  treatment  by  chronic  passive  congestion.  The 
method  of  application  of  the  treatment  is  well  shown  by  a  photograph. 

Section  VI  is  devoted  to  Tumors.  The  various  types  of  tumors  are 
discussed  in  a  hasty  manner,  very  little  pathological  anatomy  is  given 
and  some  very  poor  histological  drawings  are  added,  making  this  section 
one  of  the  least  useful  in  the  book. 

Section  VII  on  Laboratory  Aids  in  Surgical  Diagnosis  and  Prognosis 
treats  of  a  subject  which  is  daily  becoming  of  more  interest  and  importance 
The  author  seems  to  fully  appreciate  the  important  bearing  of  this  subject 
to  Surgery.  "Successful  surgery  demands  prompt  and  accurate  diagnosis 
and  to  this  end  laboratory  examinations  frequently  offer  conclusive  proof 
on  corroborative  evidence  of  much  value.  With  the  great  advances 
in  surgical  skill  and  the  consequent  improved  statistics  of  surgical  pro- 
cedure, the  question  of  prognosis  has  also  become  more  important,  and 
laboratory  aids  form  no  mean  part  in  reaching  conclusions  in  this  regard. 
The  brilliant  outcome  of  laboratory  diagnostic  methods  in  some  cases 
may  lead  the  novice  to  attempt  to  make  a  definite  diagnosis  with  the 
microscope  and  test  tube  at  the  expense  of  clinical  methods.  This  is  a 
grave  error — the  diagnosis  must  be  made  at  the  bed-side,  and  the  results 
of  laboratory  works  considered  for  what  experience  teaches  they  are  worth, 
just  as  the  clinical  signs  and  symptoms  are  considered."  The  important 
laboratory  aids  to  diagnosis  are  presented  in  a  concise  and  interesting 
manner.  The  gross  examination  of  pathological  specimens  and  their 
preservation  is  discussed.  The  importance  of  careful  histological  ex- 
amination is  emphasized ;  special  mention  being  made  of  the  rapidity  and 
accuracy  that  may  be  obtained  by  the  use  of  frozen  sections.  The 
clinical  significance  of  blood  changes  is  carefully  taken  up. 

The  attitude  of  the  modern  surgeon  toward  the  subject  of  urine  ex- 
amination is  summed  up  in  the  author's  opening  paragraph  on  that  topic: 
"In  consequence  of  the  increased  value  of  this  procedure  during  late 
years,  its  technic  has  undergone  change  and  improvement.  At  one  time 
the  clinician  believed  that,  when  he  had  found  the  specific  gravity,  had 
tested  the  urine  for  albumin  and  sugar,  and  had  made  a  hasty  micro- 
scopic examination  of  the  sediment,  he  had  exhausted  all  practical  in- 
formation to  be  obtained  from  this  complex  fluid.  To-day  an  examination 
of  this  kind  is  not  considered  sufficiently  exhaustive  to  meet  the  exacting 
demands  of  the  expert  diagnostician."    There  follows  a  discussion  of  the 


524 


CURRENT  MEDICAL  LITERATURE 


newer  methods  of  examining  urine  including  cryoscopy,  induction  of 
artificial  glycosuria,  etc. 

Section  VIII  has  for  its  topic  Surgical  Operations  in  General. 

Section  IX,  Surgical  Anaesthesia,  discusses  the  various  anaesthetics,  the 
methods  of  administration,  dangers,  etc.  Scant  space  is  given  to  local 
anaesthesia  and  spinal  anaesthesia;  most  valuable  and  recent  work  along 
which  lines  has  been  carried  out  in  Bier's  clinic. 

Section  X  takes  up  the  General  Principles  of  Operative  Technic. 

Section  XI  treats  of  the  Operations  on  Individual  Structures.  Writing 
of  the  transplantation  of  nerves  the  author  makes  the  statement  that  the 
implantation  of  completely  separated  portions  of  nerves  has  never  been 
successful  in  man.    Recent  work  has,  of  course,  disproved  this  statement. 

Section  XII  is  on  Foreign  Bodies. 

Section  XIII,  the  last  section  of  part  I,  is  devoted  to  bandaging. 

There  are  three  more  sections  in  the  first  volume,  but  these  come  under 
the  head  of  Part  II,  Regional  Surgery.  The  sections  are  as  follows:  Sec- 
tion XIV,  Surgery  of  the  Head;  Section  XV,  Surgery  of  the  Neck;  Section 
XVI,  Surgery  of  the  Thorax. 

Such  is  a  very  brief  outline  of  the  first  volume  of  Dr.  Fowler's  surgery. 
The  author  has  called  his  book  "A  Treatise  on  Surgery."  He  does  not 
claim  for  it  a  complete  surgery  or  a  text-book  of  surgery.  The  chief 
criticism  is,  that  in  a  work  of  this  character,  certain  sections  must  of 
necessity  be  slighted.  The  sketchy  character  of  the  work  cannot  but  be 
noted  at  times.  There  is  a  marked  absence  of  surgical  anatomy  and  sur- 
gical pathology.  Many  of  the  new  fields  in  Surgery  receive  but  scant 
notice;  such  for  example,  as  the  surgery  of  the  heart  and  lungs  and  the 
surgery  of  the  nervous  system  and  brain. 

The  object  of  the  book  as  set  forth  in  the  above  mentioned  preface 
would  seem  to  have  been  carried  out  for  the  most  part.  The  subject 
matter  has  certainly  been  presented  in  an  interesting  and  instructive 
manner.  The  field  of  surgical  publications  would  seem  to  be  already  well 
covered,  but  this  work  justifies  itself  by  the  fact  that  it  has  a  distinct 
individuality.  This  individuality  is  shown  first,  in  the  logical  grouping 
of  topics,  differing  from  that  usually  employed,  and  second,  in  the  illustra- 
tions. The  illustrations  are  numerous,  well  chosen  and  well-produced. 
They  are  all  new.  It  is  a  great  relief  not  to  find  reproduced  the  old 
classical  pictures  which  have  been  handed  down  from  author  to  author 
from  time  immemorial.  The  book  is  printed  on  good  paper  with  clear 
type.  Altogether  this  is  a  work  of  merit  and  one  which  should  be  wel- 
comed alike  by  student,  the  practitioner  and  the  specialist.       j.  m.  b. 


A  Text-Book  of  Diseases  of  Women.  By  Barton  Cooke  Hirst,  M.  D. 
Second  edition,  rewritten  and  enlarged  with  701  illustrations,  many 
of  them  in  colors.  Philadelphia:  W.  B.  Saunders  &  Company, 
Publishers,  1905. 

It  must  be  admitted  that  there  is  need  for  authoritative  works  in 
gynecological  pathology  and  the  diagnosis  of  gynecological  conditions, 
and  also  on  the  treatment,  both  operative  and  otherwise,  of  these  con- 


CURRENT  MEDICAL  LITERATURE 


525 


ditions.  On  the  other  hand  there  are  too  many  text-books  in  which 
there  is  an  attempt  made  to  cover  the  entire  subject  in  one  treatise  and 
which  the  author  apparently  feels  that  he  must  write  not  because  he 
has  anything  new  to  present,  but  because  his  position  in  some  institu- 
tion demands  it.  Consequently  additions  to  this  already  over-crowded 
field,  by  new  text-books  or  the  resurrection  of  previous  ones  by  new 
editions,  is  not  welcome,  unless  it  be  the  question  of  the  u  survival  of  the 
fittest." 

The  present  volume  of  741  pages  and  701  illustrations  represents  a 
second  edition  in  which  there  has  been  added  to  the  previous  one, 
fifty-seven  pages  of  text;  and  thirty  of  the  old  illustrations  have  been 
removed  and  forty-seven  new  ones  introduced. 

The  first  part  is  devoted  to  gyn ecological  examinations  and  local  treat- 
ment: then  follows  in  succession,  consideration  of  the  anomalies  of 
development,  diseases  of  the  vulva,  vagina,  uterus,  tubes,  ovaries,  pelvic 
connective  tissues,  urinary  tract  and  finally  a  chapter  on  the  technique 
of  gynecological  surgery.  The  volume  is  compact  and  the  subject  matter 
well  arranged  and  indexed.  The  illustrations  in  most  instances  show 
what  the  author  wishes  to  emphasize,  the  photographs  being  especially 
instructive  while  some  of  the  others  are  not  quite  so  good. 

On  the  whole  this  text-book  is  one  of  the  best  of  its  class  and  for 
this  reason  can  be  recommended. 

J.  A.  S. 


A  Treatise  on  the  Diseases  of  Infancy  and  Childhood.  For  Students  and 
Physicians.  By  Henry  Koplik.  M.  D.,  Pediatrist  to  Mt.  Sinai 
Hospital,  Ex-President  American  Pediatric  Society,  etc.,  New  York. 
New  (second)  edition.  Revised  and  enlarged  in  text  and  illustra- 
tions. .  Octavo,  868  pages,  1S4  engravings  and  33  plates.  Cloth, 
$5.00;  Leather,  $6.00,  net.  Lea  Brothers  &  Co.,  Publishers,  Phila- 
delphia and  New  York,  1905. 

The  interest  of  the  medical  profession  towards  the  diseases  and  con- 
ditions peculiar  to  childhood  is  shown  by  the  increasing  number  of 
books  on  the  subject  and  by  the  frequent  appearance  of  new  books  already 
published.  The  first  edition  of  the  volume  before  us  came  out  only  four 
years  ago.  The  present  edition  has  been  thoroughly  revised  and  in 
places  entirely  rewritten  so  that  we  find  a  new  friend  with  face  and 
raiment  that  are  familiar.  It  contains  two  hundred  and  ten  additional 
pages  and  many  new  illustrations.  The  arrangement  of  the  chapters 
has  been  changed  into  a  more  satisfactory  and  systematic  order.  The 
author  shows  that  he  has  profited  by  the  criticisms  invoked  by  the  first 
edition  and  he  has  been  thorough,  painstaking,  and  conscientious  in 
this  new  edition  which  has  resulted  in  a  volume  creditable  to  American 
pediatrics. 

The  first  section  on  the  hygiene  of  infancy  and  childhood  contains 
thirty  more  pages  than  in  the  previous  edition  and  the  chapter  devoted 
to  the  methods  of  examination  is  especially  to  be  commended.  The 
section  on  infant  feeding  is  entirelv  new.    No  division  of  pediatrics 
7 


526 


CURRENT  MEDICAL  LITERATURE 


exceeds  in  importance  that  of  infant  feeding  and  the  author  has  pre- 
sented the  subject  in  a  concise,  scientific  and  thorough  manner.  The 
principles  underlying  the  processes  of  nutrition  and  metabolism  in  the 
young  infant  are  first  discussed  before  entering  upon  the  food  question. 
The  author  has  utilized  the  researches  of  the  most  recent  German  and 
French  writers,  such  as  Czerny  and  Keller  and  Marfan,  thereby  giving 
the  American  student  the  benefit  of  their  studies.  Proprietary  infants' 
foods  are  described  but  advised  to  be  used  only  as  a  temporary  makeshift 
or  to  be  added  to  milk  in  order  to  aid  its  assimilation.  The  section 
on  diseases  of  the  newborn  is  more  complete.  A  description  of  congenital 
anomalies,  mortality  and  sudden  death  in  the  newborn,  peritonitis  of  the 
newborn,  haemorrhage  in  the  newborn,  mastitis,  and  caking  of  the  breasts 
has  been  added  in  this  edition. 

Acute  articular  rheumatism  is  now  classed  under  the  specific  infectious 
diseases. 

Scrofula  or  scrofulosis  is  described  as  a  distinct  disease  and  defined 
as  a  constitutional  dyscrasia  occurring  in  childhood  characterized  by 
enlargement  of  the  lymph  nodes  and  slow  sluggish  inflammation  of  the 
numerous  membranes,  skin,  joints  and  bones.  He  recognizes  three  forms, 
the  pyogenic,  tuberculous,  and  mixed.  All  other  modern  American  writers 
include  scrofula  under  the  head  of  tuberculosis. 

The  section  of  diseases  of  the  skin  is  disappointing  and  unsatisfactory. 
Only  ten  pages'  are  devoted  to  all  the  very  important  and  common 
skin  affections  so  frequently  met  with  in  children. 

Particular  mention  should  be  made  of  the  index  which  is  very  satis- 
factory.   Its  completeness  necessitates  thirty-six  pages. 

This  new  edition  of  Koplik  is  a  book  that  should  be  in  the  library  of 
every  progressive  medical  man  and  it  is  a  work  that  will  be  frequently 
consulted.  h.  l.  k.  s. 


The  Operating  Room  and  the  Patient.  By  Russell  S.  Fowler,  M.  D. 
Surgeon  to  the  German  Hospital,  Brooklyn,  N.  Y.  Octavo  of  172 
pages,  fully  illustrated.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1906.    Cloth  $2.00  net, 

This  is  a  work  designed  for  the  use  of  surgeons,  nurses  assisting  at  an 
operation,  hospital  internes  and  for  all  others  whose  duties  bring 
them  into  the  operating  room.  In  a  book  comprising  one  hundred  and 
seventy-two  pages,  divided  into  seven  chapters,  the  author  undertakes  to 
describe  his  idea  of  a  model  operating  room,  its  personnel  and  manage- 
ment, and  also  the  treatment  of  the  surgical  patient  before,  during  and  after 
the  operation. 

Chapter  I,  The  Operating  Room  and  its  Personnel.  As  a  frontispiece, 
the  author  gives  a  diagram  showing  the  relation  of  operating  and  adjoining 
rooms.  The  chapter  opens  with  a  general  consideration  of  the  operating 
room  and  its  preparation  for  operations  after  which  the  personnel  of  the 
operating  room,  including  costumes,  duties,  etc.,  is  taken  up. 

Chapters  II  and  III  have  for  their  subject,  The  Instrument  and  Supply 
Room.    The  care  of  instruments,  the  making  of  operative  supplies,  the 


CURRENT  MEDICAL  LITERATURE 


527 


manufacture  and  sterilization  of  catgut  and  the  preparation  of  gauzes, 
sponges,  compresses,  bandages,  etc.,  are  all  considered  in  this  chapter. 
Formulae  for  all  the  ordinary  powders  and  solutions  used  in  an  operating 
room  are  given.  Instruction  in  the  use  of  the  thermo-cautery  and  the 
care  of  rubber  goods  are  some  of  the  many  other  topics  discussed.  In  fact 
there  is  a  more  or  less  thorough  consideration  of  almost  everything  used 
in  the  operating  room. 

Chapter  IV,  The  Anesthetic  Room.  The  arrangement  of  the  anes^ 
thetic  room,  its  supplies,  etc.,  are  discussed,  after  which  the  duties  of  the 
anesthetist  are  explanied.  The  author  gives  some  preliminary  remarks  on 
the  selection  of  an  anesthetic  and  then  discusses  at  length  nitrous  oxide, 
ether,  chloroform  ethyl  bromide,  nitrous  oxid,  and  oxygen,  nitrous  oxide 
and  ether,  and  the  comparative  new  product  anesthol.  Spinal  and 
cocaine  anesthesia  receive  careful  attention. 

Chapter  V,  The  Patient.  This  chapter  deals  with  the  treatment  of  the- 
patient  before,  during,  and  after  the  operation.  The  first  topic  taken 
up  is  that  of  General  Preparation.  The  author  says,  "the  general  pre- 
paration of  the  patient  begins  from  the  time  he  is  admitted  by  the  home 
surgeon.  "  Other  topics  discussed  are  local  preparation,  preparation  just 
previous  to  leaving  for  anesthetic  room,  position  of  the  patient  for  various 
operations  (well  shown  by  numerous  photographs),  application  of  dress- 
ings, etc.  This  is  one  of  the  most  interesting  and  instructive  chapters  in 
the  book. 

Chapter  VI,  The  General  Consideration  in  the  After  Treatment.  The 
author  says:  "A  successful  issue  in  many  cases  depends  upon  the  care 
which  is  exercised  in  the  after  treatment.  The  surgeon's  responsibility 
does  not  end  with  the  laying  down  of  the  scalpel,  but  continues  until 
healing  is  complete.  "  Post-operative  vomiting,  pain  and  thirst,  together 
with  a  consideration  of  the  diet,  catheterization  of  the  patient,  tempera- 
ture and  pulse,  are  some  of  the  many  subjects  referred  to. 

Chapter  VII  gives  lists  of  articles  required  for  various  operations. 

Such  is  in  brief  an  outline  of  the  work.  The  subject  matter  is  presented 
in  an  attractive  manner  and  the  book  is  well  printed  and  well  illustrated. 
It  has  been  written  more  particularly  for  nurses,  but  can  be  read  with  great 
profit  by  both  internes  and  surgeons. 

System  in  the  operating  room  is  something  to  be  greatly  desired.  It 
causes  everything  to  run  smoothly  and  enables  the  surgeon  to  work  fast 
and  sure  in  cases  of  emergency.  The  sad  experience  of  having  an  operat- 
ing room  staff  get  "rattled  "  is  a  lesson  not  soon  forgotten.  The  remedy 
is  in  having  a  perfect  working  system.  As  the  author  says,  "There 
should  be  no  confusion  in  the  operating  room.  Each  person  should  be 
thoroughly  acquainted  not  only  with  his  or  her  duties  but  also  with  the 
duties  of  others  employed  in  the  operating  room. " 

Not  all  operating  rooms  have  the  same  methods.  Methods  may  differ 
widely  and  yet  have  a  high  grade  of  excellence.  The  author  has  limited 
himself  to  the  discussion  of  one  method  of  operating  room  technic.  As 
a  consequence,  this  work  is  of  value  more  especially  to  individuals  asso- 
ciated with  an  operating  room  employing  the  method  in  question,  but 
nevertheless,  it  is  a  very  readable  and  instructive  book.  j.  m.  b. 


CURRENT   MEDICAL  LITERATURE 


The  Examination  of  the  Function  of  the  Intestines  by  Means  of  the  Test-Diet. 
Its  Application  in  Medical  Practice  and  its  Diagnostic  and  Thera- 
peutic Value.  By  Prof.  Dr.  Adolf  Schmidt,  Physician-in-chief 
of  the  City  Hospital  Friedrichstadt  in  Dresden.  Authorized  Trans- 
lation from  the  latest  German  Edition  by  Charles  D.  Aaron,  M.  D., 
Professor  of  Diseases  of  the  Stomach  and  Intestines  in  the  Detroit 
Post-Graduate  School  of  Medicine;  Clinical  Professor  of  Gastro- 
enterology in  the  Detroit  College  of  Medicine;  Consulting  Gastro- 
enterologist  to  Harper  Hospital,  etc.  With  a  frontispiece  Plate 
in  Colors.  Crown  Octavo,  91  Pages,  Extra  Cloth.  Price,  $1,00, 
net.  F.  A.  Davis  Company,  Publishers,  19 14-16  Cherry  Street, 
Philadelphia. 

In  this  little  volume  of  ninety  pages  the  author  discusses  his  method  of 
determining  the  functional  power  of  the  intestines  by  means  of  examina- 
tion of  the  feces  after  a  test  meal.  The  examination  of  gastric  contents 
after  test  diet  is  a  familiar  diagnostic  procedure,  and,  in  consequence  of 
its  widespread  employment,  we  know  much  more  concerning  the  path- 
ology of  the  stomach  than  we  do  in  regard  to  the  conditions  present  in 
disorders  of  the  intestines. 

The  author's  method  of  examining  feces,  briefly  stated,  is  as  follows: 
A  test  diet  consisting  of  milk,  zweiback,  eggs,  butter,  beef,  potatoes  and 
oatmeal  in  definite  amounts  is  given  for  three  days,  or  at  any  rate  until 
a  stool  is  obtained,  which  comes  with  certainty  from  this  diet.  Generally 
.this  is  obtained  in  the  second  or  third  defecation. 

The  examination  is  made  as  soon  as  possible,  and  requires  only  very 
-simple  apparatus  and  can  usually  be  completed  within  ten  minutes.  It 
includes  the  macroscopic  examination  which  the  author  considers  the  most 
important  part  of  the  whole  procedure.  A  small  amount  of  the  excre- 
ment is  ground  in  a  mortar,  in  the  meantime  being  reduced  to  a  fluid 
consistency  by  the  addition  of  water  The  ground-up  specimen  is  then 
spread  over  a  flat  black  plate  in  as  thin  a  layer  as  possible.  In  a  normal 
specimen  a  very  few  brown  points  smaller  than  pin  heads  appear  which 
are  remains  of  the  test  meal.  Under  pathologic  conditions  there  appear 
mucus,  remains  of  connective  tissue,  of  muscular  tissue,  potato  remains 
and  large  crystals  of  arrfmonia  magnesium  phosphate.  Large  numbers 
of  connective  tissue  remains  indicate  gastric  indigestion,  while  the  muscles 
remains  point  to  a  disturbance  of  intestinal  digestion.  Pus,  blood  seg- 
ments of  tapeworm,  etc.,  may  be  found  but  are  not  discussed  in  detail  by 
the  author.  In  the  microscopical  examination  three  separate  specimens 
are  studied,  one  without  the  addition  of  any  reagent,  another  to  which 
strong  acetic  acid  is  added  and  the  specimen  heated,  a  third  treated  with 
a  solution  of  iodine  and  potassium  iodide.  Pathological  elements  are: 
Well  preserved  muscle  fibres,  starch  cells,  masses  of  fatty  acid  flakes, 
yeast  cells,  etc. 

The  chemical  tests  made  are  test  of  the  reaction,  the  sublimate  test  and 
the  fermentation  test.  If  the  specimen  contains  particles  colored  green 
by  a  strong  solution  of  bichloride  of  mercury  it  is  considered  pathologic. 
These  particles  show  the  presence  of  unchanged  bile-pigment.  If  in  the 
fermentation  test  a  considerable  amount  of  gas  is  formed,  there  is  abnormal 


CURRENT   MEDICAL  LITERATURE 


529 


gas  production,  as  only  very  little  gas  is  formed  from  normal  feces.  If 
at  the  same  time  the  reaction  has  become  more  acid,  carbohydrate  fer- 
mentation has  occurred;  if  alkaline,  albumin  putrefaction  has  taken  place. 

The  tests  required  as  a  rule  do  not  take  more  than  ten  minutes.  They 
should  be  repeated  frequently,  just  as  in  the  examination  of  stomach 
contents.  Conditions  vary  from  day  to  day,  and  one  of  the  advantages  of 
the  method  is  that  it  shows  ephemeral  changes  in  digestion. 

The  latter  half  of  the  book  is  devoted  to  a  discussion  of  the  various 
intestinal  disorders. 

The  purpose  of  the  author  to  set  forth  a  method  of  examination  for  the 
function  of  the  intestines  that  can  be  carried  out  in  practice  analogous  to 
the  usual  examination  of  stomach  contents  seems  to  have  been  attained, 
and  the  monograph  will  be  of  great  practical  value  to  those  who  wish  to 
employ  this  method.  a.  t.  l. 


International  Clinics.  A  Quarterly  of  Illustrated  Clinical  Lectures  and 
Especially  Prepared  Original  Ariticles  on  Treatment,  Medicine, 
Surgery  and  Specialties.  Edited  by  A.  O.  J.  Kelly,  A.  M.,  M.  D. 
Philadelphia,  Pa.  Volume  IV.  Fifteenth  Series.  J.  B.  Lippincott 
Co.,  1906. 

This  volume  contains  the  usual  number  of  excellent  articles  on  Medicine 
and  Surgery  which  has  characterized  the  International  Clinics. 

"  The  Treatment  of  Psoriasis "  (with  illustrations)  by  Wm.  S.  Gott- 
heil  of  New  York,  advocates  the  hypodermic  administration  of  arsenic 
up  to  the  point  of  systemic  saturation  and  its  maintenance  as  near  that 
point  as  possible  for  prolonged  periods ;  together  with  the  local  application 
of  tar,  chrysarotDin,  pyrogallol  or  ammoniated  mercury,  and  in  sufficient 
strength  to  canse  a  reactive  erythema  of  the  healthy  skin. 

"  The  Treatment  of  Some  Common  Gastric  Disorders,"  by  N.  B.  Gwyn 
of  Philadelphia,  contains  many  healthful  suggestions  in  the  treatment 
of  acute  and  chronic  gastritis,  hyperacidity,  dilatation  and  retention. 

"  Empyema,  With  a  Report  of  Thirty  Cases,"  by  J.  N.  Hall  of  Denver, 
Colorado,  is  accompanied  by  numerous  drawings  illustrating  the  source 
of  the  commoner  mistakes  leading  to  negative  results  in  the  use  of  the 
exploratory  needle  when  collections  of  pus  are  present  in  the  pleural 
cavity. 

u  The  Thyroid  Gland,  Its  Anomalies  of  Secretion  and  Their  Manifesta- 
tions and  Treatment,"  by  Thomas  R.  Brown  of  Baltimore,  is  a  resume 
of  our  knowledge  of  this  gland  and  emphasizes  the  contrast  between 
its  two  extremes  of  perverted  function ;  inactivity  causing  myxedema  upon 
the  one  hand ;  and  hyperactivity  producing  exophthalmic  goiter  upon  the 
other.  The  treatment  of  the  former  condition  is  very  satisfactory  while 
that  of  the  latter  is  equally  the  reverse. 

"  The  Results  of  Operations  Such  as  Gastroenterostomy,  etc.,  in  the 
Treatment  of  Diseases  of  the  Stomach,"  by  John  B.  Deaver  of  Phila- 
delphia. The  author  writes  very  encouragingly  of  the  results  obtained 
in  cases  of  chronic  indigestion  such  as  are  due  to  ulcers  of  the  stomach 


530 


CURRENT   MEDICAL  LITERATURE 


and  their  cicatrizing  tendencies ;  he  attributes  the  benefit  to  two  principles : 
(i)  rest  to  the  pyloric  end  of  the  stomach,  and  (2)  drainage  of  the 
stomach. 

Extra-uterine  pregnancy  receives  a  large  share  of  attention  in  this 
volume;  an  article  upon  the  subject  by  Thomas  A.  Ashby,  M.  D.  of 
Baltimore,  reviewing  in  detail  twenty-seven  cases  and  another  by  Franklin 
S.  Newell  of  Boston,  who  summarizes  his  experience  of  sixty  others. 

The  number  of  cases  coming  under  the  observation  of  these  surgeons 
is  sufficient  evidence  of  the  frequency  of  the  -condition  and  the  clinical 
histories  present  strong  arguments  in  favor  of  importance  of  prompt 
diagnosis  and  the  radical  operative  treatment  of  a  dangerous  pathological 
condition.  h.  d.  c. 


International  Medical  Annual,  1906.  A  Year-Book  of  treatment.  Thirty- 
six  Editors.  Twenty-fourth  yearly  issue.  8vo.  588  pages.  Three 
dollars.    New  York,  E.  B.  Treat  &  Co.,  1906. 

The  present  volume,  covering  the  advances  in  medical  science  during 
the  past  year,  though  much  smaller  in  size  than  its  predecessor,  main- 
tains the  high  standard  of  the  previous  issues. 

Part  one  is  a  review  of  the  therapeutic  progress  for  1905,  and  includes 
not  only,  brief  descriptions  of  the  multitudinous  new  remedies  but  new 
methods  of  administration  of  the  better  known  preparations.  This 
section  also  contains  a  complete  review  of  organo-therapy  in  relation  to  a 
number  of  diseases  and  the  advances  in  radio-therapeutics  and  electro- 
therapeutics illustrated  by  a  number  of  plates  of  new  apparatus. 

In  part  second,  after  a  brief  synopsis  of  the  progress  in  each  of  the 
departments  of  medicine,  the  various  subjects  are  arranged  in  an 
alphabetical  manner.  Among  the  pathological  conditions  treated  more 
fully  are  the  diseases  of  the  breast,  of  the  kidneys,  of  the  stomach,  in- 
sanity and  goitre. 

The  volume  is  well  worth  a  place  in  a  physician 's  library  and  is  valuable 
as  a  book  for  ready  reference.  a.  mac  f. 


Man  and  His  Poisons.  A  Practical  Exposition  of  the  Causes,  Symptoms 
and  Treatment  of  Self-poisoning.  By  Albert  Abrams,  A.  M., 
M.  D.    New  York:    E.  B.  Treat  and  Company,  1906. 

This  is  a  volume  of  something  over  250  pages  which,  as  its  title 
indicates,  assumes  to  give  a  practical  view  of  the  subject  of  Auto-intoxica- 
tion or  Self-poisoning.  Chapters  are  devoted  to  a  discussion  of  Life, 
Man  and  His  Poisons,  Fatigue,  The  Toxicology  of  the  Emotions  and 
Sleep,  Chemistry  and  Physics  of  Thought,  and  Symptoms  and  Cure  of 
Self-poisoning. 

Anyone  who  takes  up  this  volume  with  the  idea  of  obtaining  an  accurate 


CURRENT  MEDICAL  LITERATURE 


531 


and  systematic  discussion  of  the  various  phases  of  auto-intoxication 
will  be  greatly  disappointed.  On  the  other  hand  one  who  supposes  that 
it  lacks  in  interest  is  greatly  in  error.  The  work,  like  preceding  ones  by 
Dr.  Abrams,  shows  a  wide  and  catholic  taste  in  reading,  a  sprightly  wit, 
and  great  facility  in  the  use  of  the  English  language.  As  a  storehouse 
for  a  mass  of  miscellaneous  knowledge  culled  (rather  uncritically)  from 
the  literature  of  the  day  the  work  is  a  success,  but  as  an  exposition, 
practical  or  otherwise,  of  auto-intoxication  it  is  a  failure.  In  reading  the 
book  the  interest  does  not  flag  for  a  moment,  but  one  constantly  finds 
one's  self  asking  just  where  auto-intoxication  comes  in.  All  that  is  really 
said  pertinent  to  this  subject  could  be  condensed  into  ten  pages,  but 
one  can  almost  forgive  the  padding  inasmuch  as  it  is  usually  interesting 
and  often  amusing.  The  author  is  as  discursive  as  some  novelist,  but 
unfortunately  discursiveness  is  not  quality  suited  to  scientific  literature. 
The  work  undoubtedly  contains  some  good  practical  points  and  for  this 
reason  deserves  consideration. 

G.  B. 


Nursing  in  the  Acute  Infectious  Fevers.  By  George  P.  Paul,  M.  D., 
Assistant  Visiting  Physician  and  Adjunct  Radiographer  to  the 
Samaritan  Hospital,  Troy,  New  York,  nmo  of  200  pages,  illus- 
trated. Philadelphia  and  London:  W.  B.  Saunders  Company, 
1906.    Cloth,  price  $1.00  net. 

In  this  little  book  of  200  pages  the  author  discusses  first,  the  general 
principles  of  the  nursing  in  acute  infectious  fevers,  and  second,  the  nursing 
in  the  various  infectious  diseases.  In  the  part  of  the  work  which  is  devoted 
to  general  considerations  are  discussed  such  practical  measures  as  the 
hygiene  of  the  sick  room,  the  diet  of  the  sick,  the  reduction  of  fever,  the 
alleviation  of  symptoms,  and  the  detection  of  complications.  Under 
each  special  disease  are  given  synonyms  of  the  name  of  the  disease, 
the  etiology,  symptoms,  diagnosis,  care  and  management.  The  author 
has  devoted  special  attention  to  the  paragraphs  on  care  and  management 
as  being  directly  related  to  the  duties  of  the  nurse.  In  an  appendix  he 
discusses  such  subjects  as  antitoxins,  bacteria,  urine  and  its  examination, 
signs  of  the  onset  of  the  toxic  effects  of  drugs,  poisons  and  their  antidotes, 
enemata  and  topical  applications,  antiseptics,  etc.  A  table  of  weights 
and  measures  is  given. 

The  work  will  undoubtedly  be  found  a  convenient  one  for  reference  in 
the  hospital.  The  arrangement  of  each  chapter  is  very  systematic,  and 
there  is  a  free  use  of  heavy  type  and  italics  in  designating  headings.  One 
criticism  that  might  be  made,  is  that  the  headings  are  perhaps  too  num- 
erous, and  that  the  discussion  of  each  is  too  brief.  If  used  as  a  text-book 
it  is  possible  that  nurses  would  memorize  the  brief  statements  instead  of 
acquiring  a  practical  knowledge  of  principles  a.  t.  l. 


532 


CURRENT   MEDICAL  LITERATURE 


NEW  YORK  STATE  MEDICAL  LIBRARY. 
Edited  by  Miss  Ada  Bunnell,  B.  L.  S. 

Hours  of  opening.  The  library  is  open  for  readers  and  borrowers  each 
week  day  from  8  a.  m.  to  10  p.  m.,  including  Saturdays  and  holidays,  except 
during  July  and  August,  when  it  closes  at  6  P.  m. 

Loans.  Books  can  be  lent  to  any  registered  physician,  but  will  be  deliv- 
ered only  on  personal  application  or  on  a  written  order,  by  which  full 
responsibility  for  books  so  delivered  is  assumed. 

Loans  outside  of  Albany.  Books  will  be  lent  by  the  medical  library  to 
any  registered  physician  outside  of  Albany,  provided : 

1.  That  such  precaution  be  taken  in  packing  as  to  guard  against 
any  probability  of  injury  in  transportation. 

2.  That  the  medical  library  shall  not  pay  postage  or  express  either 
way. 

The  library  is  collecting  articles  on  minute  subjects  and  will  be  glad  to 
receive  gifts  of  reprints  of  articles  in  magazines  from  authors  or  publishers. 

Recent  Accessions  to  the  Library 

Ashton,  W.  E.  A  Text-book  on  the  Practice  of  Gynecology  for  practi- 
tioners and  Students.    2d  ed.    Phil.,  1906. 

Bashore,  H.  B.    The  Sanitation  of  a  Country  House.    N.  Y.,  1905. 

Berg,  A.  A.  Surgical  Diagnosis;  a  Manual  for  Students  and  Practi- 
tioners, illustrated  with  215  engravings  and  21  plates.    N.  Y.,  1905. 

Braun,  M.  Annual  Parasites  of  Man ;  a  Handbook  for  Students  and 
Medical  Men ;  tr.  fr.  from  the  German  by  Pauline  Falcke ;  brought  up  to 
date  by  L.  W.  Sanbon  and  F.  V.  Theobald.    N.  Y.,  1006. 

Davis,  G.  G.,  M.  D.  The  Principles  and  Practice  of  Bandaging; 
ills.    Phil.,  1902. 

Dunglison,  Robley.  A  Dictionary  of  Medical  Science.  23d  ed., 
thoroughly  rev.,  with  the  Pronunciation,  Accentuation,  and  Derivation  of 
the  Terms.    By  T.  L.  Stedman.    Phil.,  1903. 

Findlay,  A.  Physical  Chemistry  and  its  Applications  in  Medical  and 
Biological  Science.    Lond.,  1905. 

Gould,  G.  M.  A  Pocket  Medical  Dictionary;  giving  the  Pronunciation 
and  Definition  of  the  Principal  Words  used  in  Medicine  and  the  Collateral 
Sciences.    4th  ed.,  rev.  &  enl.    Phil.,  1905. 

Gray,  Henry.  Anatomy,  Descriptive  and  Surgical.  Ed.  by  T.  P.  Pick 
and  Robert  Howden.  New  American  ed.  Thoroughly  rev.  and  re-edited 
with  additions  by  John  Chalmers  Da  Costa;  illustrated  with  1132  elaborate 
engravings.    Phil.,  1905. 

Hopkins,  W.  B.    The  Roller  Bandage.    6th  ed.,  rev.    Phil.,  1905. 

Hughes,  D.  E.  A  Compend  of  the  Practice  of  Medicine,  including  a 
section  on  Mental  Diseases  and  Diseases  of  the  Skin.  9th  rev.  ed.,  edited, 
rev.  and  enl.  by  Samuel  Horton  Brown.    Phil.,  1905. 

Kemper,  G.  W.  K.  The  World's  Anatomists,  concise  biographies  of 
anatomic  masters  from  300  B.  C.  to  the  present  time,  whose  names  have 
adorned  the  literature  of  the  medical  profession.    Phil.,  1905. 

Kilmer,  F.  B.   Johnson's  First  Aid  Manual;  Suggestions  for  Prompt 


CURRENT  MEDICAL  LITERATURE 


533 


Aid  to  the  Injured  in  Accidents  and  Emergencies.  Ed.  by  Fred  B.  Kilmer. 
New  Brunswick,  N.  J.,  1901. 

Mechnikov,  Il'ia  Il'ich.  Immunity  in  Infective  Diseases.  Tr.  from  the 
French  by  F.  G.  Binnie.    Cambridge,  1905. 

PfeifTer,  Richard.  Encyklopadie  der  Hygiene,  hrsg.  von  Prof.  jEL 
PfeifTer  und  Prof.  B.  Proskauer,  unter  mitwirkung  von  Carl  Oppenheimer. 
Leipzig,  1905. 

Pilcher,  J.  E.  Surgeon  Generals  of  the  Army  of  the  United  States 
of  America;  a  series  of  Biographical  Sketches  of  the  Senior  Officers 
of  the  Military  Medical  Service  from  the  American  Revolution  to  the 
Philippine  Pacification.    Carlisle,  Pa.,  1905. 

Prince,  Morton.  The  Dissociation  of  a  Personality;  a  Biographical 
Study  in  Abnormal  Psychology.    X.  Y.,  1906. 

Rotch,  T.  M.  Pediatrics,  the  Hygienic  and  Medical  Treatment  of 
Children.    4th  ed.,  rearranged  and  rewritten.    Phil.,  1903. 

Russell,  R.  Strength  and  Diet;  a  Practical  Treatise  with  special 
regard  to  the  Life  of  Nations.    London,  1905. 

Sachs,  Bernard.  A  Treatise  on  the  Nervous  Diseases  of  Children, 
for  Physicians  and  Students.    2d  ed.,  rev.    N.  Y.,  1905. 

Sahli,  Hermann.  A  Treatise  on  Diagnostic  Methods  of  Examination. 
Ed.,  with  additions,  by  Francis  P.  Kinnicutt  and  Nath'l  Bowditch  Potter. 
Authorized  translation  from  the  4th  rev.  and  enl.  German  ed.    Phil.,  1905. 

Sommer,  E.  Anatomischer  Atlas  in  Stereoskopischen  Rontgeubildern. 
Wiirzburg,  1906. 

Stall,  Sylvanus.    Social  Peril.    Phil.,  1905. 

Stevens,  A.  A.  Modern  Materia  Medica  and  Therapeutics.  4th  ed., 
thoroughly  rev.  in  conformity  with  the  8th  revision  (1905)  of  the  United 
States  Pharmacopoeia.    Phil.,  1905. 

Stevens,  A.  A.  A  Manual  of  the  Practice  of  Medicine,  Prepared 
especially  for  Students.    7th  ed.,  rev.    Phil.,  1905. 

W.,  \Y.  R.  Essentials  of  the  Practice  of  Medicine,  Prepared  especially 
for  Students  of  Medicine.  Arranged  with  Questions  following  each 
Chapter.    Phil.,  1905. 

Books  for  Nurses. 

Cooke,  J.  B.  A  Nurse's  Handbook  of  Obstetrics,  for  use  in  Training- 
Schools.    Phil.,  1905. 

Davis,  A.  E.    Eye,  Ear,  Nose  and  Throat  Nursing.    Phil.,  1905. 

Davis,  E.  P.  Obstetric  and  Gyneocologic  Nursing.  2d  ed.,  rev.  Phil., 
1904. 

De  Lee,  J.  B.    Obstetrics  for  Nurses.    Phil.,  1904. 

Dock,  Lavinia  L.  Text-book  of  Materia  Medica  for  Nurses.  4th  ed., 
rev.  and  enl.    N.  Y.,  1905. 

Friedenwald,  Julius.    Dietetics  for  Nurses.    Phil.,  1905. 

Groff,  J.  E.  Materia  Medica  for  Nurses.  Ed.3.  Based  upon  Eighth 
Decennial  Revision  of  the  U.  S.  Pharmacopoeia.    Phil.,  1905. 

Kimber,  D.  C.  Text-book  of  Anatomy  and  Physiology  for  Nurses. 
N.  Y.,  1005. 

Patee,  A.  F.  Practical  Dietetics  with  reference  to  Diet  in  Disease. 
Ed.  3.    N.  Y,  1905. 


534 


CURRENT  MEDICAL  LITERATURE 


Shaw,  Mrs.  C.  S.  A  Text-book  for  Nursing,  for  the  use  of  Training 
Schools,  Families  and  Private  Students.  3d  ed.,  thoroughly  rev.  and  enl. 
N.  Y.,  1906. 

Wilcox,  R.  W.    Manual  of  Fever  Nursing.    Phil.,  1904. 

Voswinkel,  B.  M.    Surgical  Nursing.    2d  ed.,  rev.  and  enl.    Phil.,  1900. 

Periodicals  and  Society  Transactions. 

American  Roentgen  Ray  Society.  Transactions. 

Archives  of  the  Roentgen  Ray.    Lond.  &  N.  Y.,  v.  10,  1906. 

Associations  of  American  Physicians.    Translations,    v.  1-2,  1886-1887. 

Beitrage  Zur  Pathologischen.  Anatomie  und  Zur  Allegemeinen  Patho- 
logic   Jena.,  v.  1-28,  1886-1900. 

Berliner  Klinische  Wochenschrift.    v.  4-21,  1867-1884. 

Gyneacological  Society  of  Boston.  Transactions.  1905.  (Contains 
transactions  1901-1905.) 

Lakeside  Hospital.  Clinical  and  Pathological  Papers.  Cleveland,  1905. 
Series  2. 

Medizinische  Klinik.  Berlin. 


OPHTHALMOLOGY 
Edited  by  Charles  M.  Culver,  M.  D. 

Case  of  Congenital  Word-Blindness.    (Inability  to  learn  to  read.) 

J.  Herbert  Fisher.    Ophthalmic  Review  (London),  November,  1905. 

Nettleship  published  five  cases  of  congenital  word-blindness  allied  to 
those  described  by  Hinshelwood  in  the  Lancet  of  May  26,  1900.  Though 
the  characteristic  features  of  these  cases  of  "inability  to  learn  to  read" 
must  now  be  well  known  to  ophthalmic  surgeons,  the  list  of  examples 
does  not  expand  very  rapidly.  Hinshelwood  has  published  five  cases  in 
all,  the  last  being  reported  at  the  annual  meeting  of  the  British  Medical 
Association  in  1904.  For  the  recognition  of  these  cases  we  are  to  a  large 
extent  dependent  on  the  observation  of  parents  and  the  answers  which 
they  give  to  our  questions;  this  being  so  it  is  probable  that  a  proportion 
of  the  cases  which  occur  in  hospital  practice  go  unrecognized  and  are 
treated  by  clinical  assistants  as  refraction  cases.  Hinshelwood's  keen 
observation  for  the  defect  has  enabled  him  to  detect  four  examples  in 
hospital  practice. 

Miss  F.,  aet.  6,  was  brought  to  the  author  in  October,  1904,  owing  to 
the  extreme  difficulty  which  she  experienced  in  learning  to  read:  she 
"mixed  the  letters  up."  It  did  not  appear  that  she  had  any  defect  in 
vision  for  ordinary  purposes :  each  eye  had  full  visual  acuteness,  with 
a  hyperopia  in  the  right  of  075  D.,  in  the  left  of  125  D. ;  the  right 
iris  showed  an  inner  sector,  about  two-fifths  of  its  whole  area,  which 
was  more  deeply  pigmented  than  the  remainder;  the  eyes  in  every  other 
respect  were  normel.  She  had  been  trying  to  learn  to  read  for  two 
years;  had  attended  school  for  one  term,  but  had  since  been  taught 
privately  by  a  governess.    The  author  found  that  when  trying  to  read 


CURRENT  MEDICAL  LITERATURE 


535 


she  had  to  spell  words  of  two  or  three  letters,  and  in  doing  so  often 
misnamed  the  letters;  when  spelling  words  she  might  name  the  first 
letters  correctly,  but  the  succeeding  ones  quite  inaccurately;  when  he 
tested  her  with  short  words  she  constantly  made  mistakes,  such  as  call- 
ing "was"  "of."  He  was  told  that  her  younger  sister,  who  had  been 
learning  to  read  for  only  one  month,  could  already  read  as  well  as  this 
patient — she  was,  however,  being  taught  on  a  different  method,  described 
as  the  "look  and  read"  principle.  Miss  F.  was  not  good  at  arithmetic; 
she  experienced  unusual  difficulty  in  adding  figures;  sums  were  a  trial 
to  her  and  she  was  bad  at  arithmetical  tables;  she  was  also  said  to  start 
reading  music  correctly,  but  soon  began  to  misname  the  notes.  In  all 
other  respects,  she  was  a  bright,  intelligent  child,  and  quite  sharp,  had 
a  good  memory  for  facts,  and,  learned  and  repeated  poetry  readily. 

A  point  of  special  interest  about  this  case  was  that  her  mother's  brother 
was  ten  years  of  age  before  he  succeeded  in  learning  to  read;  all  his 
letters  were  mixed  up,  and  even  in  adult  life  he  is  said  to  spell  abominably. 
We  may  fairly  take  this  as  evidence  of  a  family  tendency  to  imperfection 
in  development  of  the  visual  memory  centre  for  words  in  the  cortex  of 
the  left  angular  gyrus.  No  evidence  in  this  direction  has  been  elicited 
before,  but  such  hereditary  tendency  seems  not  improbable. 

In  the  case  of  the  patient  in  question  there  appears  to  be  reason  to  be- 
lieve that  a  congenital  defect  exists  in  the  centres  for  the  visual  memory 
of  figures  and  musical  notes  as  well  as  in  that  for  words  and  letters. 
The  association  affords  support  to  the  view  Hinshelwood  has  advanced 
that  the  allied  visual  memory  centres  are  in  all  probability  located  in 
adjoining  areas  of  the  cerebral  cortex,  and  emphasizes  his  objection  to 
Wernicke's  statement  that  in  the  diagnosis  of  these  cases  great  import- 
ance may  be  attached  to  the  fact  that  these  children  have,  as  a  rule,  no 
difficulty  in  recognizing  and  dealing  with  figures.  In  the  present  case 
a  wise  step  had  already  been  taken  when  the  child  was  withdrawn  from 
school  and  placed  under  private  tuition;  much  patience  is  necessary  in 
the  teaching  of  these  children,  who  are  detrimentally  embarrassed  by 
their  mistakes  when  being  taught  in  class.  Miss  F.'s  younger  sister  was, 
as  far  as  is  known,  in  no  way  defective,  but  was  being  taught  to  read 
on  the  "look  and  read"  principle;  this  the  author  understands  to  mean 
that  the  recognition  of  individual  letters  and  the  spelling  of  them  into 
words  is  no  part  of  the  method;  the  child  is  taught  to  study  and  recog- 
nize printed  words  as  a  whole;  the  unit  for  observation  and  visual 
memory  is  the  word  and  not  the  letter;  both  Hinshelwood  and  Nettle- 
ship  insist  on  the  necessity  of  steady  perseverence  in  the  development 
of  the  defective  visual  memory  centre  or  the  training  of  a  vicarious  one 
probably  in  the  angular  gyrus  of  the  right  hemisphere,  and  advocate  be- 
ginning on  the  old  plan  of  teaching  individual  letters.  The  author  thinks 
it  is  worth  considering  whether  the  "look  and  read"  system  is  not  the 
one  to  be  adopted  for  cases  of  congenital  word-blindness ;  it  is,  after  all, 
by  the  visual  memory  of  words,  rather  than  by  that  of  their  constituent 
letters,  that  we  are  enabled  to  read  accurately  and  fluently.  In  cases  of 
"inability  to  learn  to  read"  it  is  obviously  desirable  that  the  shortest  route 
to  reading  should  be  taken.   The  study  of  words  as  a  whole  would  proba- 


536 


CURRENT   MEDICAL  LITERATURE 


bly  be  as  efficient  a  training  for  the  development  of  the  defective  centre 
as  the  study  of  individual  letters,  and  if  this  study  of  words  can  be 
carried  out  ab  initio,  much  saving  of  valuable  time  may  possibly  be  effected. 
As  scientific  men  we  need  in  these  times  to  recognize  that  in  every  case 
where  as  good  mental  training  can  be  provided  by  profitable  as  by  profit- 
less study,  the  former  is  the  course  we  should  recommend.  If  the 
"look  and  read''  system  of  instruction  is  available,  and  were  made  use  of 
for  a  case  of  congenital  word-blindness,  oral  tuition  in  spelling  would 
be  required,  and  in  writing  the  patient  would  probably  make  many  mis- 
takes in  spelling.  If  he  had  received  good  oral  instruction  in  spelling 
it  is  conceivable  that  the  use  of  a  type-writing  machine  might  help  to 
save  him  from  such  plunders  later  in  life. 

Miss  F.  paid  the  author  a  second  visit  on  August  8,  1905.  Her  mother 
informed  him  that  she  had  got  on  quite  well  on  the  "look  and  read" 
principle,  and  at  the  time  of  the  second  visit  could  not  be  kept  from  read- 
ing. She  was  getting  on  better  with  figures  and  the  music  lessons  were 
progressing  favorably;  they  were  at  a  standstill  before.  She  was  able 
to  read  two-syllable  words  well ;  having  learnt  the  alphabet  before,  she 
is  not  a  pure  example  of  the  "look  and  read''  method ;  studying  the  word 
"remain"  she  got  the  first  syllable  correct ;  then,  not  familiar  with  "main" 
she  next  scrutinized  "ain ;"  unable  to  identify  this  combination  of  letters, 
she  next  tried  "in,"  which  she  correctly  recognized,  but  with  the  result 
that  she  vocalized  the  word  incorrectly  in  the  end. 


Hereditary  Congenital  Night-blindness  without  Visible  Ophthalmoscopic 
Changes. 

W.  W.  Sinclair.    The  Ophthalmoscopic  Review  {London),  September, 

In  a  most  instructive  paper  (Royal  London  Ophthalmic  Hospital  Reports, 
Vol.  XI,  Part  IV.),  "On  some  of  the  forms  of  congenital  and  infantile 
amblyopia,"  Nettleship  describes  a  group  of  cases  characterized  by  con- 
genital, stationary,  night-blindness  with  inconspicuous  fungus  changes, 
consisting  mainly  of  irregularity  of  the  pigmented  epithelium  and  the 
presence  of  scattered  minute  white  dots,  and  gives  a  remarkable  pedigree 
of  a  family  so  affected.  One  of  the  cases  examined  by  Nettleship  is 
stated  to  have  shown  "no  ophthalmoscopic  changes."  All  the  affected 
persons  were  males  and  the  great  majority  inherited  through  the  mother. 
It  is  to  be  noted  that  the  four  patients  examined  by  Nettleship  were  all 
myotic.  Nettleship,  in  the  same  paper,  gives  notes  of  three  single  cases 
of  night-blindness,  all  in  males.  Two  were  myopic.  In  one  of  these 
there  were  "no  definite  ophthalmoscopic  changes,  except  large  myopic 
crescents,"  in  the  other  there  were  fairly  well-marked  changes  in  the 
retinal  epithelium.  In  the  third  case  there  was  considerable  amblyopia, 
not  improved  by  glasses,  with  "ophthalmoscopic  appearances  perfectly 
normal  in  every  particular." 

Nettleship  refers  to  Leber's  short  account  of  congenital  night-blindness 
without  retinitis  pigmentosa,  and  with  only  slight  changes  (Graefe  und 
Saemisch.,  Vol.  V,  p.  648). 


CURRENT  MEDICAL  LITERATURE 


537 


In  Vol.  XIII  of  the  Transactions  of  the  Ophthalmological  Society, 
Morton  gives  the  pedigree  of  a  family  case  of  hereditary  night-blindness 
without  visible  fungus  change.  All  the  affected  persons  were  males  and 
the  condition  appears  to  have  been  associated  with  fair  hair.  Both  the 
patients  examined  by  Morton  were  myopic,  and  both  had  markedly  con- 
tracted fields.  Another,  seen  by  Tatham  Thompson,  of  Cardiff,  had 
progressive  myopia  with  "irregularly  scattered  pigment  at  the  periphery," 
but  the  aspect  was  "not  at  all  typical  of  pigmentary  retinitis."  Three 
other  brothers  had  night-blindness  but  "no  pigmentary  retinitis,"  (re- 
fraction of  not  stated). 

The  affected  members  of  the  family,  now  reported,  appear  to  belong 
to  a  group  related  to  those  above  mentioned,  but  differing  from  them  in 
one  or  two  important  respects.    The  interesting  points  are: 

1.  Females  were  affected  as  well  as  males. 

2.  In  neither  of  the  cases  seen  was  the  condition  associated  with 
myopia. 

3.  In  the  -  two  cases  examined  the  ophthalmoscopic  appearances  were 
perfectly  normal  in  every  respect. 

4.  Where  a  father  or  mother  was  unaffected  their  children  invariably 
escaped. 

Case  1.  A  boy  of  11  years.  V.  =  5/6  in  each  eye.  Field  of  full-size 
in  ordinary  day  light.    Color  vision  normal  (Holmgren). 

Case  2.  Mother  of  case  1,  age  50.  V  =  5/6  in  each  eye.  Field  full  in 
day  light.    Color  vision  normal  (Holmgren). 

In  spite  of  the  normal  sight  and  field  in  ordinary  light,  and  the  absence 
of  any  visible  pathological  changes  in  the  eye,  both  patients,  like  the  others 
in  the  family  who  were  affected,  were  night-blind  to  such  a  degree  that 
when  they  had  to  go  out  anywhere  after  dusk  one  of  the  unaffected  mem- 
bers had  .to  accompany  them  in  the  capacity  of  guide. 

In  testing  the  visual  field  under  diminished  illumination,  it  was  noticea- 
ble that  a  moderate  reduction  of  light  caused  no  alteration  in  the  size 
of  the  field;  but  when  the  illumination  fell  below  a  certain  point  the 
field  was  very  markedly  reduced  as  compared  with  the  author's,  under 
the  same  conditions.  Examination  with  the  photometer  revealed,  as  was 
to  be  expected,  a  great  defect  in  the  light  sense.  The  author  tested 
the  light  minimum  in  Case  2,  in  a  sister  who  was  not  affected  by  night- 
blindness  and  in  himself,  after  thorough  (twenty  minutes)  adaptation. 
Th'*.  light  minimum  in  the  sister  and  in  his  own  case  was  two,  while  that 
of  the  night-blind  patient  was  seven,  a  very  striking  difference. 

The  night-blindness  appears  to  be  congenital,  and  non-progressive. 
There  was  no  consanguinity  so  far  as  could  be  ascertained,  and  no 
associated  deafness  or  other  defect,  either  physical  or  mental.  Indeed 
those  members  of  the  family  whom  the  author  saw  were  without  excep- 
tion "pictures  of  health,"  and  exceptionally  intelligent  members  of  the 
lower  middle  classes.  The  existence  of  night-blindness  as  a  family 
complaint  was  of  course  well  known  to  them,  and  they  took  much  interest 
in  helping  the  author  to  collect  the  pertinent  facts.  At  least  five  genera- 
tions have  been  affected.  It  is  unknown  whether  any  of  the  children 
forming  the  sixth  generation  are  night-blind  or  not. 


538  CURRENT  MEDICAL  LITERATURE 


The  meaning  of  such  a  condition  as  exists  in  this  family  must  at  present 
be  quite  uncertain,  but  it  seems  best  explained  as  an  inherited  diminution 
in  the  photo-chemical  activity  of  the  retina. 

GYNECOLOGY 
Edited  by  John  A.  Sampson,  M.  D. 

A  Discussion  of  the  Diagnosis  and  Treatment  of  Cancer  of  the  Uterus. 
Twenty-third  Annual  Meeting  of  the  British  Medical  Association, 
July,  1905. 

Wertheim's  (of  Vienna)  Report.  British  Medical  Journal,  1905,  Septem- 
ber 25,  p.  689-695. 

We  owe  to  Wertheim,  more  than  to  anyone  else,  the  development  and 
acceptance  of  what  is  known  as  the  more  radical  abdominal  operation 
for  cancer  of  the  uterine  cervix.  He  is  not  the  originator  of  the  abdominal 
route  nor  the  first  to  suggest  the  wide  removal  of  the  parametrium  or 
the  pelvic  lymph  nodes,  but  he  has  demonstrated  the  indications  for  this 
route  and  how  the  operation  may  be  safely  accomplished. 

Since  1898,  he  has  removed  27c  cancerous  uteri  by  his  operative  methods 
and  an  idea  may  be  formed  of  the  improvement  in  the  technique  of  the 
operation  from  the  fact,  that  while  the  primary  mortality  claimed  twelve 
of  the  first  30  cases;  he  lost  only  two  in  the  last  30  cases. 

In  the  present  report,  he  describes  the  various  steps  in  this  operation, 
which  has  in  view,  first  the  freeing  of  the  ureters  and  then  the  wide 
excision  of  the  parametrium;  the  removal  of  the  lymph  glands  being  a 
secondary  consideration. 

Wertheim  was  first  induced  to  try  his  present  methods  "  only  to  hold 
cut  a  possibility  of  relief  for  those  advanced  cases  in  which  the  vaginal 
operation  was  considered  contraindicated,"  but  later  he  employed  them 
in  all  cases. 

A  study  of  the  specimens  removed  by  him  have  shown  that  a  soft 
feeling  parametrium  does  not  necessarily  exclude  the  presence  of  cancer 
or  an  indurated  one  indicated  cancer.  In  only  40  per  cent,  of  the  cases 
studied  was  the  disease  limited  to  the  uterus,  it  having  invaded  the  para- 
metrium or  lymph  nodes  in  the  rest  of  the  cases.  In  10  per  cent,  of  the 
cases  the  lymph  nodes  were  involved  but  the  parametrium  free;  in  20 
per  cent,  both  were  involved  and  in  27^  per  cent,  the  parametrium  was 
cancerous  but  the  lymph  nodes  were  free.  The  above  emphasizes  the 
great  importance  of  a  wide  excision  of  the  parametrium  which  is  not 
accomplished  by  the  vaginal  or  even  by  the  usual  abdominal  hysterectomy. 

The  results  of  his  work  show  that  60  to  70  per  cent,  of  the  cases 
operated  upon  are  free  from  recurrence  four  and  five  years  afterwards, 
and  also  that  cases  are  operated  upon  which  were  heretofore  considered 
inoperable  and  that  even  a  large  number  of  these  are  well  after  a  period 
of  three,  four,  and  five  years.  He  states  that  at  present,  no  decisive 
opinion  can  be  given  as  to  the  value  of  extirpating  the  lymph  nodes  but 
that  the  disease  has  recurred  in  the  majority  of  cases  in  which  they  were 
found  cancerous  at  operation,  although  some  of  these  cases  are  apparently 
free  from  recurrence  three  and  a  half  years  afterwards.    In  nearly  all 


CURRENT   MEDICAL  LITERATURE 


539 


cases  in  which  the  disease  has  recurred  this  has  taken  place  in  the  lymph 
nodes  and  not  in  the  vaginal  vault. 

He  compliments  the  work  of  Winter,  who  has  done  so  much  to  educate 
the  laity  and  also  the  profession  as  to  the  importance  of  an  early  diagnosis 
of  this  condition. 

The  Gonococcus  in  the  Puerperium,  with  Report  of  Seventeen  Cases. 
Stone  and  McDonald.    Surgery,  Gynecology  and  Obstetrics,  1906,  II, 
151-161. 

The  presence  of  the  gonococcus  in  the  uterus  during  the  puerperium 
should  be  of  interest  to  the  gynecologist  as  well  as  the  obstetrician,  for, 
undoubtedly,  it  frequently  leads  to  acute  inflammatory  disease  of  the  tubes 
and  the  numerous  sequelae  of  this  condition. 

The  writers  report  seventeen  cases  where  the  gonococcus  was  obtained 
from  the  uterus  during  the  puerperium,  out  of  fifty-three  cases  examined 
for  it,  in  the  wards  of  the  Lying-in  Hospital  (New  York)  in  the  year 
1904. 

In  the  above-mentioned  hospital,  bacteriological  examinations  are  made, 
as  a  routine,  in  all  cases  of  fever  in  the  puerperium,  and  the  taking  of 
intra-uterine  cultures  offered  an  opportunity  to  examine  for  the  gono- 
coccus, by  means  of  smears.  In  addition  other  cases  were  examined  and 
among  them  cases  where  the  temperature  was  elevated,  but  not  high 
enough  to  effer  an  indication  for  taking  an  intra-uterine  culture. 

The  effects  of  the  disease  during  the  pregnancy  were  not  studied  as  the 
cases  did  not  come  under  observation  until  after  labor  had  begun.  The 
demonstration  of  a  biscuit-shaped  intracellular  diplococcus,  negative  to 
Gram's  stain  was  considered  sufficient  evidence  upon  which  to  make  a 
diagnosis  of  gonorrhoea.  Smears  were  taken  at  different  times  during 
the  puerperium  but  the  demonstration  of  the  organism  was  seldom 
successful  until  the  fifth  day  and  increased  success  was  obtained  as  the 
puerperium  advanced.  Smears  taken  earlier  in  the  puerperium  were 
found  to  be  obscured  by  red  blood  cells.  The  site  in  the  genital  canal, 
which  gave  the  greatest  success  in  finding  the  organism,  was  within  the 
cervix  and  about  the  level  of  the  internal  os. 

All  of  the  seventeen  patients  were  primipara,  the  majority  of  the 
patients  in  the  hospital  are  primipara  as  it  is  planned  to  attend  the  multi- 
parae  in  their  own  homes.  In  three  patients  premature  labor  occurred, 
at  periods  varying  from  six  months  and  one-half  to  seven  months. 

In  twelve  of  the  seventeen  patients  there  was  an  elevation  of  tem- 
perature above  100  degrees,  but  in  three  of  these  twelve  patients,  a  mixed 
infection  was  found,  twice  streptococcus  and  gonococcus  and  once  colon 
and  gonococcus. 

The  average  duration  of  the  fever  in  the  nine  cases  of  gonococcus 
infection  alone,  who  had  an  elevation  of  temperature  of  100  degrees  or 
over  was  4.1  days  varying  from  three  cases  in  which  the  fever  lasted  one 
day  to  two  cases  in  which  it  lasted  nine  days.  The  fever  was  irregular 
in  all  cases  and  did  not  follow  any  definite  curve  In  three  of  the  nine 
cases  it  began  on  labor  day.  In  two  cases  the  temperature  reached  103 
degrees  but  in  the  majority  of  the  cases  it  was  less  than  102  degrees. 


540 


CURRENT   MEDICAL  LITERATURE 


In  addition,  three  patients  with  mixed  infection  had  a  temperature 
above  100  degrees.  In  one,  colon  and  gonococcus  infection,  the  tem- 
perature rose  on  the  sixth  day.  lasted  six  days,  and  reached  102  degrees 
three  times.  Two  cases  of  streptococcus  and  gonococcus  infection  had 
widely  varied  courses.  One,  admitted  on  the  eighth  day,  with  a  history 
ot  fever  and  chills  following  an  operative  labor,  had  a  mild  course,  and 
fever  lasted  only  one  day;  the  other,  admitted  on  the  sixth  day,  with  a 
history  of  a  seven  months  abortion  and  fever,  had  a  high  temperature,  a 
severe  course,  and  a  general  peritonitis  followed  by  death. 

In  five  of  the  seventeen  women,  the  temperature  never  rose  to  100 
degrees,  although  there  were,  in  two  of  these  cases,  slight  abdominal  pain 
and  rigidity. 

Pain  w-is  present  in  nine  of  the  seventeen  cases;  severe  in  seven, 
moderate  in  two  and  slight  in  four.  It  was  usually  referred  to  the  lower 
abdomen.  One  patient  whose  puerperium  had  been  uneventful  except  for 
the  presence  of  a  profuse  discharge  and  a  moderate  amount  of  pelvic  pain 
and  tenderness,  had  an  attack  of  pelvic  peritonitis  five  months  later  and 
bcth  tubes  filled  with  pus  were  removed  at  operation. 

Fourteen  full  term  babies  and  three  premature  labors  were  the  result 
of  the  seventeen  pregnancies.  Gonococcus  conjunctivitis  occurred  in 
three  of  these  infants,  the  discharge  appearing  in  the  third,  sixth  and 
ninth  days.  No  infant  at  birth  showed  any  signs  of  inflamed  eyes,  and 
all  had  Crede's  nitrated  of  silver  treatment  for  the  prevention  of  infec- 
tion. In  addition,  during  this  time,  two  infants  of  healthy  mothers  had 
gonococcus  infection,  thus  showing  that  in  all  institutions  there  is  a 
possibility  of  infants  acquiring  gonococcus  conjunctivitis  from  other 
causes  than  vulvar  discharges.  Three  of  the  fourteen  infants  died  and 
the  majority  of  the  rest,  all  breast  fed,  showed  evidences  of  disturbed 
nutrition  and  intestinal  disturbances.  The  marked  difference  between 
the  nutrition  of  these  babies  and  of  those  nursed  by  non-infected  women 
was  very  striking  and  suggests  the  possibility  of  a  gonococcus  toxin 
affecting  the  child. 

The  author  concludes  that  gonococcus  infection  is  present  in  a  much 
larger  proportion  of  the  patients  of  obstetrical  clinics  than  they  had  pre- 
viously supposed  and  that  the  puerperal  state  has  a  direct  influence  upon 
the  course  of  the  disease.*  They  think  that  gonorrhoea,  which  has  been 
been  latent  before  labor,  commonly  spreads  upward  with  rapidity  during 
the  puerperium,  as  shown  by  the  abnominal  pain  and  rigidity  in  patients 
not  previously  thus  affected;  and  that  the  presence  of  these  symptoms, 
when  accompanied  by  fever,  is  considered  to  indicate  the  extension  of  the 
disease  beyond  the  uterus,  thus  possibly  explaining  many  of  the  cases  of 
salpingitis  following  labor,  which  are  supposed  to  be  the  result  of  puer- 
peral infection. 


*The  findings  of  the  writers  agree  very  well  with  those  of  Little,  who 
found  the  gonococcus  in  the  puerperal  uterus  of  sixteen  out  of  fifty  con- 
secutive labors  at  the  Obstetrical  Department  of  the  Johns  Hopkins 
Hospital.  (The  Bacteriology  of  the  Puerperal  Uterus,  American  Journal 
of  Obstetrics,  1905,  Hi,  815-847-) 


Vol.  xxvii 


AUGUST,  1906 


No  8. 


ALBANY 
MEDICAL  ANNALS 


®riamal  Communications 

AN  ADDRESS 

TO   THE   GRADUATING   CLASS   OF   ST.    PETER'S   HOSPITAL  TRAINING 
SCHOOL   FOR  NURSES, 

Delivered  on  June  27 ,  iqo6. 
By  HENRY  HUN,  M.  D. 

The  Reverend  Bishop  will  give  you  your  well-earned  diplomas 
and  it  gives  me  great  pleasure  to  present  to  you,  the  Graduating 
Class  of  St.  Peter's  Hospital  Training  School  for  Nurses,  the 
congratulations  of  all  your  friends  here  present  on  the  successful 
completion  of  your  long  and  arduous  course  of  training  and 
further  to  give  to  you  the  good  wishes  of  us  all  for  your  success 
in  your  life's  work. 

In  leaving  the  not  less  important  domestic  work  of  your  quiet 
homes  to  enter  into  the  wider  work  of  the  world,  to  earn  your 
own  living  and  to  become  independent,  you  have  chosen  a  career 
which  is  essentially  womanly  and  beneficent.  From  the  earliest 
times  of  barbaric  tribes  down  to  the  present  day,  whenever  sick- 
ness has  entered  a  household,  it  is  ever  the  women  of  the  house 
who  care  for  and  nurse  the  sufferer.  The  nursing  of  the  sick 
and  the  teaching  of  girls  and  younger  boys  are  duties  for  which 
women  have  an  especial  and  a  natural  aptitude,  but  which  men, 
with  the  best  of  good  will,  can  perform  very  imperfectlv. 

Now  there  was  no  trained  nurse  during  the  earlv  ages  of 
civilization ;  every  woman  was  an  amateur  nurse  in  her  own 
family  and  to  a  great  extent  still  is  even  in  these  days.  But 
when  the  Christian  religion  began  to  spread  over  the  world,  it 
preached  and  practised  a  broad  spirit  of  charity  hitherto  unknown 
and  under  its  influence  there  came  into  the  hearts  of  good  men 


542 


AN  ADDRESS 


and  women  that  wonderful  idea  of  service  and  self-sacrifice 
which  has  since  borne  such  abundant  fruit.  There  sprang  into 
existence  the  various  religious  monastic  orders  composed  of  per- 
sons willing  and  anxious  to  withdraw  from  both  the  pleasures 
and  the  fetters  of  the  world  in  order  to  devote  their  lives  to  good 
deeds  in  the  service  of  God.  Among  the  many  good  deeds  to 
which  these  orders,  such  as  the  Franciscans,  Augustinians,  the 
Sisters  of  St.  Elizabeth  of  Hungary  and  many  others,  devoted 
themselves,  nursing  early  became  prominent.  The  willing  hands 
of  these  sisters  soon  became  trained  and  skilful  in  their  daily 
work,  and  thus  was  started  the  first  body  of  trained  nurses  in 
the  world.  The  real  origin  of  the  trained  nurse  lies  in  the  con- 
vents of  Asia  Minor,  in  the  Holy  Land,  a  fitting  origin  for  such  a 
beneficent  work.  From  the  Holy  Land  the  convents  spread  west- 
ward over  Europe.  During  the  crusades  many  Hospices  were 
established  for  the  care  and  nursing  of  the  pilgrims  and  crusaders 
who  fell  ill  on  the  journey,  although  this  was  not  their  only  duty. 
The  most  noted  of  these  probably  is  the  Hospice  of  St.  Bernard, 
still  standing  on  the  Simplon  Pass  in  Switzerland  and  still  in 
active  service.  A  very  great  impetus  was  given  both  to  medicine 
and  nursing  when  Pope  Innocent  the  Third,  at  the  beginning  of 
the  fifteenth  century,  founded  the  great  hospital  St.  Spirito,  in 
Rome,  a  great  light  in  the  world  down  to  the  present  day. 

From  early  times  the  religious  orders  associated  with  them- 
selves lay  members  to  aid  in  caring  for  the  sick.  Later,  religious 
orders  were  founded,  whose  especial  duty  was  nursing.  As  far 
back  as  the  twelfth  century  that  curious  lay  order  of  Beguines, 
or  hospital  sisters,  originated  in  Belgium.  They  were,  for  the 
most  part,  widows  of  men  killed  in  the  constant  wars  of  those 
times  and  were  gathered  together  in  large  houses  and  supported 
themselves  in  part  by  nursing.  At  one  time  they  spread  rapidly 
throughout  Europe,  then  dwindled  away,  but  have  continued  in 
Belgium  down  to  the  present  time.  The  nursing  within  the  strictly 
religious  orders  was  necessarily  confined  to  the  convents  and 
monasteries,  and  thus  its  usefulness  was  limited.  So  that  finally 
St.  Vincent  de  Paul,  in  1629,  founded  the  order  of  the  Sisters  of 
Charity,  whose  duty  was  to  care  for  the  sick,  for  children,  and 
for  the  aged ;  not  in  convents  but  in  the  world  at  large.  St. 
Vincent  de  Paul  wrote,  the  Sisters  of  Charity  should  have  "  no 
monasteries  but  the  rooms  of  the  sick,  no  cells  but  hired  rooms, 
no  cloisters  but  the  streets  of  the  town  and  the  wards  of  a  hos- 


HENRY  HUN 


543 


pital,  no  inclosure  but  obedience,  and  for  convent  bars,  only  the 
fear  of  God." 

These  were  great  and  inspiring  sentiments.  The  success  of 
such  orders  as  the  Sisters  of  Charity  and  the  Sisters  of  Mercy 
was  immediate,  immense  and  enduring.  They  soon  had  charge 
of  practically  all  the  hospitals  on  the  continent  of  Europe  and  of 
most  of  those  of  England.  In  the  other  hospitals  of  England, 
during  the  seventeenth  and  eighteenth  centuries  the  nursing 
was  done  for  the  most  part  by  criminals  and  by  women  of 
ill-repute,  and  was  wretched  indeed.  And  so  for  many 
centuries  all  the  trained  nursing  in  the  world  was  done  by  the 
Sisters  of  the  Catholic  Church,  and  until  quite  recently,  until 
less  than  100  years  ago,  they  had  no  rivals.  The  Trained  Nurse 
was  originally  a  Sister  of  Charity  just  as  the  Doctor  was  orig- 
inally a  Priest. 

In  1836  Frederika,  the  wife  of  Theodor  Fliedner,  a  German 
Pastor,  established  at  Kaiserwerth  on  the  Rhine,  a  protestant 
order  of  nurses,  somewhat  similar  to  Sisters  of  Charity,  called 
the  Deaconess  Sisters,  whose  duty  was  alternately  to  nurse  the 
sick  and  to  care  for  children  and  for  the  insane. 

Finally  in  1856,  taught  by  bitter  experiences  in  nursing  in  the 
Crimean  War,  Florence  Nightingale,  herself  a  former  pupil  in 
Kaiserwerth,  organized  in  St.  Thomas  Hospital  in  London,  the 
first  training  school  for  nurses,  entirely  unconnected  with  re- 
ligious influences  or  authority  and  thus  originated  the  idea  of 
the  modern  training  school  for  nurses. 

Now  I  have  given  you  this  very  brief  outline  of  the  history  of 
nurses  because  I  wished  to  point  out  to  you  that  St.  Peter's  Hos- 
pital, in  the  less  than  forty  years  of  its  existence,  has  experienced 
in  its  nursing,  all  the  stages  which  the  evolution  of  the  nurse  in 
the  world  has  passed  through  in  its  many  centuries. 

When  St.  Peter's  Hospital  was  opened  in  1869,  there  were  no 
trained  nurses  in  the  United  States.  Nursing  was  then  in  its 
barbaric  stage,  and  was  done  by  the  women  of  the  household  with 
the  aid  of  other  women,  mostly  widows,  who  had  had  some 
experience  in  nursing  relatives  and  friends,  but  no  other  training. 
Some  of  these  women  made  in  time  excellent  nurses  as  far  as  the 
care  of  the  patient  was  concerned,  but  of  course,  having  had  no 
medical  training,  they  could  make  no  clinical  notes  or  observa- 
tions, and  were  of  little  direct  help  to  the  doctor.  The  first 
Training  School  for  Nurses  in  the  United  States  was  started 
in  Bellevue  Hospital,  New  York,  in  May,  1873.    In  the  fall 


544 


AN  ADDRESS 


of  1873,  in  the  Massachusetts  General  Hospital  in  Boston,  a 
second  training  school  for  nurses  was  organized,  and  still  later 
in  the  same  year  in  the  Connecticut  State  Hospital  in  New  Haven 
a  third  training  school  was  started.  Since  1873  very  many  train- 
ing schools  in  every  section  of  the  country  have  been  organized. 

During  the  first  twenty  or  thirty  years  of  its  existence,  the 
nursing  in  St.  Peter's  was  done  practically  entirely  by  the  Sisters. 
And  in  those  early  days,  before  success  in  practice  came  to 
destroy  my  real  scientific  work  in  medicine,  when  I  spent  as 
many  hours  in  the  hospital  wards  as  I  do  minutes  now,  I  had  an 
opportunity  to  judge  of  their  nursing.  It  was  excellent,  and 
where  all  were  good,  it  seems  unjust  to  mention  any  names;  but 
I  remember  so  vividly,  many  desperate  cases  which  I  and  Sister 
Martina  in  the  men's  ward,  and  Sister  Agnes  in  the  women's 
ward,  struggled  over  day  after  day,  and  I  never  wish  for  better, 
more  intelligent,  more  devoted  nurses  to  help  me.  Even  in  those 
days  the  Sisters  needed  some  help,  and  Thomas  in  the  men's 
ward,  and  Maggie  McXulty  in  the  women's  ward,  were  faithful 
souls  who  did  their  best  and  who  gained  some  little  knowledge 
of  nursing,  and  left  the  hospital  to  care  for  private  patients,  but 
later  came  back  to  St.  Peter's,  both  with  inoperable  cancers,  to 
die  amid  the  scenes  of  their  former  labors.  But  as  St.  Peter's 
grew  larger,  the  Sisters  were  obliged  to  give  more  and  more  time 
to  its  management,  and  to  get  more  and  more  help  in  the  nursing ; 
for  Sister  Philomena  knows  well  how  great  is  the  labor  and  how 
heavy  are  the  cares  and  anxieties  of  the  management  of  a  large 
hospital.  Then  the  garb  of  a  Sister  is  not  suitable  for  surgical 
wrork,  and  Sister  Immaculata,  whose  supervision  is  so  indis- 
pensable in  our  operating  room,  has  been  obliged  to  change  her 
colors  and  to  don  a  raiment  so  white  that  it  can  the  more  readily 
be  kept  as  spotless  as  is  her  character  and  her  name. 

For  these  and  other  reasons,  it  was  decided  a  few  years  ago 
to  start  a  training  school  in  St.  Peter's,  and  of  this  training  school 
you  are  some  of  the  brightest  products.  And  I  consider  that 
you  are  especially  fortunate  in  being  graduates  of  this  school  for 
two  reasons.  First,  because  you  have  a  history  and  a  tradition 
behind  you.  You  have  been  taught  by  members  of  a  great  guild 
or  order  of  nurses  extending  back  over  centuries.  All  the  tra- 
ditions of  nursing  during  these  centuries  are  theirs  to  be  trans- 
mitted to  you.  The  second  reason  is,  that  you  have  been  taught 
nursing  by  those  who  nurse  from  the  very  highest  motives. 


THE  ETIOLOGY  AND  TREATMENT  OF  HEMORRHOIDS 


Motives  of  self  sacrifice,  of  duty,  of  love  of  God.  You  have 
chosen  nursing  as  a  means  of  earning  your  living.  It  is  right 
that  you  should  be  paid  for  your  service,  and  I  hope  and  believe 
that  you  will  make  a  good  living  and  be  able  to  lay  up  money  for 
your  old  age,  if  you  do  not  early  stray  from  nursing  into  the  more 
blessed  state  of  matrimony,  as  so  many  nurses  do  just  when  they 
are  most  capable  in  their  profession.  But  you  ought  to  thor- 
oughly appreciate  that  there  is  something  more  than  the  pecuniary 
side  to  nursing.  It  is  a  noble  vocation.  When  by  doing  just  the 
right  thing  at  just  the  right  time  in  a  critical  case  you  save  a 
person's  life,  you  have  done  something  which  money  cannot  re- 
pay. You  have  earned  not  only  the  patient's  money,  but  also  his 
gratitude.  You  have  done  a  good  deed  and  the  world  is  better 
for  it.  In  such  a  high  vocation,  the  fact  that  you  have  graduated 
at  this  school  should  always  be  an  inspiration  to  you,  should 
make  you  look  upon  nursing  not  only  as  a  means  of  earning 
money,  but  as  a  high  calling  in  which  you  should  strive  to  do  the 
most  disagreeable  duties  cheerfully  and  gladly,  and  in  which  you 
should  make  your  work  and  your  life  a  blessing  to  all  who  come 
in  contact  with  it,  pleasing  to  God  and  man.  You  have  been 
taught  in  the  hospital  the  details  of  nursing,  but  while  doing  so, 
I  think  that  the  graduates  of  St.  Peter's  Hospital  Training  School 
must  catch  from  the  Sisters  an  inspiration  which  will  fill  their 
souls  with  the  spirit  of  duty  and  self  sacrifice,  and  will  add  to 
the  technical  skill  of  their  hands  a  spiritual  longing  of  their  hearts 
towards  the  highest  ideal  of  the  perfect  trained  nurse. 


THE  ETIOLOGY  AND  TREATMENT  OF 
HEMORRHOIDS. 

Read  before  the  Medical  Society  of  Glover  sville,  March,  igo6. 
By  DOUGLAS  C.  MORIARTA,  M.  D. 

Mr.  President  and  Gentlemen: 

The  subject  I  am  to  present  this  evening,  "The  Etiology  and 
Treatment  of  Hemorrhoids,"  was  elected  by  our  president. 
I  have  absolutely  nothing  original,  either  in  thought  or  pro- 
cedure, to  suggest;  so  shall  only  review  the  subject,  emphasiz- 


546        .THE  ETIOLOGY  AND  TREATMENT  OF  HEMORRHOIDS 


ing  such  detail  as  has,  I  believe,  made  my  personal  work  in  this 
line  satisfactory. 

The  universal  occurrence  of  this  disease  in  all  mankind 
since  time  immemorial,  stamps  it  as  one  with  which  all  classes 
of  practitioners  must  be  familiar.  It  has  constant  etiological 
factors  which  are  perfectly  comprehended,  though  presenting 
several  different  pathological  conditions,  for  the  correction  c£ 
which  surgeons  have  many  methods  of  procedure.  Thus  far,  no 
single  operation  has  been  universally  accepted  or  adopted  for  the 
varied  conditions  present  in  this  disease,  each  operator  seeming  to 
accept  and  prefer  the  one  with  which  he  is  most  familiar.  The 
chief  interest  in  this  subject  at  present  is  whether  the  operation 
for  internal  hemorrhoids  can  be  successfully  and  painlessly  ac- 
complished with  local  anesthesia,  thus  avoiding  the  loss  of  time 
and  the  danger  of  an  anesthetic. 

The  pathological  condition  comprehended  as  hemorrhoids,  in 
its  strictest  sense,  is  a  varicosity  of  the  hemorrhoidal  vessels, 
whether  of  venous,  capillary  or  arterial  origin.  It  is  common  to 
all  classes,  all  ages,  and  both  sexes.  It  afflicts  the  high  liver, 
as  well  as  the  abstemious,  the  professional  man  as  well  as  the 
laborer,  those  who  are  exposed  to  the  elements  as  well  as  those 
who  are  not,  persons  of  sedentary  as  well  as  those  of  active  habit. 
There  is  no  disease  more  common,  more  tedious,  or  more  annoy- 
ing than  hemorrhoids. 

This  disease  is  another  one  of  the  many  in  which  the 
physician  often  allows  himself  to  lose  prestige  and  be  at  fault 
in  diagnosis  and  treatment.  As  you  all  know,  it  is  common 
for  patients  to  consult  us  concerning  some  rectal  trouble  which 
they  designate  as  piles,  and  ask  us  to  prescribe  for  them.  An 
examination  is  necessary  for  a  diagnosis,  and  is  suggested,  but 
the  patient  refuses  it,  insisting  the  trouble  is  not  serious  enough 
for  that,  or  they  haven't  time,  or  it  is  not  convenient.  So  we 
acquiesce  and  proceed  to  prescribe  an  ointment,  suppositories, 
or  direct  some  particular  local  application,  such  as  ice,  hot 
water,  witch  hazel,  or  similar  remedies,  with  some  internal  pre- 
scription to  relieve  the  bowels  if  indicated.  If  the  patient  is 
not  relieved,  he  may  become  dissatisfied  and  go  to  a  colleague 
who  insists  on  an  examination,  determines  the  trouble  and 
promptly  corrects  it.  The  patient  may  not  have  had  hemor- 
rhoids at  all,  as  the  lay  mind  calls  everything  piles,  from  eczema 
about  the  anus  to  malignant  trouble  in  the  rectum.    Thus  we 


DOUGLAS  C.  MORI  ART  A 


547 


have  through  carelessness  lost  the  respect  of  a  patient.  There 
is  no  excuse  for  any  of  us  not  making  examination  in  this  disease, 
in  either  sex,  at  any  age,  under  proper  conditions. 

The  anatomy  of  the  vascular  system  of  the  lower  rectum, 
or  hemorrhoidal  area,  is  of  much  significance  in  the  etiology 
and  treatment  of  this  disease.  The  arterial  supply  is  peculiarly 
diverse  and  free,  and  comes  from  the  branches  of  the  inferior 
mesenteric,  the  internal  illiac  and  internal  pudic.  The  branches 
of  these  vessels  pierce  the  muscular  wall  of  the  rectum  at  various 
levels.  They  run  parallel  with  each  other,  as  well  as  with  the 
rectum,  and  communicate  freely  by  lateral  branches  and  form  a 
complicated  arterial  plexus.  The  veins  have  a  similar  plexiform 
distribution  in  the  tissues,  just  inside  the  anus,  and  return  in  their 
general  course  parallel  to  the  arteries,  and  pass  through  the  mus- 
cular wall  of  the  rectum  by  innumerable  button-hole  like  openings 
to  empty  into  the  inferior  mesenteric  vein  and  so  on  to  the  portal 
circulation.  These  veins  do  not  have  valves,  and  are  only  loosely 
supported  by  the  surrounding  tissues.  The  remaining  veins,  and 
their  branches,  find  their  way  into  the  inferior  hemorrhoidal  veins, 
finally  reaching  the  general  systematic  venous  circulation.  This 
anastomosis  between  the  portal  and  venous  systemic  circula- 
tions is  a  very  decided  etiological  factor  in  hemorrhoidal  condi- 
tions, and  only  secondary  in  importance  to  the  valveless  veins 
of  the  portal  system.  These  local  veins  may  become  congested, 
secondary  to  diseases  of  the  liver,  the  heart  or  lungs.  Probably 
without  exception  the  primary  cause  of  hemorrhoids  is  a  weak- 
ened or  diseased  condition  of  the  vessels  at  the  lower  end  of  the 
rectum.  This  condition  may  exist  for  a  time,  without  giving  rise 
to  any  wTell-marked  symptoms ,  until  a  phlebitis  occurs,  terminat- 
ing in  thrombosis.  A  hemorrhoid  may  be  the  inflammation  of  a 
single  vein,  or  of  several  veins. 

This  condition  presents  itself  at  a  point  where  the  superior 
and  inferior  sets  of  veins  anastomose,  which  is  just  within 
the  anal  orifice,  often  spoken  of  as  the  hemorrhoidal  area.  If 
only  the  superior  set  of  veins  is  involved,  the  tumors  or  tissues 
are  designated  internal  piles,  and  are  covered  by  mucous  mem- 
brane and  are  inside  the  sphincter ;  w7hile  if  the  inferior  set  is 
involved,  they  are  designated  external  piles,  are  covered  with 
skin,  and  are  outside  the  sphincter. 

The  exciting  causes  may  be  from  the  portal  or  general  systemic 
circulation,  straining  incident  to  constipation,  cystitis,  vesicle 


548        THE  ETIOLOGY  AND  TREATMENT  OF  HEMORRHOIDS 

calculi,  enlarged  prostate,  anal  fissure,  stricture  of  the  urethra  or 
rectum,  or  from  tumors  causing  pressure  such  as  pregnancy,  dis- 
placed organs,  or  growths  in  the  pelvis  ;  also  excesses  in  highly 
seasoned  food,  alcoholic  beverages,  violent  exercise,  exposure  to 
cold,  or  occupation. 

The  general  treatment  of  hemorrhoids  will  be  considered  under 
three  sub-divisions,  prophylactic,  palliative  and  operative  meas- 
ures ;  and  anatomically,  in  two  divisions,  internal  and  external. 

From  what  has  been  stated,  the  necessity  of  an  early  diagnosis 
must  be  apparent.  This  can  only  be  determined  by  a  careful 
physical  examination  of  the  heart,  lungs,  liver  and  pelvis  ;  and 
the  local  examination  of  the  rectum. 

To  make  the  latter,  the  patients  should  be  previously  pre- 
pared by  having  had  a  cathartic  followed  by  an  enema  before 
presenting  themselves  for  the  examination.  The  examiner  should 
have  a  proper  table  (which  should  be  a  firm  one)  and  a  good 
light.  Personally,  I  follow  a  digital  examination  by  one  in  which 
I  use  a  short  cylindrical  speculum  which  must  have  an  obturator 
and  not  be  over  three  inches  long.  Both  the  instrument  and  the 
external  parts  should  be  well  lubricated,  and  we  should  remember 
that  the  instrument  when  being  introduced  should  first  point 
upward  and  forward,  and  then  backward.  After  it  is  in  place, 
withdraw  the  obturator,  and  when  you  are  ready  the  instrument 
is  slowly  withdrawn,  when,  with  a  good  light,  all  parts  of  the 
rectal  mucous  membrane  reached  by  the  speculum  can  be  per- 
fectly seen.  If  one  realizes  that  ninety  per  cent,  of  all  the 
lesions  of  the  rectum  lie  within  two  inches  of  the  anus,  it  is  easy 
to  appreciate  the  value  of  a  full-sized  short  speculum.  Fre- 
quently the  parts  are  so  painful  that  an  examination  is  not 
practicable  without  local  anesthesia.  The  application  of  cocaine 
to  the  parts,  a  solution  externally  and  a  suppository  of  the  same 
inside  the  sphincter,  makes  an  examination  under  these  sensitive 
conditions  possible  and  essentially  painless. 

Prophylaxis  is  a  potent  factor  in  the  treatment  of  hemorrhoids 
and  is  of  value  not  only  in  advising  those  patients  who  are  peri- 
odically afflicted  with  hemorrhoids  how  to  avoid  an  attack,  but  is 
of  equal  value  in  the  cases  in  which  exacerbations  occur  that  are 
not  operable.  The  prophylactic  treatment  includes  the  correcting 
of  the  diet,  habits,  and  occupation  of  the  patient ;  also  the  correct- 
ing of  any  portal  or  general  venous  congestion  by  the  appropriate 
remedies.    It  also  includes  the  correction  of  straining  from  con- 


DOUGLAS  C.  MORIARTA 


549 


stipation,  rectal  or  urethral  stricture,  enlarged  prostate,  vesical 
calculi  or  cystitis ;  and  further,  the  correction  by  operation  or 
otherwise  of  the  pressure  incident  to  growths,  or  displaced 
organs  within  the  pelvis  that  interfere  with  the  return  venous 
circulation. 

Palliative  treatment  is  frequently  a  necessity ;  at  other  times  an 
expedient  measure. 

Under  the  first  head  are  (a)  the  patients  whose  organic  com- 
plications contra-indicate  surgical  procedure;  (b)  those  patients 
whose  hemorrhoids  are  secondary  to  pathogenic  lesions  already 
enumerated;  (c)  those  patients  who  are  willing  to  submit  to 
operative  measures,  but  are  not  in  a  proper  physical  condition. 

The  second  class  includes  those  who  absolutely  refuse  opera- 
tive procedure.  They  prefer  to  go  on  from  month  to  month,  or 
from  year  to  year  a  slave  to  their  daily  stool  and  their  own  bath 
room.  They  are  able  to  be  about,  except  at  time  of  exacerbation, 
when  they  are  forced  to  rest.  Their  daily  routine  consists  in 
washing  the  parts  with  cold  water  after  stooling,  followed  by 
some  bland  lubricant,  to  aid  in  returning  the  parts  inside  the 
sphincter. 

All  palliative  treatment  is  similar.  The  patient  should  go  to 
bed  in  acute  conditions,  the  pelvis  should  be  elevated,  the  bowels 
moved  with  some  gentle  evacuant  (at  which  time  we  should  insist 
on  their  using  a  bed-pan).  The  diet  should  be  of  the  plainest, 
restricted  and  non-stimulating.  Ice  locally  is  grateful  at  times, 
as  is  dry  heat.  The  parts  should  be  thoroughly  cleaned  after 
each  stool  with  cold  water,  and  some  astringent  applied,  per- 
haps combined  with  a  sedative.  If  hemorrhages  are  of  frequent 
occurrence,  they  must  be  remedied ;  or  the  patient  will  become 
anemic,  or  even  exsanguinated.  The  remedy  depends  somewhat 
upon  the  etiology.  If  from  constitutional  venous  congestion, 
this  must  be  overcome ;  if  from  pressure,  that  must  be  relieved. 
If  due  to  local  hemorrhage,  the  use  of  astringents,  cold  water, 
ice,  solution  of  adrenalin,  or  best  of  all,  local  pressure,  will  be  of 
service. 

In  the  operative  treatment  of  hemorrhoids,  we  must  con- 
sider their  anatomical  situation,  i.  e.,  whether  internal  or  external 
to  the  sphincter,  as  they  require  different  procedures.  External 
piles  are  easily  and  painlessly  removed  with  local  anesthesia. 
They  are  either  single  or  multiple,  and  are  situated  just  at  the 
muco-cutaneous  junction,  are  blue  in  color,  and  only  covered  by 


550        THE  ETIOLOGY  AND  TREATMENT  OF  HEMORRHOIDS 


the  skin.  They  are  distinct  in  contour,  and  when  acute,  are  very 
painful. 

After  the  parts  are  anesthetized,  they  are  incised  when  the 
clot  or  clots  are  turned  out ;  the  relief  is  instantaneous  and  per- 
manent, if  all  the  clot  is  removed.  If  a  bleeding  point  is  ob- 
served, it  must  be  controlled,  and  a  bit  of  gauze  packing  will  pre- 
vent refilling.  Should  they  refill  they  are  to  be  reopened.  If 
this  line  of  treatment  is  rejected,  the  tumors  ultimately  contract, 
and  a  tab  of  skin  remains ;  this  can  be  readily  snipped  off.  In 
opening  an  acute  pile  without  local  anesthesia,  use  a  sharp  curved 
bistoury  and  cut  quickly,  as  the  process  is  very  painful  though 
of  short  duration. 

Internal  hemorrhoids  are  venous,  capillary  or  arterial,  pedicu- 
lated  or  sessile,  single  or  multiple,  and  occasionally  involve  the 
entire  pile-bearing  area.  They  appear  first  in  defecation,  and 
return  when  the  effort  is  over.  The  sphincter  is  often  irritable, 
and  grasps  and  strangulates  the  hemorrhoid ;  at  other  times,  they 
burst  from  the  force  of  the  sphincter,  and  there  is  free  hemor- 
rhage. In  this  condition,  relief  comes  by  pressing  them  back  into 
the  rectum.  At  other  times  they  do  not  remain  in  at  all,  if  the 
sphincter  is  relaxed ;  thus  while  they  are  really  internal  piles,  they 
are  habitually  external  in  position.  As  you  know,  there  are  sev- 
eral methods  of  treatment,  with  their  many  modifications.  I  shall 
not  attempt  to  mention  them  all,  but  confine  myself  to  those 
which  seem  most  important  for  us  as  general  practitioners  to 
discuss. 

The  injection  method,  which  has  had  such  a  meteoric  prom- 
inence, originating  with  the  quack,  and  revealed  to  the  profes- 
sion by  Dr.  Andrews,  I  only  mention  to  condemn.  Any 
surgical  procedure  which  has  such  a  large  percentage  of  serious 
complications  and  fatalities  is  not  justifiable  in  my  judgment, 
under  any  circumstances ;  even  if  the  patient  is  willing  to 
accept  the  risk  because  of  personal  reasons.  Because  of 
its  former  prominence,  a  short  review  of  it  is  permissible. 
Dr.  Andrews  became  aware  of  the  work  done  by  quacks,  in 
this  line,  and  proceeded  to  investigate.  It  seems  that  Mitchell 
of  Illinois  was  the  man  to  originate  the  method.  He  adver- 
tised freely,  and  as  a  result  had  many  patients,  with,  it  is 
said,  marvellous  results.  He  also  sold  to  anyone  the  method 
and  formula  used  for  injecting  the  hemorrhoids  and  gave  in 
such  sale  exclusive  territorial  rights  to  their  use.    For  a  time 


DOUGLAS  C.  MORI  ART  A 


551 


after  the  method  and  solution  became  known,  some  practitioners 
advocated  the  method,  but  later,  after  a  large  experience  con- 
demned it,  because  of  numerous  anxious  complications,  with 
some  fatalities.  Thus  it  stood  until  Martin  of  Philadelphia 
published  his  article  on  the  subject  in  American  Medicine, 
August,  1904.  Martin  believes  the  unfavorable  complications 
due  entirely  to  the  solution  formerly  employed.  He  advocates 
the  use  of  the  original  phenalsodique  solution,  from  which  he 
reports  most  satisfactory  results.  He  also  advocates,  as  part 
of  the  treatment,  the  dilation  of  the  sphincter.  This  he  does  in 
his  office,  and  uses  nitrous  oxide  gas  as  an  anesthetic.  He  be- 
lieves that  the  results  he  now  obtains  are  due  to  the  solution  he 
employs,  and  his  extreme  skill  and  familiarity  with  the  procedure  ; 
though  he  admits  the  necessity  of  daily  observation  of  his  patients, 
for  complications,  that  they  may  receive  immediate  treatment; 
otherwise  the  method  would  be  less  satisfactory. 

The  ligature  operation,  which  is  one  of  the  oldest  for  the 
disease,  has  many  advocates.  I  can  neither  endorse  nor  condemn, 
as  I  have  had  no  experience  with  it. 

Whitehead's  operation  has  many  advocates,  and  an  equal 
number  who  object  to,  and  have  discarded  it  after  what  they 
claim  is  a  fair  trial.  Whitehead's  claim  is  that  piles  are  not 
independent  tumors,  but  a  part  of  the  general  plexus  of  veins, 
and  that  they  are  severally  and  equally  affected  by  the  same 
cause,  whether  constitutional  or  mechanical.  He  accordingly 
advocates  the  removal  of  the  entire  pile  area.  Those  who  con- 
demn the  Whitehead  operation  do  so  on  the  following  grounds : 
first,  because  of  the  large  amount  of  blood  lost ;  second,  because 
of  the  length  of  time  required ;  third,  because  of  poor  results ; 
fourth,  because  it  is  unscientific  and  not  effectual.  Personally, 
the  method  has  served  me,  and  I  will  surely  make  use  of  it 
again  when  indicated. 

The  clamp  and  cautery  is  the  procedure  of  my  election;  I 
feel  familiar  with  it,  and  I  have  never  had  any  complications  or 
untoward  symptoms  from  its  use,  nor  have  I  ever  had  occasion 
to  operate  a  second  time  on  the  same  patient. 

Pennington  of  Chicago  mentions  a  method  which  I  have 
never  tried,  but  which  I  shall,  as  it  seems  feasible.  He  removes 
an  ellipse  from  the  summit  of  each  hemorrhoid  and  through 
these  incisions  dissects  the  hemorrhoidal  tumor.  The  mucous 
membrane  then  falls  into  place.    His  dressing  is  a  rectal  tube 


552         THE  ETIOLOGY  AND  TREATMENT  OF  HEMORRHOIDS 

which  he  leaves  in  place  for  forty-eight  hours,  when  it  is  easily 
removed  with  the  first  stool.    His  results  are  satisfactory. 

When  we  are  arranging  for  an  operative  case  of  internal 
hemorrhoids,  there  are  several  conditions  to  be  determined. 
First,  is  the  patient  a  proper  subject  for  an  anesthetic?  i.  e., 
are  the  kidneys,  heart  and  lungs  in  a  condition  warranting  the 
procedure ;  second,  can  this  operation  be  done  successfully  with 
local  anesthesia? 

I  have  always  given  an  anasthetic  when  operating  for  inter- 
nal hemorrhoids,  and  believed  it  necessary.  Others  do  not; 
notably,  Gant,  who  reported  some  two  years  ago  the  value  of 
pressure  anesthesia  by  the  use  of  sterile  water  directly  into  the 
tumors  and  surrounding  tissues.  He  has  found  this  procedure 
satisfactory  from  his  own  and  the  patients'  standpoint,  in  over  200 
cases.  He  reports  doing  all  his  work  in  this  way,  and  has  been 
able  to  discard  entirely  general  anesthesia.  He  reports  the 
patients  able  to  be  up  and  about  immediately  after  the  opera- 
tion ;  and  states  that  the  local  anesthesia  is  sufficient  for  either 
the  ligature  or  clamp  and  cautery  operation,  though  he  prefers 
the  ligature  as  the  patient  is  to  continue  his  vocation  and  hemor- 
rhage is  less  apt  to  complicate  the  convalescence.  His  method 
is  to  dilate  the  sphincter  first,  without  an  anesthetic.  If  he  does 
this,  he  is  certainly  very  clever,  for  to  be  able  to  dilate  a 
sphincter  without  pain,  or  at  all  without  an  anesthetic,  seems 
almost  an  exaggeration  to  one  familiar  only  with  the  usual  pro- 
cedure. I  propose  to  give  myself  the  pleasure  in  the  near  future 
of  witnessing  Dr.  Gant's  procedure,  and  trust  I  may  be  able  to 
accept  all  he  publishes. 

Third.  Is  the  case  one  in  which  we  would  be  justified  in  at- 
tempting to  operate?  To  decide  this,  we  must  consider  the 
etiology  of  this  particular  case  of  piles ;  for  certainly  we  would 
not  operate  on  a  case  in  which  the  portal  or  venous  systems  were 
at  fault ;  or  in  cases  due  to  spasm,  pressure  or  malignancy. 

Fourth.  What  method  shall  we  employ?  This  question  is 
always  a  personal  one. 

Fifth.  Is  there  any  condition  in  acute  cases  in  which  operative 
procedures  per  se  are  contra-indicated  ?   I  believe  not. 

The  operation  being  decided  on,  the  first  thing  is  to  prepare 
the  patient.  I  prefer  to  have  the  patient  under  observation 
for  seventy-two  hours,  though  of  course  a  less  time  is  permis- 
sible in  an  emergency.    The  diet  should  be  arranged  and  re- 


DOUGLAS  C.  MORIARTA 


553 


stricted,  particularly  during  the  last  twenty-four  hours.  Calomel 
and  soda  should  be  administered  the  second  night  before  the 
operation,  and  a  saline  the  following  morning. 

The  night  preceding  the  operation,  the  patient  should  have  a 
full  bath,  the  parts  should  be  shaved,  and  a  dose  of  compound 
liquorice  powder  given.  A  full  enema  should  be  given  at  least 
four  hours  before  the  operation,  and  the  nurse  should  know  that 
it  has  all  returned.  Many  operators  wish  the  enema  given  imme- 
diately before  the  operation ;  but  I  have  seen  part  of  it  retained 
so  often,  particularly  with  nervous  patients,  that  I  consider  it 
important  to  take  this  precaution.  Otherwise  the  operator  may 
be  annoyed, — should  it  return  during  the  operation. 

The  usual  surgical  technique  is  to  be  observed.  I  prefer  the 
patient  in  the  lithotomy  position.  After  the  patient  is  anesthe- 
tized, place  a  gauze  tampon,  having  a  tape  attached,  high  in  the 
rectum  to  protect  the  field  of  operation.  Dilate  the  sphincter 
thoroughly,  being  careful  to  avoid  tearing  the  mucous  mem- 
brane or  injuring  the  deeper  tissues.  I  believe  dilation  of  the 
sphincter  is  of  the  greatest  value  in  all  operations  for  internal 
hemorrhoids.  The  field  of  operation  is  more  accessible,  venous 
hemorrhage  is  materially  less,  the  patient's  convalescence  is  more 
comfortable,  there  is  scarcely  ever  retention  of  urine,  and  seldom 
any  tenesmus.  Now  irrigate  the  rectum,  with  sterile  salt  solu- 
tion, and  you  are  ready  to  do  the  operation  of  your  election. 

If  the  ligature  is  to  be  used,  grasp  the  hemorrhoid  with  a 
small  tenaculum,  and  with  the  scissors,  cut  through  the  mucous 
membrane,  just  inside  the  muco-cutaneous  juncture.  The  in- 
cision is  carried  up  the  bowel  on  either  side  of  the  pile,  leaving 
only  an  isthmus  at  the  top  composed  of  mucous  membrane  and 
blood  vessels.  The  pile  is  now  drawn  out  and  securely  ligated 
at  its  base  with  braided  silk.  Operate  on  as  many  tumors  as  is 
indicated,  after  which  they  are  returned  within  the  sphincter. 
The  ligatures  usually  slough  off  on  the  tenth  day. 

If  Whitehead's  operation  is  to  be  done,  each  quadrant  of 
tissue  about  the  anus  is  grasped  at  the  muco-cutaneous  junction 
with  a  pair  of  forceps  which  are  held  by  an  assistant.  Then  with 
a  pair  of  scissors,  the  mucous  membrane  is  incised  just  inside 
its  junction  with  the  skin,  for  the  entire  circumference  of  the 
bowels.  If- this  is  well  done,  it  is  very  easy  to  separate  the  mucous 
membrane,  and  attached  hemorrhoid,  from  the  muscular  tissues 
and  bring  down  the  cuff  until  we  are  above  the  pile-bearing 


554         TIIE  ETIOLOGY  AND  TREATMENT  OF  HEMORRHOIDS 

area.  We  now  completely  sever  the  cuff  at  a  point  above  the 
piles,  transversely,  in  limited  stages,  controlling  all  hemorrhage 
as  we  proceed  either  by  ligature  or  twisting.  The  upper  margin 
of  the  cuff  is  brought  down  and  attached  to  the  muco-cutaneous 
margin  with  a  running  suture,  which  must  be  very  loosely  ad- 
justed and  must  never  be  tightened  to  control  hemorrhage. 

If  Pennington's  method  is  used,  remove  an  elliptical  piece 
of  mucous  membrane  from  each  pile,  and  then  remove  the 
entire  tumor,  through  this  opening.  The  mucous  membrane 
collapses  and  covers  the  denuded  portion. 

If  the  submucous  ligature  suggested  by  Dr.  Ricketts  is  em- 
ployed, a  silk  ligature  is  introduced  under  the  mucous  membrane, 
commencing  at  the  muco-cutaneous  line,  and  extending  to  the 
upper  border  of  the  pile  area ;  it  is  then  reintroduced  at  the 
point  of  emergence  and  carried  to  the  original  point  of  entrance. 
This  leaves  both  ends  of  the  ligature  just  outside  the  anus.  As 
many  of  these  ligatures  are  placed  as  are  required,  and  when 
all  are  in,  they  are  then  tied.  Dr.  Ricketts'  claim  is  that  no 
tissue  is  sacrificed,  no  hemorrhage  or  infection  occurs,  and  per- 
fect cure  results. 

If  the  clamp  and  cautery  operation  is  to  be  done,  seize  the 
tissue  with  a  forceps,  adjust  the  clamp,  first  cutting  the  mucous 
membrane  just  inside  the  muco-cutaneous  line,  and  apply  the 
cautery  at  a  dull  heat,  practically  cooking  the  tissue  down  to 
the  clamp.  If  there  is  an  excess  of  tissue,  it  can  be  removed 
with  the  scissors  before  the  cautery  is  applied.  As  many  piles 
are  removed  as  indicated.  In  doing  the  operation,  we  must 
be  careful  to  place  the  clamp  parallel  with  radiating  lines  of 
tissue,  not  to  take  too  much  tissue  in  our  clamp,  and  not  to 
cauterize  the  adjoining  tissue.  The  operation  is  done  very 
quickly.  I  have  never  seen,  as  I  have  said,  any  untoward  re- 
sults from  it,  nor  have  I  ever  had  to  operate  a  second  time. 
In  doing  the  operation,  a  Pacquelin  cautery  is  essential,  and  a 
clamp  whose  jaws  are  parallel  gives  the  greatest  protection  from 
hemorrhages,  as  the  crushing  of  the  tissue  by  such  an  instrument 
will  be  uniform.  The  original  clamp  of  Smith  does  not  possess 
this  advantage,  though  it  is  the  one  I  have  always  used.  The 
patient  is  up  and  about  in  from  six  to  ten  days.  For  a  dress- 
ing, I  use  a  rectal  plug  about  three-fourths  inch  in  diameter, 
made  by  winding  gauze  over  a  rubber  tube,  four  inches  long  and 
one-fourth  inch  in  diameter,  all  being  covered  by  rubber  tissue. 


SANITARY  DEPARTMENT  OF  ARMIES 


555 


When  this  is  introduced,  adjust  a  full  dressing  of  gauze,  which 
is  held  in  place  by  a  T  bandage  snugly  adjusted;  much  unneces- 
sary discomfort  results  if  this  is  not  done.  The  plug  is  of  value 
in  case  of  flatus,  and  also  makes  pressure  which  controls  hemor- 
rhage, if  such  were  to  occur.  The  patient  is  now  placed  in  bed, 
with  the  foot  of  the  bed  elevated,  while  the  usual  precautions 
after  an  anesthetic  are  observed.  If  the  pain  is  severe,  a  seda- 
tive is  indicated.  Defer  its  use  if  practicable.  The  nurse  must 
bear  in  mind  the  possible  retention  of  urine  and  act  accordingly. 
At  the  end  of  twenty- four  hours,  an  enema  is  given  through  the 
tube  in  the  rectal  plug,  and  all  allowed  to  come  away.  A  nurse 
should  be  present  at  the  first  movement  of  the  bowels  following 
the  operation.  From  this  time  on,  I  endeavor  to  have  the  patients 
have  a  soft  stool  daily.  The  diet  should  be  moderate  and  non- 
stimulating.  After  a  few  days,  prophylactic  measures  can  be 
prescribed. 

The  treatment  of  the  complications  following  operative  pro- 
cedures I  have  not  taken  up,  as  they  are  met  in  the  usual  way. 


THE  SANITARY  DEPARTMENT  OF  ARMIES  AND  THE 
MILITARY  MEDICAL  OFFICER  * 
By  JOHN  VAN  RENSSELAER  HOFF,  A.  M.,  M.  D., 

Colonel.  Assistant  Surgeon  General,  U.  S.  Army. 
{Concluded  from  July  Annals,  page  482.) 
The  Management  and  Control  of  Military  Hospitals. 

The  various  hospital  establishments  of  armies  of  course 
differ  in  name,  and  sometimes  in  interior  economy,  but  are 
identical  in  function.    They  are: — 

First.  Permanent,  station  (post),  general  (base,  fixed,  home, 
water-cure,  special  sanitoria,  etc.) 

Second.  Temporary  or  Mobile,  regimental  (battalion  or  bat- 
tery), divisional  (brigade,  communicating),  floating  (ships,  boats, 
sick-bay),  ambulant  (railroad  trains,  wagons,  etc.) 

Regulations  governing  military  hospitals  are  more  or  less 
detailed  in  different  armies,  but  everywhere  much  must  be  left 

*  Part  of  a  course  of  lectures  on  military  sanitation  delivered  before  the  Medical  School, 
University  of  Nebraska. 


4 


556 


SANITARY  DEPARTMENT  OF  ARMIES 


to  lex  non  scripta,  which  can  only  be  learned  from  precept  and 
experience. 

In  most  countries  even  in  peace-time  military  general  hospitals 
are  maintained  to  meet  the  current  requirements  of  their  armies 
and  to  be  ready  for  immediate  expansion  in  case  of  war.  Ex- 
perience has  taught  that  accommodations  in  fixed  hospitals  at 
the  base  will  be  required  for  at  least  ten  per  cent,  of  the  roster- 
strength  of  an  army  in  active  service,  while  five  per  cent,  will 
suffice  for  all  ordinary  demands  during  peace.  Moreover, 
experience  has  further  taught  that  base  hospitals  should  at  all 
times  be  maintained  of  sufficient  capacity  to  meet  the  extreme 
requirements  of  an  actually  organized  army,  no  matter  if  that 
army  be  active  or  inactive. 

In  the  United  States  army  general  hospitals  only  are  under 
command  of  the  Surgeon  General.  It  must  be  understood, 
however,  that  in  that  army  all  hospitals  of  whatever  kind  are 
under  immediate  command  of  medical  officers,  who  are  respon- 
sible to  the  general  or  other  line  officer  commanding,  except  as 
specified. 

Paragraph  1467,  U.  S.  Army  Regulations,  reads:  "General 
hospitals  will  be  under  the  exclusive  control  of  the  Surgeon 
General,  and  will  be  governed  by  such  regulations  as  the  Secre- 
tary of  War  may  prescribe.  The  surgeon  in  charge  will  command 
the  same       *       *       *  ." 

Paragraph  1468  reads:  "Hospital  transports,  boats,  and 
railroad  trains,  after  being  properly  assigned  as  such,  will  be 
exclusively  under  control  of  the  Medical  Department    *    *  *." 

The  full  meaning  of  this  will  be  appreciated  when  it  is  learned 
that  on  December  17th,  1864,  the  capacity  of  the  military 
general  hospitals  in  the  Unit°.d  States  was  118,057  beds,  of  which 
number  83,400  were  occupied. 

It  may  be  said  that  the  general  hospital  is  a  development  of 
the  station  hospital,  as  the  brigade  is  the  development  of  a 
regiment,  and  a  regiment  of  a  company.  Indeed,  in  many 
armies  this  is  the  process  of  expansion  followed  in  passing  from 
peace  to  war,  the  station  or  fortress  hospitals  becoming  general 
hospitals.  In  the  United  States  during  the  Spanish-American 
war  three  entire  posts — Forts  Myer,  Thomas  and  McPherson — 
were  converted  into  general  hospitals,  with  an  aggregate  accom- 
modation of  3,000  beds.  This  however  was  but  a  drop  in  the 
bucket,  ten  times  that  number  should  have  been  available. 


JOHN  VAN  RENSSELAER  HOFF 


557 


A  military  hospital  may  be  regarded  as  a  combination  of 
hotel,  barracks,  and  department  store,  with  an  operating  room 
annex,  and  it  goes  without  saying  that  its  satisfactory  manage- 
ment demands  careful  organization,  a  well-instructed  personnel, 
and  exact  administration. 

A  standard  United  States  army  hospital  for  a  regimental 
post  has  accommodations  for  sixty  patients.  For  convenience 
in  administering  such  a  hospital  it  should  be  divided  into  depart- 
ments as  follows:  Records,  property,  mess,  wards,  patients' 
effects,  laboratories  and  operating  rooms,  squad  rooms  for 
hospital  corps;  outside  dependencies,  including  ambulance 
house,  stable  repair  shop,  garden,  grounds,  etc. 

Each  one  of  these  departments  should  be  under  the  immediate 
charge  of  an  officer  or  noncommissioned  officer  and  such  number 
of  assistants  as  may  be  necessary.  The  duties  of  the  personnel 
should  be  specifically  described  in  standing  orders,  and  every 
chief  of  a  department  should  be  held  to  a  strict  observance  of 
orders. 

The  management  of  a  small  hospital  is  not  difficult,  particu- 
larly if  everything  is  systematized,  but  when  such  an  institution 
develops  into  a  great  general  military  hospital,  with  a  thousand 
patients  and  the  necessary  personnel,  it  becomes  one  of  the 
most  exacting  commands  a  military  officer  can  have  short  of  a 
division,  and  demands  administrative  ability  of  the  highest 
order. 

The  field  hospitals  for  the  various  units  will  be  considered 
under  "The  Army  in  Active  Service."  It  will  be  seen  that 
the  interior  economy  of  these  organizations,  mutatis  mutandis, 
follows  the  type  of  the  post  hospital. 

As  might  be  supposed,  from  ancient  times  water  transporta- 
tion has  been  used  for  the  conveyance  of  the  sick  and  wounded 
of  armies.  The  primitive  vessels  of  early  days  have  given  place 
to  the  floating  palaces  of  the  present,  and  the  development  of 
the  floating  hospital  has  been  pari  passu.  The  ocean-going 
hospital  ship  "J.  K.  Barnes"  and  the  Mississippi  river  hospital 
boat  "Charles  McDougal"  were  the  outcome  of  the  war  of 
Secession,  upon  which  the  "Relief,"  "Missouri"  and  "Maine" 
represent  an  advance  measured  only  by  the  advance  in  marine 
architecture.  The  interior  economy  of  such  hospitals  is  on 
the  lines  of  other  like  military  organizations. 

Troop  ships  in  the  United  States  service  have  commodious 


558  SANITARY  DEPARTMENT  OF  ARMIES 

sick-bays,  under  command  of  the  ship's  surgeon,  which  accom- 
modate from  20  to  40  patients,  and  are  managed  much  as  is  a 
post  hospital. 

Railroad  ambulance  trains  are  transient  hospitals  on  wheels 
which  have  a  prescribed  personnel  with  adequate  materiel. 

The  Provision  and  Training  of  the  Enlisted  Personnel. 

The  necessity  for  a  trained  body  of  sanitary  soldiers  working 
under  the  immediate  direction  of  medical  officers  has  been  recog- 
nized by  military  sanitarians,  certainly  since  the  days  of  the 
Napoleonic  wars,  and  more  or  less  efficient  organizations  of  this 
character  have  existed  in  some  armies  for  that  time.  In  the 
army  of  the  United  States  up  to  1887  the  work  pertaining  to 
the  interior  economy  of  the  medical  department  was  done  by 
men  detailed  on  "extra  duty"  from  the  line  of  the  army;  their 
connection  with  the  department  was  of  the  most  temporary 
character,  and  they  no  sooner  became  useful  than  they  were 
returned  to  their  companies,  and  others,  uninstructed,  detailed 
in  their  stead.  The  logic  of  the  situation  forced  the  organization 
of  an  ambulance  corps  during  the  war  of  the  Secession,  in  spite, 
strange  to  say,  of  the  most  determined  opposition  from  the 
military  authorities;  but  that  opposition  was  strong  enough  to 
prevent  a  specially  enlisted  force  for  this  purpose,  and  it  and  the 
field  hospitals  continued  to  be  manned  by  temporary  details 
from  the  line.  This  opposition  was  so  far-reaching  that,  not- 
withstanding the  fact  that  a  hospital  corps  had  existed  in  the 
regular  establishment  for  eleven  years,  and  such  an  organization 
was  a  recognized  part  of  most  of  the  State  forces,  Congress 
failed  to  provide  a  hospital  corps  for  the  volunteers  of  1898. 

The  Hospital  Corps  of  the  United  States  army  is  a  body  of 
soldiers  whose  special  function  is  the  care  of  the  sick  and  wounded 
under  all  conditions  of  service.  Its  present  strength  is  about 
3,000  men,  20  per  cent,  of  whom  are  non-commissioned  officers. 

The  grades  are  Sergeant  First  Class,  Sergeant,  Corporal,  Lance 
Corporal,  Private  First  Class,  and  Private.  Privates  are  enlisted 
from  civil  life  by  authority  of  the  Surgeon  General  or  Chief  Sur- 
geon; or  are  transferred  from  the  line  by  the  Secretary  of  War 
or  a  Department  Commander. 

On  enlistment  the  recruit  is  ordinarily  assigned  to  a  company 
of  instruction  for  four  months'  preliminary  training,  and  is 
thereafter  transferred  to  one  of  the  various  detachments  serving 


JOHN  VAN  RENSSELAER  HOFF 


559 


wherever  the  army  may  be.  In  active  service  there  is  a  more 
detailed  organization,  which  wTill  be  considered  later. 

The  preliminary  training,  which  is  necessarily  theoretical,  is 
of  two  kinds,  military  and  technical.  The  military  instruction  is 
for  the  most  part  identical  with  that  for  other  recruits.  In  drill 
regulations  the  Hospital  Corps  men  are  taken  through  the  school 
of  the  company,  including  in  most  services  the  manual  and  use 
of  firearms.  This,  however,  is  not  the  case  in  the  United  States 
army,  instruction  in  the  use  of  arms  not  being  authorized. 

It  goes  without  saving  that  the  Company  of  Instruction  takes 
care  of  itself,  cooks  its  own  food,  polices  its  own  quarters, 
grounds,  etc.,  and  performs  the  numberless  minor  duties  required 
of  all  military  bodies. 

The  technical  instruction  is  in  the  direction  of  the  special  work 
of  the  sanitary  soldier,  and  is  imparted  by  lectures,  recitations, 
demonstrations  and  .practical  exercises. 

When  sufficiently  proficient  the  recruit  is  assigned  to  some  post 
detachment  where  his  practical  work  begins  as  nurse,  cook,  dis- 
penser, clerk,  ambulance  driver,  attendant,  etc. 

The  duty  of  training  his  men  must  necessarily  fall  upon  the 
shoulders  of  the  medical  officer,  as  does  like  duty  regarding  the 
combatant  soldier  fall  upon  the  line  officer,  and  the  value  of  the 
man  is  to  a  considerable  extent  determined  by  the  character 
of  this  instruction.  There  can  be  no  specialists  in  the  Hospital 
Corps  any  more  than  in  the  Medical  Corps.  Each  man  should 
be  equal  to  the  performance  of  any  duty  that  an  emergency 
might  place  upon  him;  and  while,  of  course,  it  is  recognized  that 
no  man  can  do  all  things  equally  well,  he  must  at  least  be  able 
to  do  his  full  duty  in  any  position. 

Privates  First  Class  and  Corporals  are  appointed  on  recom- 
mendation of  immediate  commanders,  without  examination. 
Sergeants  are  appointed  from  these  two  classes  after  a  written 
and  oral  examination.  Sergeants  First  Class  are  appointed  from 
Sergeants  who  have  served  as  such  at  least  one  year,  and  after  a 
competitive,  written  and  oral  examination.  The  pay  and  allow- 
ances of  a  Sergeant  First  Class  approximate  one  hundred  dollars 
monthly,  and  his  duties  are  thus  described  in  regulations:  "To 
nurse  or  supervise  the  nursing  of  the  sick ;  to  compound  and  ad- 
minister medicines ;  to  look  after  and  distribute  hospital  stores 
and  supplies;  to  supervise  the  preparation  and  serving  of  food; 
to  care  for  hospital  property;  to  maintain  discipline  in  hospitals, 


56° 


SANITARY  DEPARTMENT  OF  ARMIES 


and  watch  over  their  general  police ;  to  prepare  reports  and  re- 
turns ;  to  supervise  the  duties  and  assist  in  the  instruction  of  the 
members  of  the  Hospital  Corps  in  garrison  and  field,  and  to  per- 
form such  other  duties  as  may,  by  proper  authority,  be  required." 

From  this  it  will  be  seen  that  the  function  of  the  Hospital 
Corps  is  broad  enough  to  cover  almost  all  the  work  of  the  Medical 
Department.  A  noncommissioned  officer  or  even  a  private 
may  be  the  only  medical  attendant  of  a  considerable  body  of  men ; 
consequently  the  average  of  all  the  members  of  this  organization 
must  be  high,  though  all  must  at  times  be  hewers  of  wood 
and  drawers  of  water  The  pay  and  allowances  of  a  private  have 
a  commutation  value  of  about  fifty  dollars  monthly. 

The  Army  Nurse  Corps. 

In  European  armies  there  are  nursing  sisterhoods,  chiefly  from 
the  national  churches,  who  have  a  defined  relationship  to  the 
military  body ;  and  in  the  British  army  there  is  a  nursing  service 
known  as  "Queen  Alexandra's  Imperial  Military  Nursing  Ser- 
vice," regarding  the  duties  of  which  there  are  very  specific  regu- 
lations and  the  control  of  which  lies  in  a  mixed  board,  civil  and 
military.  Candidates  for  this  service  must  be  of  "British 
parentage,  between  twenty-five  and  thirty-five  years  of  age, 
possess  a  certificate  of  not  less  than  three  years'  training  and 
service  in  medical  and  surgical  nursing  in  a  civil  hospital  recog- 
nized by  the  advisory  board,  and  furnish  satisfactory  references 
as  to  character,  education,  and  social  status." 

When  in  April,  1808,  hostilities  between  the  United  States 
and  Spain  began,  it  may  be  safely  said  that  the  army  of  the 
United  States,  consisting  of  twenty-five  thousand  men,  had 
reached  the  highest  state  of  efficiency  in  its  history.  There  was 
one  army  corps,  complete  in  every  detail,  but  no  trained  reserve 
or  reserve  materiel.  The  Hospital  Corps  was  barely  adequate  for 
the  regular  establishment,  without  a  man  to  spare  for  any  other 
purpose. 

When  the  President  called  for  volunteers,  no  mention  was 
made  of  men  for  a  hospital  corps,  because,  as  previously  stated, 
Congress  had  failed  to  authorize  the  enlistment  of  volunteers 
for  this  service.  The  practical  outcome  of  this  was  that  the 
War  Department  was  forced  to  transfer  a  certain  percentage  of 
men  from  the  volunteer  regiments  into  the  Hospital  Corps  of 


JOHN  VAN  RENSSELAER  HOFF 


the  regular  army.  The  situation  was  not  hopefui,  and  the  sick 
were  suffering. 

In  this  stress  the  trained  nurses  of  the  United  States  offered 
their  services,  and  the  army  and  the  people  owe  a  deep  debt  of 
gratitude  for  the  good  work  they  did  in  the  military  hospitals 
in  1898  especially. 

As  the  result  of  that  war  a  nurse  corps  has  now  become  a  part 
of  the  regular  Medical  Department.  The  exact  relation  of  this 
important  addition  to  the  nursing  force  is  being  determined  by 
time  and  experience.  Ultimately  the  department  will  train  its 
own  nurses,  as  it  does  the  rest  of  its  personnel.  A  training  school 
will  be  established  in  some  great  military  hospital,  where  every- 
thing pertaining  to  military  nursing  will  be  taught.  Indeed, 
this  is  most  necessary,  as  military'  nurses  must  learn  military 
methods,  which  are  very  different  from  those  obtaining  in  civil 
hospitals,  and  they  must  imbibe  the  military  esprit,  the  discipline, 
and  ability  to  control  others.  With  these  they  will  be  fitted  to 
take  charge  of  the  nursing  detachments  in  our  fixed  military 
hospitals  in  active  service,  the  personnel  of  which  will  come  from 
civil  life,  and  without  these  they  can  never  be  real  "soldier 
nurses." 

The  Furnishing  of  Medical  and  Hospital  Supplies. 

The  Medical  Department  of  the  United  States  army  under 
the  law  furnishes  the  medical  and  hospital  supplies  which  its 
own  officers  use;  but  as  this  armamentarium  is  only  a  means  to 
its  own  ends,  this  department  is  not  in  the  same  sense  a  supply 
department  as  are  those  whose  sole  function  is  that  of  supply. 
Indeed,  in  some  armies  the  Medical  Department  has  nothing 
whatever  to  do  with  the  purchase  of  supplies  of  any  character, 
but,  as  previously  stated,  the  development  is  in  the  direction  of 
autonomy  in  materiel  as  well  as  personnel,  and  it  is  now  claimed 
by  many  that  the  sanitary  service  must  lack  in  efficiency  to  the 
extent  that  it  is  denied  the  right  to  supply  everything  it 
needs. 

At  the  same  time,  it  must  be  recognized  that  the  purchase, 
care  and  distribution  of  the  medical  supplies  for  large  armies 
add  immensely  to  the  duties  of  a  department,  and  demand  a 
knowledge  of  business  methods  and  many  trades  and  products 
quite  foreign  to  the  training  and  experience  of  the  civil  prac- 
titioner. 


562 


SANITARY  DEPARTMENT  OF  ARMIES 


The  Medical  Department  in  Active  Service. 

"In  theory,  an  army  should  be  so  trained  for  war  as  to  be 
ready  to  take  the  field  at  literally  a  moment's  notice.  The 
various  parts  composing  it  should  be  so  organized  that  almost 
as  quickly  as  the  telegram  flies,  they  can  be  brought  together 
at  any  point,  prepared  to  commence  those  combined  actions  by 
which  a  body  of  men  are  moved,  fed,  clothed,  kept  supplied  with 
munitions  of  war,  maintained  in  health  or  cured  if  sick,  and  to 
undertake  all  the  engineering,  mechanical,  strategical,  and 
tactical  movements  which  constitute  the  art  of  war." 

It  goes  without  saying  that  such  an  organization  should  be 
proportionately  strong  in  all  of  its  constituent  parts,  or  else 
when  the  stress  comes  the  weaker  part  will  fail  and  the  whole 
apparatus  be  hindered  or  even  put  out  of  operation.  Food, 
transportation,  engineering  and  medical  supplies,  are  preemi- 
nently necessary  in  the  prosecution  of  a  campaign;  and  it  has 
been  well  said  that  "  it  is  a  narrow  and  dangerous  view  which 
sees  in  war  merely  the  movements  of  the  soldier,  without  recog- 
nizing the  less  seen  agencies  which  insure  that  the  soldier  shall 
be  armed,  fed,  clothed,  healthy  and  vigorous." 

In  actual  service  the  work  of  the  medical  department  is  of 
the  most  arduous  and  complex  character,  but  may  be  epitomized 
in  a  single  phrase,  to  free  the  front  of  the  army  of  its  invalids.  This 
is  the  essentially  military  duty  of  the  medical  department, 
and  upon  its  satisfactory  performance  the  successful  outcome 
of  a  campaign  may  depend. 

A  single  illustration  of  the  magnitude  of  the  task  will  serve. 
"In  1863,  at  the  battle  of  Gettysburg,  14,193  of  the  wounded 
of  the  Union  army  were  left  on  the  field  of  battle,  requiring 
professional  care,  and  6,802  of  the  opposing  force,  in  all,  20,995. 
The  strength  of  the  Union  army,  which  provided  accommoda- 
tions for  these  wounded,  may  be  considered  as  90,000.  So 
that  by  one  coup  a  number  equal  to  more  than  23  per  cent,  of 
its  strength  suddenly  required  succor  and  professional  care, 
shelter,  food,  and  transportation." 

Allusion  has  heretofore  been  made  to  general  regulations, 
the  code  of  laws,  rules,  and  orders  governing  armies  under  all 
conditions  of  service.  In  addition,  there  are  also  special  regu- 
lations for  troops  in  campaign,  which  in  the  United  States  army 
are  now  called  Field  Service  Regulations. 

The  Reglement  sur  le  Service  de  Santt  en  Campagne  of  the 


JOHN  VAN  RENSSELAER  HOFF 


French  Army  may  be  accepted  as  a  model  for  all.  Of  these  a 
recent  issue  of  the  Broad  Arrow  says  they  "are  marked  by  a 
thoroughness  and  attention  to  detail  which,  if  carried  into 
effect  in  war-time,  will  result  in  the  complete  efficiency  of  their 
hospital  service  and  a  corresponding  diminution  of  suffering 
to  the  sick  and  wounded.  The  tactical  employment  of  the  ambu- 
lance service  is  most  carefully  treated,  and  what  is  remarkable 
is  the  provision  made  for  its  presence  with  the  most  advanced 
troops." 

The  duties  of  the  medical  department  in  active  service  are 
thus  outlined: 

First.  The  origination,  development,  and  execution  of  sani- 
tary measures  to  preserve  the  health  of  soldiers. 

Second.  The  care  of  the  ill  and  injured  in  camp,  on  the  march 
and  in  battle. 

Third.  The  examination  of  the  sick  and  wounded  to  deter- 
mine who  shall  remain  with  the  command  and  those  who  shall 
be  sent  back  to  the  base. 

Fourth.  The  care  of  those  who  are  to  remain,  and  the  sending 
back  of  those  transferred  to  the  base. 

Fijth.    The  suppression  of  epidemics. 

Sixth.  The  establishment  of  hospitals  of  different  kinds  to 
meet  all  requirements  of  the  service. 

Seventh.  The  organization  of  the  sanitary  service  in  siege 
operations. 

Eighth.  The  supply  of  the  various  sanitary  organizations 
with  medical  and  surgical  materiel. 

In  the  field  the  Medical  Department  of  the  United  States 
Army  is  charged  with  the  following  duties: 

(a)  The  initiation  of  all  hygienic  measures  to  insure  the  good 
health  of  troops. 

(6)  Management  of  epidemics  among  the  inhabitants  of  the 
country  under  military  control  to  prevent  infection  of  new 
territory  or  of  the  army. 

(c)  Care  of  sick  and  wounded  on  the  march,  in  camp,  on  the 
field  of  battle,  and  after  removal  therefrom. 

(d)  Methodical  disposition  of  sick  and  wounded  so  as  to 
assure  the  retention  of  those  effective  on  the  field  of  battle  and 
to  relieve  the  fighting  force  of  the  noneffective. 

(e)  Transportation  of  sick  and  wounded. 

(/)    Establishment  of  new  hospitals  and  utilization  of  old 


5^4 


SANITARY  DEPARTMENT  OF  ARMIES 


ones  sufficient  in  number  and  capacity  to  care  for  all  sick  and 
wounded. 

(g)  Supply  of  troops  and  hospitals  with  all  articles  needed 
for  the  care  of  sick  and  wounded. 

(h)  Preparation  and  preservation  of  individual  records  of 
sickness  and  injury  in  order  that  claims  may  be  adjudicated 
with  justice  both  to  the  Government  and  the  soldiers. 

It  will  be  observed  that  nothing  is  said  of  the  organization 
and  training  of  the  personnel,  for  that  is  essentially  a  peace 
function.  Any  part  of  an  army  whose  training  is  undertaken 
after  war  is  declared,  is  not  likely  to  be  efficient  before  the  war 
ends,  for  in  these  days  wars  will  be  "short,  sharp,  and  decisive." 

In  European  armies  this  training  is  altogether  possible,  since 
every  sound  man  must  serve,  and  the  civil  physicians  of  those 
countries  are  all  more  or  less  trained  soldiers.  In  Great  Britain 
extraordinary  efforts  are  making  to  encourage  a  dissemination 
of  military  knowledge  among  medical  men,  but  in  the  United 
States  neither  the  people  nor  the  medical  profession  seem  to 
be  impressed  by  the  necessity  for  such  action. 

The  passage  from  a  state  of  peace  to  that  of  war  is  not  nec- 
cessarily  attended  with  great  confusion  if  every  thing  has  been 
prearranged,  and  all  materiel  in  store.  On  the  outbreak  of 
hostilities  the  garrison  hospitals  of  a  well-organized  medical 
department  are  expanded  into  general  hospitals  and  manned 
by  a  designated  trained  reserve,  who  relieve  the  "active" 
sanitary  personnel  for  duty  at  the  front;  each  man  falling  into 
his  proper  place,  the  duties  of  which  he  is  quite  familiar  with, 
if  not  by  actual  experience  in  war  at  least  through  precept  and 
practice. 

The  lines  of  sanitary  assistance  are  practically  identical  in  all 
active  armies.  In  battle  each  fighting  unit  is  responsible  for  its 
wounded,  from  its  skirmish  line  back  to  its  own  aid  station. 
There  the  wounded  are  left ,  to  be  taken  thence  by  a  highly  special- 
ized organization  variously  named  in  different  armies,  but  in  all 
with  identical  function.  This  organization  is  essentially  a 
"flying  hospital,"  and  in  the  United  States  army  is  called  an 
Ambulance  Company.  The  Ambulance  Company  is  responsible 
for  all  invalids  in  the  zone  between  the  regimental  aid  stations 
and  the  field  hospitals,  and  is  the  principal  factor  in  freeing  the 
front  of  the  army  of  its  sick  and  wounded.  The  Ambulance 
Company  is  not  so  called  because  part  of  its  equipment  is  am- 


JOHN  VAN  RENSSELAER  HOFF 


56s 


bulance  wagons,  but  because  of  its  extreme  mobility,  and  all  its 
equipment  has  this  fact  in  view. 

This  Company  establishes  and  mans  the  dressing  station,  to 
which  it  transfers  the  wounded  from  the  aid  stations  at  the 
front.  The  dressing  station  may  indeed  be  the  only  field  hos- 
pital available  for  some  time  if  for  any  reason — and  in  active 
service  there  are  often  such — the  field  hospital  fails  to  arrive. 
At  this  station  the  wounded  are  fed,  redressed,  and  emergency 
operations  done ;  then  in  due  time  they  are  moved  back  to  the 
field  hospital,  at  which  point  the  Ambulance  Company  rendezvous 
after  it  has  cleared  the  front  of  wounded.  Its  function  here  is  to 
assist  in  manning  the  field  hospital  and  also  in  carrying  the 
wounded  from  it  still  further  back  to  boat,  train,  or  fixed  hospital. 

The  field  hospitals  are  also  intended  to  be  mobile  and  to  follow 
closely  the  command  to  which  they  may  be  assigned,  but  their 
mobility  cannot  equal  that  of  the  Ambulance  Company,  which 
must  always  be  up  with  its  command,  no  matter  what  the  con- 
ditions may  be.  The  field  sanitary  organizations  on  the  line  of 
communication  are  the  advanced  supply  depot,  fixed  hospitals, 
and  rest  stations;  and  at  the  base,  the  base  hospital,  supply 
depot,  and  convalescent  camp.  The  special  organizations  are 
boat,  ship,  and  railroad  ambulances. 

Each  one  of  these  various  units  has  a  definite  function,  a  fixed 
personnel,  and  prescribed  materiel  equal  to  the  requirements  of  its 
particular  part  of  the  work,  all  of  which  are  laid  down  in  regu- 
lations and  regarding  which  further  remark  here  is  not  deemed 
necessary. 

It  has  been  said  that  war  is  a  widespread  epidemic  of  injuries 
and  special  diseases,  whose  victims  are  the  young  and  strong,  the 
flower  of  the  race,  ordinarily  little  exposed  to  these  conditions. 
To  meet  this  epidemic  medical  departments  exist  and  their  entire 
training,  medical  and  military,  has  this  contingency  in  view.  The 
statistics  of  war  appall  one  with  the  magnitude  of  the  casualty  list. 
In  the  United  States  army  during  the  war  of  Secession  6,454,834 
cases  were  reported  on  the  medical  returns,  of  which  number 
210,400  died  of  disease  and  90,969  of  wounds.  In  the  German 
army  during  the  Franco-Prussian  war  757,200  cases  were  re- 
ported, of  which  17,332  died  of  disease  and  28,278  of  wounds. 
In  the  Turco-Russian  war  the  Russians  reported  919,315  cases, 
of  which  45,791  died  of  disease  and  21,699  of  wounds.  According 
to  the  estimates  of  statisticians  there  perished  in  wars  during  the 


566 


SANITARY  DEPARTMENT  OF  ARMIES 


last  half  of  the  19th  century  2,500,000  human  beings,  while  there 
was  expended  to  carry  them  on  no  less  than  the  inconceivable 
sum  of  $13,000,000,000. 

If  these  statistics  be  correct,  then  during  that  period  the 
medical  department  was  immediately  responsible  for  fifty  million 
soldiers — responsible  not  alone  for  their  professional  care,  but 
for  their  every  material  want. 

The  20th  century  has  begun  as  did  the  19th  in  the  midst  of 
wars  and  rumors  of  war.  We  as  a  nation  have  grown  rich  and 
great,  great  in  the  arts  of  peace,  but  we  are  yet  novices  in  the  art 
of  war.  Our  military  resources  are  inexhaustible,  our  militarv 
availability  is  to-day  almost  negligible. 

We  have  taken  upon  ourselves  the  responsibilities  of  a  world 
power.  We  have  to  be  consulted  in  all  matters  of  world  politics, 
and  yet  we  are  not  in  the  least  prepared  to  sustain  by  force  of 
offence  or  defence,  any  position  we  may  be  thrust  into  which  will 
threaten  our  national  honor  or  integrity. 

We  cannot  escape  war,  and  the  medical  profession  cannot  put 
aside  its  responsibilities  in  this  direction  until  war  comes,  for 
if  it  does,  disaster  to  our  forces  is  sure  to  result.  It  is  the 
bounden  duty  of  every  American  physician  to  know  at  least 
enough  of  the  special  work  of  the  Military  Medical  Officer  to 
enable  him  to  intelligently  take  his  place  with  the  other  soldiers 
of  our  country  when  the  call  to  arms  sounds.  Such  has  not 
heretofore  been  the  case,  and  such  will  not  be  unless,  in  time  of 
peace,  our  medical  students  are  required  to  have  some  knowledge 
of  this  subject,  as  a  prerequisite  to  graduation. 

Nay,  more:  Military  sanitation  should  be  a  subject  in  the 
State  examinations,  and  no  physician  should  be  licensed  to  prac- 
tice medicine  who  could  not  demonstrate  the  ability  to  perform, 
at  least,  the  elementary  duties  of  a  medical  officer  of  Volunteers  in 
war  time. 


VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE  567 

THE  VICTIMS  OF  THE  MEDICIS  AND  THE  BOR- 
GIAS IN  FRANCE  FROM  A  MEDICAL 
STANDPOINT. 

By  CHARLES  GREENE  CUMSTON,  M.  D., 

Boston,  Mass. 

In  going  over  the  history  of  the  XVI  Century  a  series  of 
facts  will  be  found  which  prove  the  rapidity  with  which  the 
Italian  customs  spread  throughout  France.  Letters  and  arts 
reached  a  high  point  of  perfection,  while  the  passions  only 
became  exasperated.  Like  the  Italian  prince,  the  courtier 
no  longer  saw  any  limit  to  his  ambition  and  any  means  were 
acceptable  which  might  bring  his  projects  to  a  successful 
outcome.  Italy  offered  him  a  sure  and  rapid  means  to  rid 
himself  of  those  who  were  an  obstacle  to  his  designs,  and  this 
mysterious  means  was  poison.  It  accomplished  the  end  with- 
out noise  and  without  the  loss  of  blood  and  he  who  had 
administered  it  to  his  victim  could  follow  the  progress  of  the 
slow  and  terrible  death  that  surely  came.  He  saw  the  pale 
and  convulsed  face  of  his  adversary,  heard  the  cries  of  agony 
and  all  this  time  he  knew  that  no  sign  would  denounce  him 
as  guilty.  The  same  care  that  was  given  to  improve  the 
study  of  arts  was  used  in  the  practice  of  poisoning.  It  was 
the  epoch  of  fetes  and  when  one  wished  to  give  death  to  his 
enemy  in  the  midst  of  a  ball,  with  the  shake  of  the  hand  the 
fingers  of  his  victim  were  torn  with  the  ring  armed  with 
poisoned  claws.  It  was  the  epoch  of  the  Borgias.  The  epi- 
demic of  poisoning  made  fearful  ravages  and  L'Estoile  says, 
in  speaking  of  the  execution  of  a  magician  named  La  Miraille, 
that  at  Paris  in  1572  the  number  of  sorcerers  and  manufac- 
turers of  love  philters  was  above  thirty  thousand.  History 
has  preserved  the  name  of  the  most  celebrated  among  them 
and  everyone  is  familiar  with  the  Florentine  Rene  Bianchi  or 
Bianco,  who  came  to  France  with  Catherine  de  Medicis  and 
who,  at  the  same  time,  was  her  confidant  and  accomplice. 
He  it  was  who  furnished  the  Queen  with  poisoned  substances 
of  which  she  had  need  and  it  is  well  known  that  she  passed 
much  time  in  his  shop.  Later  on,  Rene  became  an  assassin 
and  finally  died  miserably.  A  famous  astrologer,  Cosme 
Ruggieri,  was  also  looked  upon  at  this  time  as  a  poisoner; 


568     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 

he  was  accused  of  having  hastened  the  death  of  Charles  IX 
with  Mole  and  Coconnas  and  was  condemned  to  the  galleys. 
The  prior  of  Cluny  and  his  valet,  Saint-Barthelemi,  were  also 
ranked  among  those  who  employed  poisons.  They  caused  all 
those  who  were  any  hindrance  to  them  to  disappear,  even 
their  physicians,  in  order  to  avoid  paying  them.  The  monks 
and  the  nuns  who  had  tried  to  denounce  them  suddenly  died 
and  in  less  than  one  year  they  caused  from  sixty  to  eighty 
persons  to  perish. 

All  these  poison  dramas  have  not  come  down  to  us,  but 
those  which  have  been  related  by  the  contemporary  historians 
are  sufficient  to  show  how  frequent  they  were.    What  still 
more  confirms  their  great  number  is  the  tendency  of  writers 
to  class  all  sudden  deaths  occurring  in  full  health  among 
them.    The  "  Histoire  universelle,"  by  d'Aubigne,  published 
at  Amsterdam  in  1626,  contains  many  instances  of  this  kind. 
Pope  Marcel  the  Second  was  poisoned  on  the  twenty-second 
day  after  his  election  u  because  he  wished  to  reform  the 
Church.    Thus  have  the  Italians  written  before  us,  who  re- 
marked that  in  this  design  he  had  begun  by  not  changing  his 
name."    During  the  religious  wars  poison  was  frequently 
employed  and  the  following  is  an  anecdote  related  by  d'Au- 
bigne/ which  took  place  at  the  siege  of  Chatellerault  and 
Poitiers  in  1569:  "Upon  this  same  day  was  executed  Dom- 
inique d'Albe,  captured  by  the  people  of  Monsieur,  for  having 
killed  or  poisoned  his  master,  the  Admiral;  for  the  head  of 
whom,  likewise  on  that  of  Vidame  de  Chartres,  Count  de 
Montgomeri  and  others,  there  had  been  made  a  promise  for 
the  sum  of  fifty  thousand  escus,  for  the  Admiral,  and  lesser 
sums  for  those  of  less  importance,  and  in  order  to  assure  the 
compensation  and  the  justification  of  the  assassins,  it  was 
expressed  by  a  decision  pronounced  in  the  Court  of  Parliament 
in  Latin,  German,  Spanish,  English  and  French."    In  1570 
Charles,  Prince  of  Spain,  also  died  of  poisoning.    "  He  allowed 
himself  to  call  cruelties,  the  exploits  of  the  Duke  d'Albe  in 
Flanders  and  to  express  his  detest  for  him  by  wishing  for 
executioners ;  it  was  known  that  he  had  had  made  two  pistols 
to  carry  in  his  boots,  that  he  placed  them  under  his  pillow 
with  other  arms  at  night;  it  was  suspected  that  his  intent 
was  to  kill  Jean  d'Austrie,  his  bastard  brother;  and  all  this 
was  declared  by  his  confessor.    And  still  more  a  Jesuit  said 


CHARLES  GREENE  CUMSTON 


569 


that  he  had  considerable  commerce  with  France,  even  with 
Admiral  de  Chastillon.  The  King  of  Spain  became  suspicious 
that  his  son  wished  to  avenge  himself  upon  him  for  having 
taken  away  Queen  Elizabeth,  who  was  devoted  to  him,  so 
that  the  affair  was  communicated  to  the  Inquisition.  It  was 
resolved  to  make  him  prisoner  and  by  the  artifice  of  the  one 
who  had  made  the  pistols,  the  door  of  his  room  being  un- 
locked, the  King  had  all  those  whom  he  believed  to  be  enemies 
of  his  son  enter  the  room  before  him.  They  found  him  sleep- 
ing so  soundly  that  he  was  with  difficulty  aroused.  Then 
seeing  his  father  and  the  others  he  cried  out  that  he  was  dead. 
The  King  after  menacing  him  a  little  said  that  he  only  wished 
to  chastise  him  paternally.  All  his  royal  belongings  were  re- 
moved, as  well  as  his  servants,  and  in  their  place  guards 
dressed  in  mourning  were  substituted.  He  endeavored  to 
commit  suicide  in  various  manners ;  in  the  first  place  he  threw 
himself  into  the  fire,  from  which  there  was  much  difficulty  to 
withdraw  him;  for  two  days  he  would  not  drink  and  on  the 
third  he  nearly  suffocated  on  account  of  taking  too  much 
water;  he  then  tried  starving  and  then  overeating,  and  also 
by  a  diamond  that  his  guards  seized  from  him  just  as  he  was 
about  to  swallow  it;  finally  in  July  he  was  condemned  to  be 
poisoned  and  his  death  was  sealed  in  November.  A  few  days 
later  Elizabeth,  Queen  of  Spain,  went  through  the  same  death 
entirely  by  the  authority  of  the  Inquisition." 

Cardinal  de  Chatillon,  who  was  a  refugee  in  England,  died 
suddenly  at  Canterbury  in  1571,  just  as  he  was  preparing  to 
return  to  France.  His  mother  declared  that  he  had  been 
poisoned.  "An  autopsy  wras  ordered.  Upon  opening  the 
body  the  physician  who  was  in  charge,  having  found  the  liver 
and  the  lungs  corrupted,  said  that  it  was  most  marvellous 
that  the  Cardinal  had  lived  so  long  with  such  deteriorated 
organs  *  *  *  but  it  was  a  question  only  of  poisoning, 
when,  after  having  washed  and  cleansed  the  stomach  some 
spots  were  found  on  its  surface,  as  well  as  a  perforation  in 
its  walls,  with  the  tissues  lacerated  all  about  the  orifice,  as 
the  doctor  said  he  saw.  But  the  condition  of  affairs  was  not 
so  evident  so  that  the  others  present  were  able  to  see  only  a 
few  spots  on  the  sides  of  the  stomach.  It  was  then  the  physi- 
cian who  secretly  told  the  surgeon  and  who  repeated  it  to 
Madame  de  Chatillon  that  he  thought  that  somebody  had 


570     THE  VICTIMS  OF  THE  MEDICIS  AND  BORGIAS  IN  FRANCE 


administered  some  corrosive  substance  to  the  Cardinal  which 
had  resulted  fatally."  Cabanes  and  Nass,  who  relate  this 
story  in  their  work  entitled  "  Poisons  et  Sortileges,"  Paris, 
1903,  comment  upon  the  results  of  this  autopsy  and  come  to 
the  conclusion  that  the  Cardinal  died  of  a  subacute  peritonitis 
resulting  from  a  perforation  of  a  gastric  ulcer. 

We  now  come  to  the  death  of  Jeanne  d'Albret,  Queen  of 
Navarre,  who,  according  to  d'Aubigne,  and  nearly  all  other 
historians,  was  the  victim  of  poison  given  her  at  the  insti- 
gation of  Catherine  de  Medicis.  "  The  Queen  of  Navarre 
was  engaged  in  the  preparation  for  the  marriage  of  the  Prince 
of  Beam  at  Paris,  when  she  was  taken  with  fever,  which  she 
only  resisted  four  days ;  her  death  was  caused  without  any 
secrecy  by  a  poison  communicated  to  her  brain  by  scented 
gloves  and  which  were  given  to  a  person  called  Messer 
Rene,  a  Florentine,  since  then  execrable,  even  to  the  enemies 
of  this  Princess,  by  a  so-called  Saint  Barthelemi,  a  great 
poisoner,  and  accused  of  having  given  death  to  several  princes. 
The  latter  was  the  servant  of  the  Abbe  of  Cluny,  a  bastard  of 
Claude  de  Guise,  and  who  bore  the  name,  and  both  of  them 
were  in  the  employ  of  the  Cardinal  of  Lorraine.  Thus  died 
this  Princess,  a  woman  only  in  sex,  her  entire  soul  given  up 
to  virile  things,  the  mind  powerful  in  great  affairs  and  the 
heart  invincible  in  adversity." 

At  this  time  perfumed  gloves  were  very  frequently  used 
for  murder,  but  it  is  a  very  difficult  matter  to  imagine  what 
substance  would  emit  sufficiently  poisonous  vapors  that  would 
kill  in  a  few  minutes.  It  has  been  supposed  that  Jeanne 
d'Albret  was  presented  with  a  box  having  a  double  bottom 
and  that  in  the  upper  part  were  placed  the  gloves,  while  in 
the  false  bottom  toxic  plants  like  opium,  belladonna,  hyocya- 
mus,  etc.,  had  been  deposited.  These  means  have  been  re- 
lated by  Porta  in  his  "  Magie  naturelle  "  and  he  says  that  it 
was  given  so  as  to  allow  the  administration  of  the  poisons 
during  sleep,  by  exposing  the  box  under  the  nostrils  of  the 
sleeper.  On  the  other  hand,  there  are  historians  wrho  deny 
that  Jeanne  d'Albret  was  poisoned,  and  among  them  may  be 
found  many  who  are  authority,  such  as  Palma  Cayet,  the 
assistant  preceptor  of  the  Prince  of  Navarre,  who  later  on 
became  Henri  IV.  He  believed  that  the  Queen  died  of  a 
pulmonary  abscess  and  states  that  her  surgeon  performed  the 


CHARLES  GREENE  CUMSTON 


571 


autopsy.  The  body  and  skull  were  opened  in  the  presence 
of  the  Queen's  physician  and  several  officers  of  her  household, 
who  were  still  alive  at  the  time  when  Cayet  wrote.  All  were 
called  upon  to  note  the  disease  in  the  lungs  and  their  testi- 
mony appears  to  fully  establish  that  it  was  this  that  produced 
the  Queen's  death,  so  that  poisoning  would  appear  to  be 
merely  a  myth. 

In  1574  we  again  meet  with  the  most  questionable  case  of 
poisoning,  that  of  the  Cardinal  of  Lorraine.  It  was  said  that  he 
was  poisoned  by  Saint  Barthelemi.  The  latter  was  to  give 
him  money  and  he  obtained  fifty  to  sixty  pieces  which  he 
"  perfumed  with  greater  subtility  than  the  gloves  of  the 
Queen  of  Navarre,"  and  arranged  the  purse  likewise.  As 
soon  as  the  Cardinal  touched -the  pieces  of  gold  he  fell  dead. 
Now  in  reality  he  died  on  September  26th  from  a  pleurisy 
that  he  contracted  during  the  procession  of  the  Battus  at 
Avignon.  During  this  procession  the  pilgrims  were  obliged 
to  march  with  the  feet  and  head  bare  and  it  was  this  custom 
that  produced  the  disease  from  which  resulted  the  Cardinal's 
death. 

During  the  same  year  another  attempt  at  poisoning  was 
directed  against  the  Duke  of  Amiville.  D'Aubigne  says  that 
"  another  attempt  at  poisoning,  composed  by  the  wife  of  the 
defunct  Corbouzon,  placed  by  her  in  the  hands  of  the  corrupt 
physician  of  the  Marshal  d'Amiville,  was  undertaken ;  this 
was  discovered  by  a  valet  of  the  King  of  Navarre,  who 
warned  the  Duchess  of  Montmorenci  and  her  brother-in-law." 
Then  in  1574,  Coffe,  Marshal  of  France,  died  poisoned.  In 
December,  1585,  it  was  the  Duke  of  Anjou.  As  his  valet  had 
forgotten  to  test  his  wine,  it  was  immediately  noised  about 
that  he  had  died  from  poison  administered  to  him  by  Cath- 
erine de  Medicis.  "  The  Queen  Mother  was  obliged,  so  good 
was  her  reputation,  to  protest  against  the  accusation  brought 
against  her  of  having  wished  to  get  rid  of  her  son."  It  is 
more  probable  that  they  died  from  their  excesses,  but  never- 
theless two  persons,  Salcede  and  Baza,  were  arrested  in  1587 
and  were  put  to  torture,  having  been  found  guilty  of  this 
tentative  against  the  Duke  of  Anjou.  On  March  5,  1588,  the 
Prince  of  Conde  died  at  Saint-Jean-d'Angely  after  an  illness 
of  forty-eight  hours  and  d'Aubigne  says  that  "  we  will  see  the 
Journee  des  Barricades  where  we  shall  find  very  sad  matter 


5 


572     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 

and  confusion,  without  therein  mixing  the  death  of  the  Prince 
of  Conde,  which  occurred  from  poison  on  the  5th  day  of 
March ;  on  the  suspicion  of  which  the  Princess,  who  had  just 
given  birth  to  a  child  by  Henri  de  Bourbon,  to-day  Prince 
of  Conde,  was  poisoned,  together  with  some  officers  of  the 
household ;  and  upon  the  absolute  report  of  the  physicians, 
the  affair  was  examined  with  all  rigor;  Breillant,  comptroller, 
was  drawn  by  four  horses,  and  the  princess,  not  having  suffi- 
cient proof  against  her,  or  by  the  discretion  of  the  State,  was 
allowed  her  freedom."  De  Thou  also  relates  this  death  and 
the  acquittal  of  the  Princess.  "  She  was  acquitted  by  Par- 
liament and  gave  up  the  Calvinistic  religion  shortly  after- 
wards; one  found  the  two  absolutions,  temporal  and  spiritual, 
a  little  too  united  one  with  the  other." 

All  the  physicians  called  to  examine  the  cause  of  death 
considered  that  it  was  due  to  poison,  but  Cabanes  and  Nass, 
who  have  recently  studied  this  question,  came  to  the  conclu- 
sion that  the  Prince  de  Conde  died  from  a  subacute  peritonitis 
following  perforation  of  a  gastric  ulcer.  They  base  this  diag- 
nosis upon  the  fact  that  on  several  occasions  he  was  seized 
with  vomiting  and  violent  colics  and,  although  these  are  cer- 
tainly symptoms  of  the  affection  referred  to  by  these  authorities, 
they  consider  them  as  only  temporary  and  do  not  attach  the 
importance  and  the  duration  that  they  should  have  had,  if 
the  Prince  was  really  the  possessor  of  an  ulcer.  This  hypoth- 
esis is  not  inadmissible,  but  it  would  appear  to  me  that  that 
of  poison,  verified  by  all  the  physicians  who  had  seen  the 
cadaver,  is  not  to  be  rejected  without  very  serious  considera- 
tion. Cabanes  and  Nass  endeavor  to  explain  this  death  from 
natural  causes,  just  as  they  do  in  the  case  of  Jeanne  d'Albret, 
Cardinal  de  Chatillon  and  the  Cardinal  of  Lorraine,  in  order 
to  endeavor  to  improve  the  memory  of  Catherine  de  Medicis. 
This  endeavor  is  extremely  arduous,  because  all  contemporary 
historians  represent  her  to  us  as  astucious,  corrupted,  without 
sincere  convictions  and  devoid  of  virtue,  having  the  taste  for 
stormy  proceedings  and  only  consulting  in  her  acts  those 
things  which  were  to  her  interest.  One  is  certainly  obliged 
to  admit  that  those  who  knew  her  were  far  better  placed  to 
judge  her  than  we  are,  and  all  of  them  are  unanimous  respect- 
ing her  defects.  Perhaps  they  have  exaggerated  them  and 
have  had  a  too  great  tendency  to  credit  her  with  all  the  vices 


CHARLES  GREENE  CUMSTON 


573 


of  her  ancestors,  but,  if  we  are  obliged  to  reject  her  reputa- 
tion as  a  poisoner  in  the  legends,  we  feel  compelled  to  point 
out  that,  if  the  original  sources  are  consulted,  one  will  always 
find  a  certain  amount  of  truth  attached  to  them. 

In  1600  the  King  was  the  victim  of  an  attempt  at  poisoning. 
"  Soon  after  the  departure  of  the  Duke  of  Savoye,  it  happened 
that  a  vivandiere,  who  became  ruined  by  following  the  King's 
army,  addressed  herself  to  the  Count  of  Soissons,  recalling  to 
him  the  discontent  that  she  had  had  on  account  of  the  King 
and  begged  him  to  allow  her  husband  to  lodge  in  the  kitchen, 
by  which  means  the  King  was  poisoned ;  the  Count  asked  the 
King  for  a  faithful  servant  to  hear  with  him  that  which  this 
woman  proposed  to  him  at  the  second  assignation ;  L'Omenie 
chosen  for  this  purpose,  having  heard  this  unfortunate  per- 
son, she  was  seized  and  burned  alive  in  Greve,  although  on 
account  of  her  losses  she  was  found  insane  in  every  sense. 
There  was  also  another  seizure  and  punishment  of  a  certain 
Piemontois,  upon  the  designs  of  which  some  have  written 
that  the  Duke  of  Savoye  had  held  the  affairs  in  the  balance ; 
but  it  has  been  verified  since  that  he  had  in  no  way  been 
mixed  up  in  such  kinds  of  fraud,  which  never  enter  generous 
hearts." 

The  use  of  poison  had  become  so  common  in  France  that 
the  people  of  the  army  employed  it  to  reduce  the  enemy. 
Under  these  circumstances  they  placed  poisonous  substances 
in  a  well  or  a-- fountain  and  d'Aubigne  relates  a  story  of  this 
kind  which  took  place  during  the  siege  of  Paris.  "  The  ex- 
ploits of  this  siege  were  not  very  hazardous,  because,  after  a 
few  small  skirmishes  near  Monfaucon,  the  army  went  to 
Saint-Denis,  where  the  Parisians  hoped  for  more  resistance 
than  they  had  had ;  because  the  besieged  did  not  allow  the 
approaches  to  be  formed  without  parleying;  the  army  took 
ten  days  to  gain  some  few  lands,  which  were  thought  to  be 
the  stronghold ;  and  then  the  King  gave  them  a  capitulation, 
which  was  found  far  too  good  by  the  people  of  the  Army, 
among  whom  the  much  too  favorable  conditions  of  those  who 
gave  themselves  up  are  reputed  as  a  dishonor.  They  conse- 
quently had  the  article  the  least  permitted  in  such  affairs, 
which  is  to  bring  the  pieces  on  wheels  and  even  two  large 
cannon,  and  before  going  out  in  order  to  reimburse  such  a 
great  courtesy  they  poisoned  the  wells  with  ergot  and  other 


574     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 

artifices  and  filled  the  larger  number  of  them  with  dead  bod- 
ies." And  finally  Brantome  relates  quite  an  original  duel 
in  which  the  chosen  arm  was  a  cup  of  poison ;  the  adversaries 
were  to  drink  one-half,  but  he,  however,  neglects  to  tell  us 
what  the  issue  of  this  new  type  of  combat  was. 

The  history  of  the  small  principalities  of  Italy  is  a  long 
chain  of  crimes  of  every  nature  and  especially  dramas  from 
poison.  In  this  respect  the  family  of  the  Medicis  has  become 
sadly  celebrated  and  their  court  was  always  filled  with  tragic 
intrigues.  The  character  of  the  two  first  grand  dukes  was 
a  mixture  of  underhandedness,  mercantile  avidity  and  san- 
guinary perfidity,  while  at  the  same  time  prudence,  political 
ability  and  a  certain  governmental  science  was  mixed  therein. 
Their  acts  show  this  peculiar  character, — that  beside  the  well- 
regulated  administration  and  the  love  of  arts  that  they  always 
encouraged,  one  finds  crimes  of  every  description,  treason, 
poisonings  and  so  forth.  Cosme  the  First,  the  first  of  the 
grand  dukes,  the  destroyer  of  the  Florentine  Republic,  pos- 
sessed to  a  remarkable  degree  all  the  vices  and  all  the  quali- 
ties which  we  have  just  enumerated.  His  leisure  moments 
were  occupied  in  the  study  of  diemistry  and  for  these  pre- 
tended experiments  he  had  a  laboratory  constructed  in  the 
interior  of  his  palace  which  was  nothing  more  nor  less  than 
a  poison  manufactory.  He  studied  the  effects  of  poisons  on 
animals  and  was  enabled  to  calculate  the  necessary  dose  to 
kill  those  people  who  were  in  his  way,  and  the  number  of- 
poisonings  is  so  considerable  that  it  would  be  far  too  long 
to  enumerate  them  here. 

His  son,  Francois-Marie,  who  succeeded  him  in  1574,  pos- 
sessed all  the  defects  of  his  father  without  having  his  quali- 
ties. Avid,  dissipated  and  vindictive,  he  continued  the  long 
series  of  crime  that  he  had  seen  accomplished  by  his  father. 
The  history  of  his  love  affair  with  Bianca  Capello  is  a  true 
drama.  Frangois  de  Medicis  took  a  great  fancy  to  her  and 
thought  of  marrying  her,  finding  no  obstacle  in  the  fact 
of  his  union  with  Jeanne  d'Autriche.  In  order  to  attach  her 
new  lover  as  completely  as  possible  to  her,  Bianca  employed 
all  possible  means ;  superstitious,  like  all  the  Italians  of  her 
time,  she  gave  him  love  philters,  the  use  of  which  had  been 
taught  her  by  a  certain  Jewess.  We  unfortunately  have  been 
unable  to  ascertain  the  composition  of  these  drinks.  She 


CHARLES  GREENE  CUMSTON 


575 


even  went  so  far  as  to  simulate  a  labor  and  caused  to  perish 
he  who  had  procured  the  supposed  child,  whom  she  wished 
to  make  the  heir  of  the  Grand  Duke.  She  finally  married  her 
lover  after  the  death  of  Jeanne  of  Austria,  but  she  was  not 
long  to  bear  the  title  of  the  Grand  Duchess  of  Tuscany.  On 
October  S,  1587,  the  Grand  Duke  was  suddenly  seized  with  a 
disease  that  his  physicians  qualified  as  intermittent  fever  and 
two  days  later  Bianca  was  attacked  with  the  same  malady. 
Francois  died  on  October  15th  and  fifteen  hours  later  his  wife 
followed  him  to  the  tomb.  Both  had  been  killed  by  a  poison 
and  not  by  intermittent  fever.  The  poison  had  been  given 
them  by  Cardinal  Ferdinand  de  Medicis,  who  had  never  been 
able  to  accept  this  misalliance  on  account  of  his  proud  spirit. 
These  suspicions  were,  for  that  matter,  confirmed  by  his  readi- 
ness to  leave  the  red  robe  in  order  to  succeed  his  brother. 
Later  on,  he  was  accused  of  the  death  of  Gabrielle  d'Estrees, 
but,  as  I  shall  point  out,  this  is  very  questionable. 

The  pontifical  court  was  not  exempt  of  all  the  horrible 
disorders  which  made  Italy  desolate,  a  Borgia  was  Pope 
under  the  name  of  Alexander  VI,  and  this  name  alone  brings 
to  mind  all  the  cruelties  which  were  committed  during  his 
reign.  But  the  crime  which  pushed  him  and  his  family  to  the 
extreme  limits  of  refinement  was  without  any  doubt  poison- 
ing. He  possessed  the  secret  of  a  poison  which  killed  at 
variable  times  and  surely.  This  family  possessed  poison 
which  killed  in  a  day  or  in  a  year,  according  to  their  desire. 
They  were  infamous  poisons,  which  made  wine  better  and 
caused  the  bottle  to  be  emptied  with  greater  pleasure.  One 
thought  himself  intoxicated  when  in  reality  he  was  dead,  or, 
on  the  other  hand,  a  man  was  suddenly  seized  with  lassitude, 
his  skin  became  wrinkled,  his  eyes  sunken,  his  hair  whitened 
and  his  teeth  broke  like  glass  when  he  partook  of  bread;  he 
could  no  longer  walk  and  merely  dragged  himself  along;  he 
could  not  breathe  and  only  gasped;  he  no  longer  laughed,  no 
longer  slept  and  he  shivered  in  the  full  mid-day  sun ;  from  a 
young  man  he  became  an  old  one  and  thus  he  went  through 
agony  for  some  time  and  finally  died.  He  died,  and  then  it 
was  recalled  that  six  months  or  a  year  previously  he  had 
drunk  a  glass  of  Chypre  at  one  of  the  Borgias'. 

Alexander  VI  commenced  a  series  of  his  horrible  executions 
by  the  murder  of  Djem,  the  son  of  Mahomet  II.    He  had  been 


576     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 

captured  by  the  cavaliers  of  Rhodes  and  was  given  to  the 
Saint  Father.  Some  time  afterwards  he  was  demanded  by 
Charles  VIII,  King  of  France,  who  by  this  hostage  hoped  to 
obtain  a  more  efficacious  control  over  Turkey.  He  had  hardly 
been  given  over  to  the  French  when  the  unfortunate  Djem 
died  from  poison  that  had  been  given  him  by  the  Pope.  By 
this  treacherous  assassination  he  received  three  hundred  thou- 
sand ducats  which  had  been  promised  him  by  the  Sultan  if 
he  could  do  away  with  the  son  of  Mahomet  II.  This  death 
was  due  entirely  to  political  reasons,  because  the  Sultan  was 
perfectly  well  aware  of  the  part  that  Charles  VIII  would  make 
his  hostage  play,  and  it  was  in  order  to  avoid  this  that  he 
advised  Alexander  VI  to  do  away  with  his  prisoner.  Avid 
and  wicked,  the  Pope  in  no  way  receded  before  any  means 
which  might  bring  about  his  political  projects  or  to  bring 
money  into  the  sacks  of  his  own  treasury.  As  a  natural  heir 
to  the  Cardinals,  he  allowed  them  to  become  rich  from  their 
administrators  and  when  he  considered  their  fortune  sufficient 
he  gave  them  poison  in  order  to  come  into  possession  of  their 
money.  The  Cardinals  of  Modene,  Mechiel  and  Arragon 
were  thus  poisoned  in  succession  and  the  Cardinal  Orsini, 
convicted  of  a  plot  against  the  Pope  and  his  son  Caesar,  was 
arrested  and  put  in  prison.  A  few  days  after  his  incarcera- 
tion he  died  poisoned ;  the  Pope  had  given  him  his  famous 
slow  poison,  venenum  attemperatum.  The  entire  Orsini  fam- 
ily was  stripped  of  its  belongings,  the  men  were  killed,  while 
the  women  and  children  were  poisoned. 

Caesar  Borgia,  the  second  natural  son  of  Alexander  VI  and 
of  the  beautiful  and  intriguing  Vanosa,  was  no  less  cruel  than 
his  father.  He  had  his  brother  Jean  Borgia  assassinated  and 
the  body  was  thrown  into  the  Tiber.  At  the  head  of  an  army 
of  mercenaries  he  seized  the  best  places  in  Romandiole,  Imola, 
Forli,  Faenze  and  afterwards  imprisoned  the  chiefs  of  these 
States,  who  gave  themselves  up,  at  discretion.  Cardinal  Bor- 
gia, his  cousin,  died  from  poison  that  was  given  him.  The 
principal  Italian  nobility  finally  united  in  order  to  rid  them- 
selves of  this  usurper.  Being  unable  to  overcome  them  by 
force  Caesar  resorted  to  perfidy.  He  pretended  to  make  peace 
with  them  and  luring  them  to  Sinagaglia  he  did  away  with 
them,  having  given  orders  to  have  them  strangled.  The  Car- 
dinal des  Ursins,  who  had  declared  himself  a  partisan  of  these 


CHARLES  GREENE  CUMSTON 


577 


unfortunate  people,  was  arrested  in  his  turn  and  imprisoned 
in  the  Chateau  Saint-Ange.  Caesar  then  obliged  him  to  sign 
an  order  by  which  all  his  places  were  to  be  delivered  up  to 
him  and  then  afterwards  poisoned  him.  Cardinals  de  la 
Rouere,  de  Capoue,  Zeno  and  many  others  underwent  the 
same  death.  According  to  Gordon,  Alexander  VI  was  the 
victim  of  the  poison  that  he  had  prepared  for  others.  On 
August  18,  1503,  he  had  invited  several  Cardinals  to  dinner 
and  a  faithful  servant  had  received  the  order  to  pour  out  to 
them  a  special  wine  which  had  been  poisoned.  The  Pope 
thus  hoped  to  do  away  with  nine  Cardinals  at  a  single  stroke 
and  fill  his  sacks  with  numerous  ducats.  Unfortunately  for 
him  he  entered,  accompanied  by  his  son  Caesar,  before  the 
hour  fixed  for  the  rendezvous.  They  asked  to  drink  and  a 
servant  who  had  not  been  advised  about  the  plot  poured  them 
out  some  of  the  wine  destined  for  the  Cardinals.  Its  effect 
was  sudden  and  a  few  minutes  after  Alexander  VI  rolled  on 
the  ground,  the  prey  of  horrible  sufferings.  He  was  taken  up 
unconscious  and  in  spite  of  the  most  energetic  care  he  died 
during  the  evening.  Caesar  Borgia,  who  had  also  partaken 
of  the  poisoned  wine,  was  less  ill  than  his  father  and  owed 
his  salvation  to  an  antidote  which  was  the  most  efficacious  at 
the  epoch  and  consisted  in  opening  the  belly  of  a  mule  and 
placing  himself  within  it.  This  story  is  also  given  by  another 
historian  of  the  Borgia  family,  namely  Guichardin.  It  ap- 
pears that  he  happily  terminated  the  horrible  drama  which  the 
life  of  this  Pope  represents.  Just  like  the  end  of  a  novel  the 
reader  is  satisfied  to  learn  that  he  who  had  committed  the 
murders  by  poisoning  is  at  last  caught  in  his  own  trap.  Un- 
fortunately for  the  moral  part,  this  story  is  purely  a  myth. 
It  is  formally  denied  by  Burchard,  all  of  whose  recitals  are 
stamped  with  the  greatest  frankness.  He  states  that  the  Pope 
died  very  rapidly  from  a  malignant  fever  and  there  is  no  rea- 
son to  doubt  this  version.  Voltaire  was  one  of  the  first  to 
rise  against  the  legend  of  the  poisoning  and  here  are  the  rea- 
sons that  he  gives  in  his  dissertation  on  the  death  of  Henri 
IV :  "  J'ose  dire  a  Guichardin ;  l'Europe  est  trompee  par  vous 
et  vous  1'  avez  ete  par  votre  passion;  vous  etiez  l'ennemi  du 
pape,  vous  en  avez  trop  cru  votre  haine  et  les  actions  de  sa 
vie.  II  avait  a  la  verite  exerce  des  vengeances  cruelles  et 
perfides  contre  des  ennemis  aussi  perfides  et  aussi  cruels  que 


57&     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 


lui.  De  la  vous  concluez  qu'un  pape  de  soixante-quatorze 
ans  n'est  past  mort  d'une  facon  naturelle;  vous  pretendez  sur 
des  rapports  vagues,  qu'un  vieux  souverain  dont  les  coffres 
etaient  remplis  alors  de  plus  d'un  million  de  ducats  d'or, 
voulut  empoisonner  quelques  cardinaux  pour  s'emparer  de 
leur  mobilier.  Mais  ce  mobilier  etait-il  si  important?  Ces 
efTets  etaient  presque  toujours  enleves  par  les  valets  de  cham- 
bre  avant  que  les  papes  pussent  en  saisir  quelques  depouilles. 
Comment  pouvez-vous  croire  qu'un  homme  prudent  ait  voulu 
hasarder,  pour  un  aussi  petit  gain,  une  action  aussi  infame, 
une  action  qui  demandait  des  complices  et  qui  tot  on  tard  eut 
ete  decouverte?  Ne  dois-je  pas  croire  le  journal  de  la  maladie 
du  pape  plutot  qu'un  bruit  populaire?  Ce  journal  le  fait 
mourir  d'une  fiere  double  tierce ;  il  n'y  a  pas  le  moindre  vestige 
de  preuve  de  cette  accusation  intentee  contre  sa  memoire. 
Son  fils  Borgia  tomba  malade  dans  le  temps  de  la  mort  de 
son  pere ;  voila  le  seul  fondement  de  l'histoire  du  poison !  " 

After  the  death  of  his  father,  Caesar  led  a  miserable  and 
adventurous  existence.  He  was  arrested  by  Julius  II,  then 
he  went  to  Spain,  where  he  was  again  imprisoned,  but,  having 
succeeded  in  escaping  he  took  refuge  with  his  brother-in-law, 
Jean  d'Albret,  King  of  Navarre.  He  placed  himself  at  the 
head  of  his  army  against  the  Connetable  of  Castille  and  was 
killed  by  a  lance  on  March  12,  1507,  at  the  siege  of  the  Chateau 
of  Viane.  This  was  far  too  glorious  a  death  for  this  rascal, 
who,  in  spite  of  all  his  faults,  was  endowed  with  a  true  courage 
extending  almost  to  bravery.  He  had  practised  during  his 
entire  Kfe  the  proud  motto  that  he  had  taken,  namely,  "Aut 
Caesar,  aut  nihil." 

The  fable  handed  down  to  us  relative  to  the  death  of  Fran- 
cois II  is  that  he  was  a  victim  of  poison  and  without  doubt 
everyone  is  familiar  with  the  story  of  the  famous  bonnet  that 
the  King  wore  to  hunt  and  which  was  supposed  to  have  con- 
tained a  certain  white  powder  placed  therein  by  Ambroise 
Pare,  which  gave  rise  to  vapors,  and  these  being  absorbed, 
soon  killed.  This  legend  had  for  a  starting  point  the  mys- 
terious conduct  of  Catherine  de  Medicis.  For  that  matter 
she  was  not  at  the  stage  of  essays  and  trials,  because  her  taste 
for  alchemy  was  everywhere  well  known  and  it  was  also  cur- 
rent that  she  spent  long  hours  in  the  shop  of  Rene  the  Floren- 
tine, her  confidant  and  even  accomplice,  because  his  store 


CHARLES  GREENE  CUMSTON 


579 


was  nothing  more  or  less  than  a  laboratory  for  the  manufac- 
ture of  poisons.  Many  people  were  accused  of  this  hypotheti- 
cal crime  and  these  suspicions  are  found  summed  up  in  the 
life  of  Gaspard  de  Coligny,  the  author  of  which  is  unknown, 
and  I  here  make  the  following  quotation :  "  On  ne  soupconna 
Pare,  de  lui  avoir  mis  du  poison  dans  l'oreille,  lorsqu'il  le 
pansait  et  cela  par  le  commandement  de  la  reine  mere  qui  ne 
voioit  point  d'autre  moien  d'assurer  son  authorite.  II  y  en 
eut  aussi  qui  en  soupconnerent  les  princes  et  l'amiral  et  peut- 
etre  seulement  parce  qu'en  l'etat  ou  ils  les  veioient  ils  s'etoient 
mis  en  tete  qu'il  n'y  ayoit  point  de  crime  qui  leur  dut  faire 
peur." 

As  in  the  source  of  every  legend  the  causative  fact  is  to  be 
found,  it  is  essential  to  rapidly  outline  the  portrait  of  this 
Prince  and  to  show  by  the  symptoms  of  his  disease  whether 
or  not  his  death  should  be  included  in  the  long  series  of 
poisoning  cases  which  occurred.  Francois  II  was  born  in 
1543  of  a  syphilitic  father  and  in  his  "  Histoire  de  TEstat  de 
France  sous  le  regne  de  Francois  II,"  by  Regnier  de  la  Plan- 
che,  published  at  Paris  in  1636,  the  following  description  is  to 
be  found :  "  Ce  prince  malsain  et  qui,  des  son  enfance,  avoit 
monstre  de  grandes  indispositions  pour  n'avoir  crache  ni 
mouche  *  *  *  avoit  un  visage  blafard  et  bouffi  *  *  * 
comme  aussi  se  formoit  une  corruption  en  Tune  de  ses  aureil- 
les  qui  faisoit  l'ofnce  du  nez,  lequel  U  avoit  fort  camus."  He 
was  a  degenerate  and  d'Aubigne  gives  a  very  curious  explana- 
tion of  this  condition,  which  runs  as  follows :  "  La  reyne 
avoit  eu  ses  menstrues  si  tard,  que  son  fils  estoit  de  ceux  que 
Ton  appelle  mal-nez,  ne  se  purgeant  ni  par  le  nez,  ni  par  la 
bouche,  laquelle  il  portoit  ouverte  pour  prendre  son  vent,  dont 
il  se  forma  un  abces  a  l'aureille,  et  puis  des  coliques  frequentes, 
marques  mortelles  a  tel  aage,  ne  promettant  de  luy  aulcune 
duree  aux  plus  advisez."  And  further  on  the  same  writer 
adds  that  he  had  "  a  yellow  face  covered  with  eruption,  a 
stinking  breath  and  other  signs  of  a  bad  health." 

The  King  presented  all  the  evidences  of  a  marked  degenera- 
tion ;  he  had  adenoids,  a  discharge  from  the  ear  and  from  this 
arose  a  marked  deafness.  In  his  early  life  he  also  had  a 
rebellious  diarrhoea,  which  contributed  considerably  to  make 
him  feeble  and  weak.  This  condition  of  affairs  was  described 
by  his  father  in  a  letter  to  the  preceptor  of  his  children, 


580     VICTIMS  OF  THE  MEDICIS  AND  THE  EORGIAS  IN  FRANCE 

d'Humyeres,  dated  at  Montreuil,  September  16,  1549.  "  Mon 
cousin,  j'ai  receu  deux  lettres  de  vous,  les  derniers  du  onzieme 
de  ce  mois,  per  lesquelles  j'ai  veu  que  mon  fils  le  Dauphin  se 
trouvoit  mal  d'un  flux  de  ventre  procede,  ainsy  que  dyent  les 
medecins,  des  humeurs  cuites  et  accumulees  de  dans  son  corps 
pour  ne  se  mouscher  point  la  plupart  du  temps."  At  this 
time  the  Dauphin  was  six  and  one-half  years  old  and  his  gen- 
eral condition  was  already  seriously  involved  and  it  remained 
poor  during  nearly  his  entire  life.  In  1555  he  was  12  years 
old  and  an  Italian  ambassador,  by  name  Giovanni  Capello, 
speaks  of  him  as  follows:  "  Leurs  Majestes  ont  trois  fils  et  trois 
filles;  le  premier  des  trois  fils  est  le  serenissime  dauphin  *  *  * 
"  il  parle  peu,  il  est  peut-etra  un  pau  bilieux.  Pour  les  traits, 
il  tient  plus  de  la  physionomie  de  sa  mere  que  de  celle  de  son 
pere  *  *  *  il  a  plus  de  plaisir  au  jeu  de  la  lance,  de  l'epec,  de 
la  balle  et  de  la  paume  qu'a  l'etude  des  lettres.  II  aime  beaucoup 
la  serenissime  petite  reine  d'Ecosse,  Marie  Stuart,  qui  lui  est 
destinee  pour  femme.  C'est  une  fort  jolie  petite  fille  de  douze  ou 
treize  ans.  II  advient  parfois  que  se  faisant  tous  les  deux  ces 
caresses,  ils  aiment  a  se  retirer  dans  un  coin  des  salles  pour 
qu'on  ne  poisse  entendre  leurs  petits  secrets."  This  marriage 
took  place  on  April  24,  1558,  at  which  time  Francois  was 
14  years  and  three  months  of  age.  His  wife,  extremely  ad- 
vanced for  her  age,  intended  that  her  husband  should  fulfill  his 
position  and  her  unfortunate  spouse  must  have  completely 
expended  the  little  vigor  that  he  still  possessed  in  order  to 
satisfy  her  and  the  Duke  d'Albe  has  said  "  he  died  of  Marie 
Stuart." 

He  was  called  to  succeed  his  father  on  July  10,  1559,  and 
Regnier  de  la  Planche  states  that  at  this  time  he  was  in  a 
miserable  condition.  The  King's  illness  preoccupied  the  royal 
house  and  physicians  and  surgeons  consulted  in  turn,  and  as  a 
remedy  they  advised  a  change  of  air  as  frequently  as  possible. 
Consequently,  the  greater  part  of  his  reign  was  passed  in  trav- 
els and,  under  their  influence  his  health  for  a  while  appeared  to 
be  improved.  This  arrest  in  the  progress  of  the  disease  was 
only  temporary  and  soon  it  became  more  serious  than  ever 
before.  In  the  work  already  alluded  to,  de  la  Planche  says 
"  Le  dimanche  15  novembre  1560,  sur  le  soir,  estant  le  roi  a 
vespres  au  Jacobins,  il  luy  prist  un  grand  esvanouissement, 
qui  fut  cause  qu'on  l'emporta  hastivement  en  sa  chambre;  et 


CHARLES  GREENE  CUMSTON 


revenu  de  sa  pamoison  commenca  a  se  plaindre  de  la  tete  en 
la  partie  de  l'aureille  gauche,  en  laquelle  il  avoit  eu  de  tout 
temps  une  fistule,  en  sorte  que  de  la  douleur  la  fiebvre  le 
print."  This  condition  remained  stationary  until  the  25th 
of  the  same  month,  but  from  this  time  on  the  disease  made 
rapid  progress.  A  consultation  took  place  between  Ambroise 
Pare,  Nicole  and  Servais,  in  which  they  discussed  the  pro- 
priety of  trephinning,  which  was  not  undertaken  and  the  King 
died  on  December  29,  1560,  after  a  reign  of  17  months. 

Having  followed  all  the  steps  of  the  King's  illness,  it  would 
seem  absolutely  useless  to  discuss  the  hypothesis  of  poisoning. 
Francois  II,  who  was  a  degenerate,  not  built  for  a  long  life 
and  the  violent  exercises  to  which  he  gave  himself  up,  along 
with  his  premature  marriage,  soon  removed  from  him  what 
little  strength  he  possessed.  At  the  latter  part  of  his  sickness 
he  had  in  all  probability  a  meningitis  with  purulent  absorp- 
tion. No  autopsy  was  made,  but  in  point  of  fact  it  was  not 
necessary,  and,  although,  at  this  time,  no  diagnosis  was  made, 
it  is  evident  that  his  death  was  not  the  result  of  poisoning. 

The  death  of  Charles  IX  following  a  disease,  the  nature  of 
which  the  physicians  were  not  able  to  categorically  decide,  was 
regarded  by  the  courtiers  and  many  historians  as  the  result  of 
poison.  This  supposed  crime,  attacking  this  prince  at  the  age  of 
23  years,  gave  rise  to  a  long  series  of  trials  and  the  two  individ- 
uals accused  were  beheaded.  The  constant  presence  of  Catherine 
de  Medicis  in  the  chamber  of  the  King  during  the  latter  part 
of  his  illness,  the  introduction  at  the  court  of  the  Italians  of 
her  suite  and  their  deplorable  habits  were  not  without  some 
influence  in  the  development  of  the  suspicions  of  the  people. 
Whether  these  had  any  foundation  or  not  the  history  of  the 
illness  of  the  King  can  alone  prove,  or  disprove.  Charles  IX 
had  a  pathologic  heredity  of  the  most  marked  kind  and  no  one 
is  ignorant  of  the  fact  that  his  grandfather  was  a  syphilitic. 
His  own  father  was  no  less  debauched  than  his  grandfather, 
and  consequently  their  descendants  were  all  degenerates  to 
a  more  or  less  considerable  degree  and  all  the  brothers  of  the 
King  were  afflicted  with  pulmonary  consumption. 

A  description  of  the  King  does  not  show  any  very  great 
difference  from  that  of  his  brothers.  "  II  estoit  grand  de 
taille,  mais  un  peu  votite,  avoit  le  visage  pale,  les  yeux 
jaunatres,  bilieux  et  menagants,  le  nez  aquilin  et  le  col  un  peu 


582     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 


de  travers."  From  this  it  consequently  appears  that  he  was 
feeble  and  his  education  was  such  that  he  was  greatly  over- 
worked. From  his  earliest  youth  he  gave  himself  up  with 
ardor  to  violent  exercises  and  possessed  a  real  passion  for 
riding  and  hunting.  Brantome  affirms  that  h^  contracted  a 
venereal  disease,  a  fact  which  would  prove  that,  at  the  same 
time,  he  also  committed  other  excesses.  His  character  cor- 
responded quite  well  to  his  external  appearance  and  tastes, 
and,  according  to  de  Thou,  "  il  estoit  d'un  temperament  colere 
et  emporte  et  l'exercice  continuel  et  violent  du  cheval  joint 
a  la  fatigue  des  veilles  fortifioit  encore  ce  penchant,  en  sorte 
que,  malgre  sa  dissimulation  profcnde  il  se  laissoit  quelquefois 
emporter  a  une  sorte  de  fureur." 

He  was  called  to  the  throne  at  a  very  early  age  and  was 
obliged  to  submit  to  all  the  hardships  of  a  reign  which  was, 
according  to  everybody,  one  of  the  most  unfortunate  in  his- 
tory. Badly  advised  by  everybody,  he  allowed  to  be  com- 
mitted, or  rather  ordered,  the  massacre  of  Saint  Bartholomew. 
He  was  already  ill  at  this  time  and  followed  out  a  treatment 
under  the  orders  of  Ambroise  Pare.  A  few  days  later  he 
called  the  great  surgeon  to  him  and  had  the  following  con- 
versation with  him  which  has  been  given  by  Sully  in  his 
memoirs.  "Ambroise,  je  ne  scay  ce  qui  m'est  survenu  depuis 
deux  ou  trois  jours ;  mais,  je  me  trouve  l'esprit  et  le  corps 
grandement  esmeus,  voire  tout  ainsi  que  si  j'avois  la  fievre, 
me  semblant  a  tout  moment,  aussi  bien  veillant  que  dormant, 
que  les  corps  massacres  se  presentent  a  moy  les  faces  hydeuses 
et  converts  de  sang;  je  voudrois  que  Ton  n'y  eust  pas  compris 
les  imbeciles  et  les  innocents." 

The  King  was  devoured  by  the  regrets  of  his  crime ;  he  did 
not  sleep  and  his  rest  was  haunted  by  fearful  nightmares. 
This  loss  of  rest,  to  which  was  added  the  fatigue  resulting 
from  hunting  and  the  violent  exercises  to  which  he  gave  him- 
self up  during  the  day,  were  not  long  in  aggravating  his  con- 
dition. The  cough,  to  which  he  was  subject,  increased  and 
along  with  it  he  rapidly  lost  flesh. 

The  following  year,  in  1573,  the  King  wished  to  accompany 
his  brother  the  Duke  of  d'Anjou  into  his  state,  the  latter 
having  just  been  made  King  of  Poland.  He  was,  however, 
obliged  to  stop  at  Vitry,  because  he  was  taken  with  severe 
hemoptysis.    In  spite  of  a  few  days  rest  in  this  town,  it  was 


CHARLES  GREENE  CUMSTON 


583 


impossible  for  him  to  continue  his  trip  and  he  was  brought 
back  upon  a  bed  to  Saint  Germain  en  Laye.  He  did  not 
remain  here  for  any  length  of  time,  because  the  Duke  d'Alen- 
£on  was  conspiring  to  carry  him  off  along  with  his  mother. 
Catherine  de  Medicis  prevented  the  conspiracy  from  being 
accomplished,  and  had  Charles  IX  transported  first  to  Paris 
and  afterwards  to  Vincennes.  His  illness  continued  to  pro- 
gress and  his  first  physician,  Jean  Mazille,  foresaw  a  fatal 
outcome  and  ordered  a  consultation  and,  as  related  by  Sorbin, 
in  his  "  Histoire  memorables  des  choses  advenues  pendant  le 
regne  do  roi  Charles  IX,"  it  was  "  advise  qu'il  il  seroit  purge 
et  saigne ;  ce  que  fut  execute  mais  en  vain,  car  ses  forces 
diminuoient.  a  veiie  d'oeil,  et  le  voyoite-on  descroitre,  presse 
dune  courte  haleine,  qui  l'a  accompagne  jusqu'a  a  la  mort." 

Brantome  also  tells  us  that  the  physicians  were  absolutely 
ignorant  as  to  what  name  to  give  the  King's  disease,  in  the 
following  sentence :  "  Tant  il  y  a  qu'ils  y  perdirent  leur 
latin,  d'autant  qu'ils  ne  peurent  jamais  bien  cognoistre  sa 
malladie,  car  il  lui  survint  une  fiebvre  carratique  qui  tantost 
estoit  quarte,  tantost  continue,  et  pensoit  M.  Mazille,  son 
premier  medecin,  qu'il  se  porteroit  de  bien  en  mieux,  ainsi 
que  la  fiebvre  diminueroit."  It  was  upon  this  ignorance  of 
the  physicians  that  the  suspicions  of  poisoning  were  based, 
because  it  appeared  that  poison  alone  was  capable  of  explain- 
ing the  symptoms  presented  by  the  King,  especially  when  it 
was  learned  "  qu'aux  extremes  douleurs,  il  sortoit  du  sang 
par  les  pores  de  la  peau  de  ce  jeune  prince,  presque  en  tous 
les  endroits.  De  la  plusieurs  conjecturerent  qu'il  y  avoit  du 
poison  mele  a  la  maladie  du  roy,  et  a  dire  vrai  il  y  avoit  argu- 
ment de  penser  Tun  des  trois,  ou  poison,  ou  art  diabolique,  ou 
intelligence  avec  ceux  qui  avoient  eu  le  moyen  de  cognoistre 
la  maladie  du  roy  en  en  donner  quelque  resolution." 

The  accusation  was  formal  and  may  be  summed  up  in  what 
was  whispered  at  the  court  and  among  the  people.  Follow- 
ing the  divulging  of  these  rumors,  la  Mole  and  Conconnas 
were  arrested,  tried  and  beheaded  on  April  30,  1574.  In  their 
trial  they  were  accused  of  having  conspired  against  the  life 
of  the  King,  either  by  poison,  or  by  terminating  his  agony 
by  malice  aforethought.  It  was  especially  upon  this  latter 
accusation  that  they  were  tried  and  condemned  and  they 
were  convicted  of  having  manufactured  with  the  help  of  the 


584     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 


necromancer,  Come  Ruggieri,  wax  figures  which  were  en- 
chanted and  pierced  in  the  region  of  the  heart. 

However  this  may  be,  under  the  influence  of  the  progress 
of  the  disease,  far  more  than  under  that  of  these  superstitious 
practices,  the  condition  of  the  King  became  worse  and  worse. 
He  vomited  bloody  and  purulent  matter  and  then  a  remission 
occurred  on  May  29th,  but  on  the  next  day  he  died  at  three 
o'clock  in  the  afternoon  at  the  age  of  23  years,  11  months  and 
30  days,  after  a  reign  of  13  years. 

His  autopsy  was  considered  necessary  in  order  to  enlighten 
the  physicians  in  their  diagnosis  and  the  public  opinion,  which 
still  persisted  in  believing  that  the  death  was  due  to  poison- 
ing. It  was  performed  the  next  day,  in  the  presence  of 
Mazille,  by  the  King's  surgeons,  Ambroise  Pare  and  Guil- 
lemeau.  The  latter  has  left  a  report  in  Latin  of  the  autopsy 
and  I  here  append  the  French  translation  made  by  Brouardel 
and  Giles  de  la  Tourette. 

"  L'an  du  Seigneur  1574,  la  veille  des  calendes  de  juin  (31 
Mai)  a  ete  faite  l'autopsie  du  corps  de  Charles  IX,  tres  Chre- 
tien roi  de  France,  avec  l'assistance  des  medecins  soussignes 
et  des  chirurgiens  qui  l'ont  executee.  Voici  ce  qui  a 
ete  soigneusement  observe  et  reconnu.  Tout  le  parenchyme 
du  foie  est  desseche,  exsangue  et  tirant  sur  le  noir  depuis  les 
parties  les  plus  externes  des  lobes  jusqu'a  leur  surface  plate. 
La  vesicule  biliaire  est  vide,  affaissee  sur  ellememe,  noiratre. 
La  rate  est  saine.  L'estomac  et  le  pylore  sont  sains.  Le 
colon  est  jaunatre,  les  autres  parties  de  l'intestine  etaient 
saines.  L'epiploon  etait  de  mauvaise  couleur,  tres  friable, 
rompu  par  places  et  entierement  depourvu  de  graisse.  Les 
reins,  les  ureteres,  la  vessie,  etaient  sains.  Le  coeur  etait 
flasque  at  mou,  comme  desseche,  tout  le  liquide  qui  se  trouve 
ordinairement  dans  le  pericarde  ayant  disparu.  Le  poumon 
gauche  adherait  tellement  aux  parois  thoraciques  dans  toute 
son  etendue  qu'on  ne  put  l'enlever  sans  dechirer  et  arracher 
sa  substance  qui  etait  en  putrilage.  On  y  trouva  une  vomique 
rompue,  d'ou  s'echappa  une  humeur  purulente,  putride  et  de 
mauvaise  odeur,  en  telle  quantite  qu'elle  a  du  refluer  dans  la 
trachee-artere  et  causer  une  mort  rapide  et  imprevue,  en 
mettant  obstacle  a  la  respiration.  L'autre  poumon  n'etait  pas 
adherent ;  il  etait  plus  volumineux  qu'a  l'etat  normal,  de  meme 
que  le  gauche  le  depassait  en  matiere;  gonfile  et  distendu,  il 


CHARLES  GREENE  CUMSTON 


presentait  une  notable  corruption.  II  etait  pourri  dans  sa 
partie  superieure  et  rempli  d'humeur  pituiteuse,  musqueuse, 
spumeuse,  se  rapprochant  du  pus.    Le  cerveau  etait  sain." 

According  to  the  facts  found  in  this  report  and  the  previous 
symptoms  presented  by  the  King,  it  is  an  easy  matter  to 
decide  upon  what  disease  Charles  IX  died.  The  frequent 
hemoptyses,  the  cough,  dyspnoea,  loss  of  flesh  and  finally  the 
vomiting,  leaves  no  doubt  as  to  the  existence  of  some  pul- 
monary affection,  namely  phthisis.  The  so-called  sweating 
of  blood  which  the  King  presented  towards  the  end  of  his  life 
in  no  way  alters  this  diagnosis,  because  it  is  not  at  all  infre- 
quent to  meet  with  hemorrhagic  purpura  during  this  disease. 
Then  again,  during  the  end  of  his  life,  the  King  was  afflicted 
with  an  intercurrent  affection  which  very  probably  hastened 
the  end.  According  to  Brouardel  it  was  a  broncho-pneumonia 
and  this  hypothesis  appears  well  corroborated  by  the  findings 
at  the  autopsy.  As  to  the  accusation  of  poisoning,  I  believe 
that  it  is  absolutely  erroneous  and  that  it  was  merely  due  to 
the  condition  and  the  mind  of  the  people  at  this  time.  A 
single  point  appears  obscure,  namely,  the  condition  of  the 
liver  and  gall  bladder,  but,  at  the  present  time,  no  hesitation 
can  be  permitted,  because  their  abnormal  color  can  at  once 
be  attributed  to  postmortem  changes.  However,  the  results 
of  the  autopsy  give  no  indication  as  to  the  name  of  the  disease 
which  ended  in  the  death  of  Charles  IX,  and  consequently, 
the  public  opinion  continued  to  believe  that  it  resulted  from 
poisoning.  Both  the  physicians  and  the  surgeons  refused  to 
say  anything  and  Brantome  relates  how  he  went  to  see 
Ambroise  Pare,  in  company  with  de  Strozzi,  in  order  to  have 
more  precise  information  which  the  great  surgeon  refused  to 
give  him.  "  II  nous  dist  en  passant  et  sans  longs  propos  qu'il 
estoit  mort  pour  avoir  trop  sonne  de  la  trompe  a  la  chasse 
du  cerf,  qui  lui  avoit  tout  gaste  son  pauvre  corps  et  ne  nous 
en  dist  pas  plus.  Sur  quoy  aucuns  prirent  subject  de  faire 
pour  son  tombeau  ces  deux  vers : 

Pour  aimer  trop  Diane  et  Cytheree  aussi 
L'un  et  l'autre  m'ont  mis  dans  ce  tombeau  icy." 

The  death  of  Gabrielle  d'Estrees,  mistress  of  Henri  IV, 
who  died  in  a  few  hours  from  a  disease  upon  which  the  physi- 
cians of  the  time  had  only  very  vague  notions,  was  regarded 
by  the  large  majority  of  historians  as  the  result  of  poison. 


586-    VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 

In  order  to  verify  this  assertion  which  has  been  perhaps 
treated  somewhat  lightly,  it  is  necessary  to  rapidly  consider 
the  circumstances  which  preceded  the  death  and  to  estab- 
lish, by  basing  oneself  on  the  documents  of  the  time,  whether 
or  not  the  symptoms  presented  by  the  duchess  can  only 
be  attributed  to  poison.  In  1599  the  project  of  a  divorce 
between  Henri  IV  and  Marguerite  de  Valois  was  on  the 
point  of  being  signed  by  the  Pope,  and  the  King  had  already 
exchanged  the  marriage  ring  with  Gabrielle  d'Estrees.  The 
two  lovers  had  retired  to  Fontainebleau  towards  the  middle 
of  Lent  and  employed  their  stay  in  finishing  the  preparations 
for  their  marriage.  As  the  holy  week  drew  near,  the  King 
saw  that  he  could  not  remain  with  his  mistress  during  the 
ceremonies  without  causing  considerable  scandal  and  so  he 
decided  to  send  her  to  Paris,  happy  that  she  would  perform 
her  devotions  in  public  so  "  qu'elle  se  fit  voir  au  peuple  bonne 
catholique,  qui  ne  la  jugeait  pas  telle." 

Although  this  separation  was  to  be  of  short  duration,  Gabri- 
elle d'Estrees  did  not  look  forward  to  it  with  any  amount  of 
pleasure  and  it  appears  that  she  had  very  dark  misgivings  as 
to  the  outcome  of  the  trip.  During  the  night  preceding  her 
departure  her  servant  heard  her  groan  and  asked  the  cause 
of  her  chagrin,  to  which  she  replied  "  that  an  enchanter  had 
threatened  her  relative  to  this  last  pregnancy  and  had  pre- 
dicted that  a  child  would  prevent  her  from  attaining  the  end 
she  desired."  In  point  of  fact  the  duchess  was  at  this  time 
six  months'  pregnant  and  was  extremely  upset  by  this  condition. 

In  spite  of  her  repugnance  she  started,  accompanied  by  the 
King,  who  left  her  at  Melun  with  de  Montbazon  and  de  la 
Varenne,  who  were  not  to  lose  sight  of  her  during  her  entire 
absence.  She  arrived  at  Paris  on  Tuesday,  April  6th,  and, 
according  to  the  express  wishes  of  the  King,  she  put  up  at  the 
house  of  the  Italian,  Zamet.  On  Thursday  after  having 
dined  with  good  appetite,  she  went  to  the  Church  of  the  little 
Saint  Antoine.  It  was  during  this  ceremony  that  she  first 
felt  the  symptoms  of  the  disease  which'  was  rapidly  to  kill 
her.  The  symptoms  consisted  of  vertigo,  dizziness  and  head- 
ache, sufficiently  marked  to  oblige  her  to  leave  the  church 
before  the  end  of  the  ceremony  and  return  to  her  lodgings. 
In  order  to  refresh  herself,  she  partook  of  a  citron  and  a 
few  minutes  later  was  seized  with  a  true  attack  character- 


CHARLES  GREENE  CUMSTON 


587 


ized  by  suffocation,  convulsions,  loss  of  sight  and  mind,  a 
kind  of  apoplexy,  according  to  the  accounts  of  some  of  the 
writers  of  the  times.  When  she  had  regained  consciousness 
after  this  first  attack,  the  duchess  insisted  upon  being  re- 
moved from  Zamet's  house  and  wished  to  be  taken  at  once 
to  her  aunt,  Madame  de  Sourdis,  where  she  arrived  and  im- 
mediately went  to  bed.  She  was  again  taken  with  attacks 
similar  to  the  first  and  which  increased  both  in  frequency 
and  in  intensity.  During  the  night  of  Thursday  to  Friday, 
that  is  to  say,  only  a  few  hours  after  the  commencement  of 
the  symptoms,  the  duchess  had  lost  all  reason  and  soon 
afterwards  sight,  hearing  and  all  the  other  senses  were  abol- 
ished. Her  face  became  hideous  and  frightful,  the  eyes 
deviated,  the  neck  was  the  seat  of  contracture,  the  head  being 
turned  almost  backwards,  according  to  the  expression  of  de  la 
Varenne. 

The  physicians  called  in  haste  could  apply  no  remedy 
which,  in  their  estimation  was  necessary  and  proportionate 
to  the  violence  of  the  affection,  on  account  of  the  advanced 
state  of  pregnancy.  They  were  also  not  able  to  come  to  any 
conclusion  as  to  the  nature  of  this  very  violent  disease.  The 
duchess  died  during  the  night  of  the  10th  to  the  nth  of 
April  without  having  regained  consciousness.  An  autopsy 
which  was  thought  necessary,  was  performed  by  the  most 
celebrated  physicians  and  surgeons  of  Paris,  to  which  were 
added  those  of  the  King.  The  foetus  was  dead  and  all  de- 
clared that  its  death  had  occurred  at  the  commencement  of 
the  malady,  but  none  of  them  said  or  wrote  anything  which 
would  allow  one  to  suppose  that  they  had  found  traces  of 
poison. 

Such  is,  briefly  narrated,  the  history  of  the  end  of  Gabrielle 
d'Estrees.  None  of  the  physicians  consulted  spoke  of  poison- 
ing, but  those  who  were  unable  to  understand  the  reason  of 
a  death  so  sudden  and  rapid  were  not  long  in  attributing  it 
to  a  crime  and  the  word  poison  circulated  from  mouth  to 
mouth.  But  who  could  be  accused  if  it  was  not  he  at  whose 
house  the  victim  had  taken  her  repasts  before  going  to  the 
church?  Consequently,  it  was  upon  Zamet  that  the  sus- 
picion fell  and  since  he  apparently  could  have  no  interest  in 
doing  away  with  the  duchess  the  suspicion  was  thrown  on 
the  Grand  Duke  of  Tuscany,  Ferdinand  de  Medecis,  Zamet 

6 


588     VICTIMS  OF  THE  MEDIC1S  AND  THE  BORGIAS  IN  FRANCE 

then  being  only  considered  as  his  accomplice.  M.  de  Sis- 
mondi  has  distinctly  formulated  this  accusation  as  follows: 
"  Deja  Ton  negociait  le  mariage  de  Henri  IV  avec  Marie  de 
Medicis;  la  vie  de  Gabrielle  etait  le  grand  obstacle  a  sa  reus- 
site,  elle  perit  dans  une  maison  italienne,  et  Ferdinand  n'en 
etait  pas  a  son  premier  empoisonnement."  Michelet  in  his 
"  Histoire  de  France  au  XVI  siecle,"  published  at  Paris  in 
1855,  reproduces  the  charge  in  nearly  the  same  terms,  as  may 
be  seen  from  the  following  quotation.  "  Nul  doute  que  le 
grand  due  n'ait  ete  le  mieux  informe.  II  y  avait  interet. 
C'etait  l'homme  de  Gabrielle  (Sully)  qui  avait  ecarte  les 
Italiens  de  nos  finances.  C'etait  elle  qui  fermait  le  trone  a  sa 
niece.  Le  prince  n'en  etait  pas  a  son  premier  asassinat.  Encore 
moins  rempoisonnement,  plus  discret,  lui  repugnait  il." 

Now,  in  point  of  fact,  Ferdinand  de  Medicis  belonged  to 
this  family  so  sadly  celebrated  by  its  numerous  crimes  and 
the  souvenir  of  crimes  from  poisoning  and  those  of  all  kinds, 
along  with  treasons  of  various  sorts  committed  by  his  two 
predecessors,  were  in  the  minds  of  everybody.  For  that  mat- 
ter the  Grand  Duke  of  Tuscany  was  no  longer  making  any 
essays,  because  he  had  been  accused  of  poisoning  his  brother 
Frangois  and  the  latter's  wife,  Bianca  Capello.  These  sus- 
picions appeared  confirmed  by  their  almost  simultaneous  and 
very  sudden  death,  as  well  as  the  haste  which  Ferdinand  de 
Medicis  showed  to  leave  aside  his  cardinal's  robe  in  order  to 
succeed  his  brother.  On  the  other  hand,  Zamet  was  an  Ital- 
ian and  it  was  well  known  that  he  was  in  close  relation  with 
the  Grand  Duke.  Gabrielle  d'Estrees  had  experienced  the 
first  symptoms  of  her  disease  after  a  dinner  served  at  his 
house  and  the  relationship  between  this  repast  and  her  death 
was  too  easy  to  be  established  for  one  to  neglect  it.  The 
Duchess  of  Beaufort  appears  to  have  also  had  the  same  idea 
when,  after  the  first  attack,  she  expressed  a  formal  desire  to 
leave  her  lodgings.  However,  I  believe  with  Loiseleur  that 
her  only  desire  in  leaving  was  to  be  nearer  the  Louvre  where 
the  King  would  not  fail  to  have  her  transported  as  soon  as  he 
was  informed  of  her  sickness.  It  was  also  said  that  at  this 
epoch  negotiations  had  been  opened  with  the  Grand  Duke  of 
Tuscany  and  that  the  latter  was  in  hopes  that  they  might 
terminate  by  a  union  between  the  King  of  France  and  Marie 
de  Medicis,  and  it  was  the  deception  that  the  announcement 


CHARLES  GREENE  CUMSTON 


589 


of  the  approaching  marriage  of  Henri  IV  with  Gabrielle 
d'Estrees  had  caused  him  that  lighted  the  desire  of  vengeance 
in  the  mind  of  the  Grand  Duke  Ferdinand  de  Medicis. 

.  Now,  in  point  of  fact,  it  is  difficult  to  admit  the  reality  of 
these  negotiations,  because  they  could  not  have  taken  place 
before  the  1st  of  May,  1598,  the  date  of  the  treaty  concluded 
by  D'Ossat  between  the  King  and  the  Grand  Duke,  these 
two  princes  having  been  upon  ill  terms  previously.  Then, 
again,  it  could  not  have  been  after  this  epoch,  because  it  was 
only  during  the  latter  months  of  this  same  year  that  Henri 
IV  had  decided  to  marry  his  mistress;  and  still  more,  how 
can  it  possibly  be  imagined  that  the  King  aspired  to  become 
united  to  the  race  of  Catherine  de  Medicis,  who  had,  as  he 
said,  done  so  much  harm  to  France  and  to  himself  in  par- 
ticular. As  may  be  seen  the  accusation  brought  up  against 
the  Grand  Duke  is  faulty  even  at  its  basis,  when  the  arguments 
upon  which  it  is  founded  are  carefully  investigated. 

Other  historians  have  believed  that  the  murder  of  the 
Duchess  was  due  to  one  of  the  two  great  parties  which  at 
this  time  divided  France,  but  these  suspicions  are  quite  as 
vain  as  the  preceding  ones.  Those  who  belonged  to  the 
reform  party  were,  for  the  greater  part,  openly  allied  to  the 
marriage ;  those  who  were  not  very  sympathetic  in  this  re- 
spect certainly  preferred  to  have  as  Queen  the  Duchess  of 
Beaufort  than  an  ardent  Catholic  like  the  niece  of  the  Grand 
Duke.  The  Catholics  were  not  any  more  interested  in  pre- 
venting this  union,  because  they  had  received  all  the  neces- 
sary guarantees  relative  to  the  political  consequences  that 
might  result  from  it. 

And  lastly,  suspicions  were  thrown  upon  a  man,  who,  on 
several  occasions  had  shown  some  animosity  towards  the 
Duchess,  who  took  extreme  care  to  prevent  the  fulfillment  of 
all  her  desires,  who  also  gave  his  wife  the  news  of  the 
Duchess'  death  in  these  words.  "  Vous  n'irez  pas  au  coucher, 
ni  au  lever  de  la  Duchesse,  car  la  corde  est  rompue."  This 
man  was  Sully. 

Those  writers  who  are  not  afraid  of  doing  injury  to  one 
of  the  greatest  characters  in  history  do  not  go  so  far  as  to 
uphold  that  he  played  an  active  part  in  the  conspiracy,  but 
they  believe  that  he  was  aware  of  it  and  allowed  it  to  be 
carried  out.    Such  an  accusation  made  against  a  man  like 


590     VICTIMS  OF  THE  MEDICIS  AND  THE  BORGIAS  IN  FRANCE 

Sully  does  not  seem  to  be  necessary  to  discuss  very  lengthily, 
because  it  was  he  himself  who  left  us  the  details  of  the  death 
of  the  Duchess  and  the  remarks  which  I  have  already 
alluded  to,  a  thing  which  he  would  not  have  done  had  he  been 
in  any  way  guilty.  Before  accusing  so  great  a  character  of 
such  a  crime,  it  is  of  all  necessity  to  establish  whether  or  not 
there  was  really  any  poisoning  and  if  the  death  of  the  Duchess 
was  not  due  to  some  natural  cause. 

Now,  it  has  been  pointed  out  that  at  the  time  Gabrielle 
d'Estrees  started  for  Paris  she  was  about  six  months'  preg- 
nant and  that  she  was  extremely  miserable  on  account  of  this 
condition.  If,  in  possession  of  this  fact,  we  sum  up  the  symp- 
toms of  her  illness,  which  consisted  in  headache,  vertigo, 
dizziness,  suffocation,  loss  of  sight  and  the  other  senses,  un- 
consciousness and  death  in  coma,  it  would  appear  to  me  that 
we  have  a  picture  of  a  pathologic  condition  which  at  the 
present  time  is  well  known.  I  refer  to  eclampsia.  The  en- 
tire illness  of  the  Duchess  is  a  true  picture  of  this  condition, 
showing  its  various  stages  and  lastly  the  end  in  coma.  The 
results  of  the  autopsy  are  in  no  way  hostile  to  this  hypothesis, 
^because  the  physicians  found  the  foetus  dead  since  the  com- 
mencement of  its  mother's  attack  and  it  is  well  established 
that  this  condition  of  affairs  is  what  is  ordinarily  found  in 
serious  cases  of  eclampsia,  like  that  presented  by  Gabrielle 
d'Estrees.  It  is  consequently  to  this  opinion  that  one  should 
adhere,  and  all  question  as  to  poisoning  should  be  forever 
done  away  with,  because  it  is  absolutely  without  foundation. 


EDITORIAL 


591 


Editorial 

A  hospital  is  a  quiet  place.  Suppose  one  to  go  to  a 
public  ward,  say  the  surgical  ward,  and  there  be  the 
only  patient  during  a  large  part  of  the  four  weeks'  stay; 
he  were  likely  to  have  his  fill  of  lonely  gazing  on  the 
white-coated  walls,  and  white-spread  cots,  and  white- 
shaded  windows:  of  the  fugitive  persistence  of  iodo- 
form; of  straining  the  ear  for  a  vanishing  footfall 
on  the  rubber-deadened  passage  without,  a  nurse's 
motherly,  girlish  voice,  a  young  house-surgeon's  im- 
portant tones,  the  soft  swish  of  unstarched  skirts,  or 
any  of  the  hushed  hospital  sounds  which  awaken  out 
of  the  silence,  at  first  muffling,  everything. 

Moreover,  in  such  a  case,  too  weak  to  read,  too 
poor  to  buy  privacy  with  its  consequent  allowance 
of  company,  seeing  no  visitors  except  on  the  bi-weekly 
visiting  day,  one  might  have  a  surfeit  of  leisure  to 
think. 

The  Man  of  the  Hour.  Octave  Tuanet. 

*      *  * 

In  an  address  of  characteristic  attractiveness 
The  Endow-   delivered  to  the  graduating  class  of  the  Lakeside 
ment  of  Schools  Hospital  for  Nurses,  of  Cleveland,  Dr.  Henry  M. 

for  Nurses  Hurd,  of  the  Johns  Hopkins  Hospital,  gives  some 
reasons  for  the  greater  appreciation  of  the  work  of  nurses  and 
of  schools  for  their  instruction,  and  makes  an  appeal  for  endow- 
ment. At  first  thought  one  regards  a  school  for  nurses  as  an 
adjunct  to  a  hospital,  and  it  is  to  be  feared  that  many  whose 
interest  has  been  awakened  have  had  their  attention  more  par- 
ticularly directed  to  the  service  of  the  hospital  than  to  ultimate 
effects. 

Dr.  Hurd  begins  his  address  most  appropriately  with  a  com- 
parison, or,  more  properly  speaking,  a  contrast,  between  manual 
training  or  handicraft  and  the  liberal  arts ;  and  he  uses  the  work 
of  a  nurse  as  the  most  emphatic  demonstration  of  the  value  of 
mental  training  for  the  intelligent  direction  of  the  labor  of  the 
hands.  If  the  university  makes  education  a  matter  of  thought 
without  hands,  and  the  technical  school  makes  it  a  matter  of 
hands  without  thought,  a  school  for  the  education  of  nurses  brings 
a  happy  co-ordination  of  both  for  the  accomplishment  of  the 
greatest  good.    Coming  from  such  a  source,  then,  Dr.  Hurd's 


.592 


EDITORIAL 


resolute  attitude  that  there  is  no  danger  of  an  overeducated  or 
overtrained  nurse,  will  do  much  to  turn  aside  a  suspicion  in  many- 
places  of  the  danger  of  culture  in  this  department  of  work. 
"  Knowledge  is  power,  and  the  fuller  the  knowledge  and  the  better 
the  training  of  a  good  nurse,  the  better  her  power." 

Dr.  Hurd  brings  into  focus  the  influence  of  the  nurse  in  the 
wider  work  outside  the  hospital :  "  She  has  been  introduced  into 
the  public  school  with  great  advantage  to  the  public  welfare. 
She  watches  over  the  health  of  the  pupils ;  she  observes  the 
hygienic  condition  of  the  school ;  she  visits  the  home  to  know  how 
the  pupils  live  there  and  to  give  such  instruction  as  will  improve 
the  conditions  of  living.  In  district  nursing  her  services  also 
require  the  highest  grade  of  intelligence  and  training.  She  must 
become,  to  use  Florence  Nightingale's  term,  '  a  missioner  of 
health  '  to  families  of  the  poor,  and  must  preach  the  gospel  of 
hygienic  living  and  healthful  surroundings.  Upon  the  tuber- 
culosis nurse  is  placed  the  hardest  part  of  the  battle  which  is 
being  waged  against  tuberculosis  in  every  part  of  the  country. 
She  not  onlly  must  look  after  the  sick  as  a  nurse  but  also  is 
responsible  for  the  hygienic  care  of  the  sick  and  the  instruction 
of  the  family,  so  that  tuberculosis  may  not  be  a  source  of  danger 
to  the  community.  She  must  equally  instruct  the  family  and 
supervise  the  home,  so  that  other  members  of  the  family  may  not, 
through  inadvertence  or  ignorance,  acquire  the  dread  disease. 
She  must  see  that  families  live  healthily ;  that  too  many  are  not 
crowded  into  an  infected  room;  that  rooms  are  properly  dis- 
infected after  the  death  or  removal  of  a  tubercular  patient,  and 
must  protect  the  whole  community  from  the  spread  of  tuber- 
culosis disease." 

From  this  standpoint  it  is  easily  seen  how  great  the  value  to 
the  community  is  the  work  of  the  properly  trained  nurse,  how 
much  may  be  lost  by  the  absence  of  trained  nurses,  and  how 
much  harm  may  be  done  by  inadequately  trained  nurses,  those 
who  have  thrust  themselves  into  this  occupation  after  observation 
of  two  or  three  cases  of  sickness,  or  those  who  have  been  thrust 
upon  the  public  after  an  alleged  course  of  training,  consisting 
of  a  few  didactic  lectures  and  a  few  manipulations.  Dr.  Hurd 
appeals  strongly  to  the  sentiment  which  should  encourage  nurses, 
and  he  believes  that  each  nurse  is  a  center  of  good  works, — an 
exponent  of  the  law  of  mutual  aid  and  of  personal  service  in  the 
hospital,  as  a  district  nurse,  as  a  tuberculosis  nurse  in  the  public 


LITTLE  BIOGRAPHIES 


593 


schools,  in  the  social  settlements,  in  the  army  and  navy,  in  the 
Red  Gross,  in  the  home  of  the  poor  or  the  palace  of  the  rich. 
"  Everywhere  her  presence  makes  for  comfort  in  sickness,  for  the 
minimization  of  the  loss  to  the  community  and  the  State  which 
disease,  suffering  and  death  entail ;  for  the  prevention  of  disease 
and  for  the  social  uplift  which  is  the  hope  of  the  nation  with  its 
conglomerate  population  and  racial  diversities  and  animosities. 
More  surely  than  education  alone,  more  strongly  than  the  ties  of 
religion,  more  firmly  than  self-interest  and  commercialism,  this 
form  of  service  will  bind  society  together  and  assist  each  class 
in  the  effort  to  lighten  the  burdens  of  the  other." 

And  if  all  this  cannot  be  had  without  endowment  of  the  schools 
for  nurses,  there  should  be  no  delay  in  providing  the  endowment. 

All  power  to  the  head  and  the  hand  of  the  trained  nurse! 


little  JSioarapbies 

VIII.   JACOBUS  SYLVIUS. 

JACQUES  DUBOIS  was  one  of  the  earliest  anatomists  of 
the  French  school  to  gain  distinction,  a  distinction  to 
which  his  researches  do  not  seem  to  entitle  him.   He  was 
the  son  of  Nicholas  Dubois  (De  lo  Bo),  a  cambric 
weaver  who  had  eleven  sons  and  four  daughters.    He  was  born 
in  Amiens  in  Picardy,  in  1478.    According  to  the  custom  of  his 
day  he  assumed  the  Romanized  name  of  Jacobus  Sylvius. 

At  the  instance  of  his  brother  Franciscus,  who  was  professor 
of  eloquence  in  the  College  of  Tournay,  at  Paris,  he  devoted  him- 
self to  the  study  of  the  languages  and  mathematics.  Discovering, 
however,  that  these  elegant  accomplishments  do  not  invariably 
reward  their  cultivators  with  the  goods  of  fortune,  Sylvius  forsook 
them  for  the  study  of  medicine.  Thus  it  is  said,  that  for  the 
name  of  Sylvius  the  history  of  anatomy  is  indebted  to  his  inordi- 
nate love  of  money.  His  early  knowledge  of  this  subject  he 
acquired  from  the  writings  of  Galen,  of  whom  we  are  told  he 
was  an  indiscriminate  and  irrational  admirer  and  whose  ana- 
tomical and  physiological  teachings  he  interpreted  in  preference 
to  giving  demonstrations  from  the  subject.  His  reputation  as  a 
teacher  soon  spread  and  students  came  to  him  from  all  parts  of 
Europe.  He  at  this  time,  however,  met  with  great  opposition 
from  the  physicians  of  Paris,  who  were  extremely  displeased  that 


594-  LITTLE  BIOGRAPHIES 

a  man  who  had  no  where  taken  a  degree  in  physic  should  presume 
to  teach  science  in  the  metropolis  of  the  kingdom.  These  mur- 
murs induced  him  to  go  to  Montpellier  in  1520,  at  the  age  of 
42,  to  take  his  degree.  He  returned  once  without  it,  his  avarice 
not  permitting  him  to  be  at  the  necessary  expense.  Later  his 
course  was  resumed  and  he  was  admitted  bachelor  of  physic  in 
June,  1 53 1,  then  53  years  of  age. 

Upon  his  return  to  Paris  he  again  took  up  his  work  in  anatomi- 
cal instruction  and  here  taught  anatomy  to  large  audiences  in 
the  College  of  Trinquet.  On  the  departure  of  Yidus  Vidius  for 
Italy  in  1548,  the  professorship  of  physic  in  the  Royal  College 
becoming  vacant,  Sylvius  was  chosen  to  fill  it,  which  he  did  after 
hesitating  two  years.  This  position  he  retained  until  the  time 
of  his  death,  which  occurred  in  1555,  at  the  age  of  72. 

We  are  assured  by  Vesalius,  who  was  at  one  time  his  pupil, 
that  Sylvius'  manner  of  teaching  was  calculated  neither  to  ad- 
vance the  science  of  medicine  nor  to  rectify  the  mistakes  of  his 
predecessors.  Without  talent  for  original  research  or  discovery 
himself,  his  envy  and  jealousy  made  him  detest  everyone  who 
gave  proofs  of  either.  A  human  body  was  never  seen  in  the 
theatre  of  Sylvius ;  the  carcasses  of  dogs  and  other  animals  were 
the  materials  from  which  he  taught  and  so  difficult  was  it  to 
obtain  human  bones  that  unless  Vesalius  and  his  fellow  students 
had  collected  assiduously  from  the  Innocents  and  other  cemeteries 
they  would  have  committed  numerous  errors  in  acquiring  the  first 
principles.  This  assertion,  however,  is  contradicted  by  Riolan, 
and  afterwards  by  Sprengel  and  Lauth,  the  last  of  whom  decidedly 
censures  Vesalius  for  this  ungrateful  treatment  of  his  instructor. 

Sylvius  was  never  married,  and  he  showed  even  an  aversion 
to  women.  His  behavior  was  rude  and  barbarous.  He  seldom 
jested  or  departed  from  his  gravity  and  when  he  was  inclined 
to  become  more  sociable,  he  did  so  awkwardly.  The  only  merry 
saying  attributed  to  him  is  that  "  he  had  parted  with  three  beasts, 
his  cat,  his  mule  and  his  maid."  His  avarice  was  extreme  and 
he  lived  in  the  most  sordid  manner;  he  allowed  his  servants 
nothing  but  dry  bread  and  had  no  fire  in  winter.  Two  things 
served  him  as  a  remedy  against  cold ;  he  played  foot  ball  and 
carried  a  great  log  upon  his  shoulders,  saying  that  the  heat  which 
he  gained  by  this  exercise  was  more  beneficial  to  his  health  than 
that  of  a  fire.  In  short,  his  passion  for  money  obscured  the  lustre 
of  his  better  qualities. 


SCIENTIFIC  REVIEW 


595 


His  most  important  work,  which  was  not  published  till  1630, 
seventy-five  years  after  his  death,  appears  to  have  been  his 
"  Opera  Medica  "  in  which  is  found  a  description  of  the  fissure 
and  aqueduct  of  the  brain  which  bear  his  name.  Though  his 
mention  of  injections  had  led  some  to  suppose  him  the  discoverer 
of  that  an.  he  appears  to  have  made  no  substantial  addition  to 
the  information  already  acquired.  The  first  acknowledged  pro- 
fessor of  anatomy  at  the  University  of  Paris  appears  then  in 
history  as  one  who  lived  without  true  honor  and  died  without 
just  celebrity.  George  E.  Beilby. 

BIBLIOGRAPHY. 

BujAim  Hctchixsoh.    Bicgrapbia  Medica,  Vol.  ii,  London,  i;99- 

Biographisches  Lexikon  der  hervorragenden  Art^e,  Band  t. 

Beockhans.  Konnerstrcng-Lexikon.  Band  xv,  Leipzig,  1845. 

Encyclopaedia  Brittannica,  Vcl.  i,  Edinburgh,  1875. 


Scientific  Review 

The  Treatment  of  Exophthalmic  Goitre  Without  Refer- 
ence to  Surgical  Intervention. 

Since  Caleb  H.  Parry1,  in  1786,  described  exophthalmic  goitre 
great  improvement  has  been  made  in  the  treatment  of  this  dis- 
tressing disease,  especially  in  the  last  few  years.  We  know  that 
in  this  disease  there  are  constant  pathologic  changes  in  the  thyroid 
gland.  We  know  the  nature  of  these  changes,  but  of  the  etiology 
we  have  no  definite  knowledge.  Accordingly,  no  rational  remedy 
has  been  found  and  the  treatment  has  not  been,  and  is  not  now, 
entirely  satisfactory. 

Tyson2  regards  the  disease  as  due  to  a  cysto-toxin  which  arises 
from  deranged  secretion  or  overactivity  of  the  thyroid  gland, 
and  which  produces  the  symptoms.  He  says  that  experience 
with  analogous  diseases  would  lead  us  to  believe  that  an  anti-toxin 
may  yet  be  found. 

Many  drugs  have  been  tried  and  retried  with  indifferent  re- 
sults. Iron  and  iodine  have  had  the  lead  but  are  now  relegated 
to  the  past.  Shattuck3  states  that  his  main  reliance  in  treating 
Graves'  disease  is  neutral  bromid  of  quinine  in  five-grain  doses, 
three  or  four  times  daily.  Other  men  have  reported  good  results 
from  the  bromides,  in  doses  varying  from  fifteen  to  sixty  grains, 
four  times  daily :  they  are  considered  useful  for  nervous  patients. 
Digitalis  and  strophanthus  in  doses  of  ten  to  fifteen  grains  are 


596 


SCIENTIFIC  REVIEW 


useful  as  they  relieve  tachycardia  as  a  rule;  if  not,  they  should 
be  stopped,  as  larger  doses  exhaust  the  heart  muscle.  Tincture 
of  belladonna,  ten  minims  three  times  daily,  will  also  often  relieve 
tachycardia.  Opium  has  also  been  recommended  and  should  be 
considered.  It  quiets  irritability  but  is  not  always  well  borne; 
it  constipates,  a  bad  feature,  and  as  the  elimination  of  the  toxin 
is  increased  in  diarrhoea  caution  should  be  observed  in  checking 
the  movements  of  the  bowels.  Codeine  would  be  preferable  to 
morphine. 

Jousemet4  speaks  well  of  the  long  continued  administration  of 
sodium  salicylate,  one  drachm,  three  times  daily.  Arsenic  has 
been  recommended. 

William  H.  Thompson5  of  New  York  attributes  exophthalmic 
goitre  to  gastro-intestinal  ptomaine  poisoning,  and  places  his 
patients  on  a  rigid  milk  diet  for  two  years.  He  believes  that  the 
ptomaines  are  gradually  eliminated  and  that  the  milk  diet  prevents 
their  formation.  On  the  other  hand,  it  seems  that  if  the  disease 
be  due  to  a  toxin,  the  toxin  is  formed  in  the  thyroid  gland  itself ; 
this  is  indicated  by  the  relief  experienced  after  operative  treat- 
ment. 

Although  the  use  of  electricity  has  proved  to  be  disappointing 
in  this  country  and  in  England,  the  German  observers  laud  it  as 
a  remedy.  They  claim  that  the  constant  galvanic  current  with 
the  negative  pole  over  the  fifth  cervical  vertebra  and  the  constant 
pole  over  the  sternum,  will  greatly  ameliorate  and  often  remove 
entirely  the  distressing  combination  of  symptoms  found  in  this 
disease.  In  "  Le  Nord  Medicale  September,  1905,  E.  Doumer 
and  D.  Maes6  reported  a  case  in  which  the  use  of  the  faradic 
current  according  to  Vibouroux's  method  had  cleared  up  all  the 
symptoms  in  a  very  short  time.  After  three  treatments  the 
patient  considered  himself  cured,  as  all  the  symptoms  had  dis- 
appeared. George  R.  Murray7  regards  the  use  of  the  faradic 
current  in  connection  with  small  doses  of  arsenic  as  the  most 
valuable  method  of  treating  Graves'  disease. 

Dr.  Baetjer8  has  been  using  the  X-ray  in  this  disease  and  in 
two  cases  has  had  apparently  good  results ;  the  hypertrophy  of 
the  thyroid  disappeared  and  the  general  health  improved  greatly.  - 
Charles  H.  Mayo  has  had  good  results  but  claims  no  permanent 
cure. 

In  the  past  few  years  there  has  been  great  activity  in  the  treat- 
ment of  diseases  of  the  thyroid  gland  by  organo-therapy.  At 


SCIENTIFIC  REVIEW 


597 


first  thyroid  extract  was  used.  Theoretically  it  makes  the  disease 
worse  and  the  evidence  has  confirmed  that  theory.  Thymus, 
suprarenal  and  ovarian  extracts  have  been  used,  and  have  been 
followed  in  some  cases  by  rapid  improvement.  An  anti-thyroid 
serum  in  the  form  of  rodagin,  a  powder  prepared  from  the  milk 
of  goats  after  thyroidectomy  was  presented  to  the  profession  by 
Moebius  in  1901.  This  has  given  good  results,  reducing  the 
gland  in  size,  and  improving  the  bodily  and  mental  health.  How- 
ever, if  the  treatment  is  discontinued,  relapse  is  certain.  Christens 
and  Thienger9  speak  favorably  of  serum  prepared  from  the  blood 
of  thyroidectomized  goats.  Rogers  with  Beebe10  published  in 
January,  1906,  communications  regarding  a  new  anti-toxin. 
This  is  prepared  from  the  blood  serum  of  rabbits  which  have 
been  injected  with  an  extract  derived  from  diseased  thyroids. 
Dr.  William  G.  Thompson11,  in  the  April  number  of  the  New 
York  State  Medical  Journal  says :  "  They  have  produced  a  serum 
which  by  the  promptness  and  completeness  of  its  effects  in 
Graves'  disease  leaves  no  further  room  for  doubt  as  to  the  spe- 
cifically toxic  nature  of  the  acute  exacerbations  and  the  cause  of 
the  frequent  heretofore  fatal  terminations." 

Whatever  special  method  of  treatment  is  adopted,  the  vital 
resistance  should  be  sustained  in  every  way  possible.  The  excre- 
tory organs  should  be  assisted  in  their  work  of  discharging  the 
toxins  that  produce  the  symptoms.  The  environment  of  the 
patient  should  be  cheerful,  pleasant  and  quiet.  The  writer  has 
seen  a  case  greatly  improved  by  such  measures  alone.  All  ex- 
citement, worry  and  fatigue  should  be  carefully  avoided.  Stimu- 
lating food  and  alcoholic  drinks  should  not  be  permitted.  Sexua. 
indulgence  and  pregnancy  should  be  discouraged,  and  outdoor 
life  insisted  upon  no  matter  what  method  of  treatment  is  followed, 
be  it  medicinal,  electrical  or  organo-therapeutic. 

D.  V.  O'Leary,  Jr. 

REFERENCES. 

1  Practice  of  Medicine(OsLER),  4th  edition,  p.  836. 

2  International  Clinics,  sixteenth  series,  vol.  1,  p.  1. 

3  American  Medicine,  vol.  viii,  no.  31,  p.  899. 

4  International  Clinics,  sixteenth  series,  vol.  1,  p.  210. 

5  International  Clinics,  sixteenth  series,  vol.  1,  p.  2. 

6  Medical  Record,  vol.  68,  no.  21,  p.  832. 

7  British  Medical  Journal,  no.  2341,  p.  1249. 

8  International  Clinics,  sixteenth  series,  vol.  1,  p.  279. 

9  International  Clinics,  sixteenth  series,  vol.  i,  p.  210. 

10  New  York  State  Medical  Journal,  vol.  6,  no.  4,  p.  149. 

11  New  York  State  Medical  Journal,  vol.  6,  no.  4,  p.  149. 


598 


MEDICAL  NEWS 


Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick. — Statistics 
for  June,  1906:  Number  of  new  cases  94.  classified  as  follows: 
Dispensary  patients  receiving  home  care,  1 ;  district  cases  reported  by 
health  physicians,  7;  charity  cases  reported  by  other  physicians,  42;  patients 
of  limited  means,  44;  old  cases  still  under  treatment,  54;  total  number  of 
patients  under  nursing  care  during  the  month,  148;  classification  of  diseases 
(new  cases)  medical,  28;  surgical,  8;  gynecological,  5;  obstetrical  work  of 
the  Guild,  26;  mother  and  25  infants  under  professional  care;  dental,  2; 
number  of  contagious  dis«ases  in  medical  list,  1 ;  transferred  to  hospitals, 
3 ;  leaths,  3. 

Special  Obstetrical  Department. — Number  of  obstetricians  in  charge  of 
cases,  1;  attending  obstetricians,  1;  medical  students  in  attendance,  3; 
Guild  nurses  in  attendance,  1 ;  cases,  1 ;  number  of  visits  by  attending 
obstetricians,  1;  by  the  medical  students,  10;  by  the  Guild  nurses,  9;  total 
number  of  visits  for  this  department,  20. 

Visits  of  Guild  Nurse  (all  departments) — Number  of  visits  with  nursing 
treatment.  1,032;  for  professional  supervision  of  convalescents,  193;  total 
number  of  visits,  1,225.  Five  graduate  nurses  and  five  assistant  nurses 
were  on  duty.  Cases  were  reported  to  the  Guild  by  four  of  the  health 
physicians  and  by  25  other  physicians  and  by  1  dentist. 

Medical  Society  of  the  County  of  Albany.  —  The  newly 
elected  Board  of  Censors  met  for  organization  at  the  office 
of  Dr.  A.  Vander  Veer,  July  9.  The  following  members  were  present: 
Dr.  F.  C.  Curtis,  Dr.  H.  E.  Mereness,  Dr.  S.  B.  Ward,  Dr.  A.  Vander 
Veer  and  Dr.  G.  G.  Lempe,  President  of  the  Society.  Dr.  Ward  was 
elected  Chairman  and  Dr.  Curtis,  Secretary. 

The  American  Roentgen  Ray  Society. — The  Seventh  Annual 
Meeting  of  the  American  Roentgen  Ray  Society  will  be 
held  August  29,  30,  31,  1906,  at  the  Cataract  and  International 
Hotels,  Niagara  Falls,  N.  Y.  A  large  and  interesting  program  containing 
the  names  of  the  best  known  X-ray  workers  in  this  country  as  well  as  a 
number  from  abroad,  has  been  prepared.  An  interesting  feature  of  the 
meeting  will  be  the  exhibit  of  prints  and  negatives.  The  railroads  have 
granted  a  rate  of  a-fare-and-a-third  on  the  certificate  plan. 

The  officers  of  the  society  are:  President,  Dr.  Henry  Hulst,  Grand 
Rapids,  Mich. ;  Secretary,  Dr.  Geo.  C.  Johnston,  Pittsburg,  Pa. ;  Treas- 
urer, Dr.  Leavitt  E.  Custer,  Dayton,  Ohio;  Vice-Presidents,  Dr.  Russell 
H.  Boggs,  Pittsburg.  Pa. ;  Dr.  Clarence  E.  Skinner,  New  Haven,  Conn. ; 
Dr.  Ennion  G.  Williams,  Richmond,  Va. ;  Dr.  Eugene  W.  Caldwell,  New 
York,  N.  Y. 

Full  information  regarding  the  meeting  and  application  blanks  for  mem- 


MEDICAL  NEWS 


599 


Jjership  may  be  obtained  by  addressing  the  Secretary,  Dr.  Geo.  C.  John- 
ston, 611  Fulton  Bldg.,  Pittsburg,  Pa. 

Greatest  of  Dental  Conventions — .Arrangements  are  being 
made  for  holding  the  world's  greatest  Dental  Convention 
at  the  Jamestown  Exposition,  Norfolk,  Virginia,  next  year. 
Not  only  will  the  various  State  Dental  Conventions  be  held  here  but  some 
of  the  European  countries  will  be  represented  at  this  National  Dental 
Congress.  Among  the  celebrities  to  be  in  attendance  is  Prof.  W.  D. 
Miller,  the  greatest  dental  scientist  in  Europe,  if  not  the  greatest  in  the 
world,  who  will  deliver  an  address  before  the  congress.  Dr.  Burton  Lee 
Thorpe,  of  St.  Louis,  is  chairman  of  the  Jamestown  Dental  Convention. 
The  other  officers  and  committee  are:  Dr.  R.  H.  Walker,  of  Norfolk,  Va., 
Dr.  H.  Wood  Campbell,  of  Suffolk,  Va,  Dr.  Thos.  P.  Hinman,  of  Atlanta, 
Ga.,  Dr.  F.  W.  Stiff;  of  Richmond,  Va. 

Among  the  organizations  to  participate  in  this  mammoth  convention  are 
the  National  Dental  Association,  the  Southern  Branch  of  the  National 
Dental  Association,  the  Virginia  State  Dental  Association,  the  Missouri 
State  Dental  Association,  the  Alabama  Dental  Association,  the  Tennessee 
Dental  Association  and  other  state  dental  associations. 

The  Jamestown  Dental  Convention  will  be  held  in  the  Hall  of  Congress 
or  Auditorium  at  the  Jamestown  Exposition  in  1907  and  a  series  of  clinics 
conducted  by  world  famed  experts  at  the  same  time  will  be  given.  Prep- 
arations will  be  made  to  royally  entertain  the  hundreds  of  dentists  who 
are  coming  to  this  convention,  both  at  Norfolk,  where  the  Exposition  is  to 
be  held,  and  at  the  other  points  of  historic  interest  in  this  locality. 

Treasury  Department.— Bureau  of  Public  Health  and  Marine 
Hospital  Service. — A  board  of  officers  will  be  convened  to  meet  at  the 
Bureau  of  Public  Health  and  Marine  Hospital  Service,  3  B  Street,  S.  E., 
Washington,  D.  C,  Monday,  August  6,  1906,  at  10  o'clock  a.  m.,  for  the 
purpose  of  examining  candidates  for  admission  to  the  grade  of  assistant 
surgeon  in  the  Public  Health  and  Marine  Hospital  service. 

Candidates  must  be  between  twenty-two  and  thirty  years  of  age,  grad- 
uates of  a  reputable  medical  college,  and  must  furnish  testimonials  from 
responsible  persons  as  to  their  professional  and  moral  character. 

The  following  is  the  usual  order  of  the  examinations:  1,  Physical.  2, 
Oral.  3,  Written.  4,  Clinical. 

In  addition  to  the  physical  examination,  candidates  are  required  to 
certify  that  they  believe  themselves  free  from  any  ailment  which  would 
disqualify  them  for  service  in  any  climate. 

The  examinations  are  chiefly  in  writing,  and  begin  with  a  short  auto- 
biography of  the  candidate.  The  remainder  of  the  written  exercise  con- 
sists in  examination  on  the  various  branches  of  medicine,  surgery  and 
hygiene. 

The  oral  examination  includes  subjects  of  preliminary  education,  history, 
literature,  and  natural  sciences. 

The  clinical  examination  is  conducted  at  a  hospital,  and  when  practicable, 
candidates  are  required  to  perform  surgical  operations  on  a  cadaver. 

Successful  candidates  will  be  numbered  according  to  their  attainments 


6oo 


MEDICAL  NEWS 


on  examination  and  will  be  commissioned  in  the  same  order  as  vacancies 
occur. 

Upon  appointment  the  young  officers  are,  as  a  rule,  first  assigned  to  duty 
at  one  of  the  large  hospitals,  as  at  Boston,  New  York,  New  Orleans, 
Chicago,  or  San  Francisco. 

After  five  years'  service,  assistant  surgeons  are  entitled  to  examination 
for  promotion  to  the  grade  of  passed  assistant  surgeon. 

Promotion  to  the  grade  of  surgeon  is  made  according  to  seniority,  and 
after  due  examination  as  vacancies  occur  in  that  grade. 

Assistant  surgeons  receive  sixteen  hundred  dollars;  passed  assistant 
surgeons,  two  thousand  dollars,  and  surgeons,  twenty-five  hundred  dollars 
a  year  When  quarters  are  not  provided  commutation  at  the  rate  of  thirty, 
forty,  and  fifty  dollars  a  month,  according  to  grade,  is  allowed. 

All  grades  above  that  of  assistant  surgeon  receive  longevity  pay,  ten  per 
centum  in  addition  to  the  regular  salary  for  every  five  years'  service  up  to 
forty  per  centum  after  twenty  years'  service. 

The  tenure  of  office  is  permanent.  Officers  traveling  under  orders  are 
allowed  actual  expenses. 

For  further  information,  or  for  invitation  to  appear  before  the  board  of 
examiners,  address  The  Surgeon-General  Public  Health  and  Marine 
Hospital  Service,  Washington,  D.  C. 

Personal. — Dr.  George  B.  Stanwix  (A.  M.  C,  1898),  announces  his  re- 
moval from  Binghamton,  to  1170  Dean  Street,  Brooklyn,  N.  Y.,  where  he 
will  continue  to  devote  his  practice  to  diseases  of  the  nose,  throat  and 
are  exclusively. 

Dr.  Alvah  H.  Traver  (A.  M.  C,  1898),  is  visiting  at  St.  Mary's  Hospi- 
tal, Rochester,  Minn. 

Dr.  Ransom  S.  Moscrip,  (A.  M.  C,  1899,)  is  in  practice  at  Grand  Gorge, 
Delaware  County,  N.  Y. 

Dr.  Frederick  E.  Bolt  (A.  M.  C,  1903),  is  at  East  Meredith,  N.  Y.,  and 
is  health  officer  of  the  town  of  Meredith. 

Dr.  Frank  J.  Hurley  (A.  M.  C,  1905),  has  completed  his  term  of  ser- 
vice at  St.  Peter's  Hospital,  Albany,  and  has  located  at  Bennington,  Vt. 


Death.— Dr.  John  C.  O'Haire  (A.  M.  C,  1891),  died  at  his  mother's 
home  in  Watervliet,  N.  Y.,  June  16,  1906. 


CURRENT  MEDICAL  LITERATURE 


601 


Current  ADeMcal  Xiterature 

REVIEWS  AUD  NOTICES  OF  BOOKS 

The  Practical  Medicine  Series.  Comprising  Ten  Volumes  on  the  Year's 
Progress  in  Medicine  and  Surgery.  Under  the  General  Editorial 
Charge  of  Gustavus  P.  Head,  M.  D.,  Professor  of  Laryngology  and 
Rhinology,  Chicago  Post-Graduate  Medical  School.  Volume  II. 
General  Surgery.  Edited  by  John  B.  Murphy,  A.  M.,  M.  D.,  LL.  D., 
Professor  of  Surgery  in  Rush  Medical  College  (in  affiliation  with 
the  University  of  Chicago).  Series  1906.  The  Year  Book  Pub- 
lishers, Chicago,  40  Dearborn  St. 

The  advancement  of  the  medical  sciences  is  so  rapid  and  the  medical 
literary  output  is  becoming  so  vast  that  it  is  not  within  the  bounds  of 
possibility  for  a  general  practitioner  of  medicine,  unaided,  to  keep  abreast 
of  the  times.  The  specialist  can  only  with  difficulty  keep  up  with  the  recent 
literature  on  this  particular  specialty.  F.  S.  Dennis,  in  an  address  on  the 
history  and  development  of  surgery,  calls  attention  to  the  fact  that  Ameri- 
can writers  alone  are  publishing  annually  500  medical  volumes  to  say 
nothing  of  nearly  10,000  journal  articles  each  year. 

Within  recent  years  attempts  have  been  made  to  bring  together  the  im- 
portant medical  advances  of  the  year  into  some  form  of  year  book.  The 
value  of  having  this  knowledge  in  a  compact  form  for  ready  reference  is 
obvious  to  both  the  general  practitioner  and  the  specialist. 

The  present  volume  is  one  of  a  series  of  ten  issued  at  about  monthly 
intervals  and  covering  the  entire  field  of  medicine  and  surgery.  The  sub- 
ject of  this  volume  is  "  General  Surgery"  and  is  edited  by  J.  B.  Murphy  of 
Chicago. 

To  abstract  the  book  carefully  would  be  to  reproduce  it.  The  author  has 
abstracted  articles  extensively  from  acknowledged  authorities  dealing 
with  general  subjects,  remarkable  cases,  etc.  Articles  on  new  lines  of 
treatment,  such  as  Bier's  treatment  of  tubercular  arthritis  by  chronic  pas- 
sive congestion  are  reviewed.  Considerable  space  is  devoted  to  the  subject 
of  anesthesia.  The  ideal  anesthetic  has  not  yet  been  attained.  Writing 
of  scopolamin-morphin  the  author  says :  "  It  seems  to  us  that  the  method 
is  not  justifiable  except  under  extraordinary  circumstances  and  its  general 
use  should  be  discouraged  for  the  present." 

A  summary  of  the  work  of  the  year  shows  that  abdominal  surgery  of  all 
kinds  has  made  marked  advances.  The  newer  methods  of  careful  urine 
examinations  have  led  to  beneficial  conservatism  in  kidney  surgery  and 
the  statistics  of  the  newer  methods  of  the  treatment  of  peritonitis  show 
remarkable  life  saving  results. 

The  author  abstracts  voluminously  from  his  own  writings  and  frequently 
enhances  the  value  of  the  work  by  editorial  comments. 

The  pendulum  of  surgical  judgment  swings  back  and  forth.  In  the  intro- 
duction to  the  book  the  author  calls  attention  to  some  of  the  tendencies 
of  the  times.  "Conservation  of  organs  and  tissues  is  rapidly  supplanting 
the  pan-operations  of  the  past  decade.    Surgeons  are  becoming  more  ex- 


602 


CURRENT  MEDICAL  LITERATURE 


acting  in  their  demands  for  better  functional  results  and  more  uniform  lines 
of  practice."  Again,  "  The  laity,  physicians  and  surgeons  are  learning 
to  value  the  life-conserving  significance  of  timely  operations  which  have 
robbed  appendicitis  of  its  mortal  septic  peritonitis,  have  anticipated  the 
fatal  sepis  jaundice  of  cholelithiasis  and  are  exerting  an  enormous 
preventive  influence  against  cancer  of  the  stomach  by  curing  the  gastric 
ulcer,  its  most  potent  and  frequent  cause,  and  relieving  the  etiologic  pre- 
cancerous gastic  stasis.'' 


The  Practical  Medicine  Series,  comprising  ten  volumes  on  the  year's  prog- 
ress in  medicine  and  surgery,  under  the  general  editorial  charge  of 
Gustavus  P.  Head,  M.  D.,  Professor  of  Laryngology  and  Rhinology, 
Chicago  Post-Graduate  Medical  School.  Volume  I,  General  Medi- 
cine. Edited  by  Frank  Billings,  M.  S.,  M.  D.,  head  of  the  Medical 
Department  and  Dean  of  the  Faculty  of  Rush  Medical  College, 
Chicago,  and  J.  H.  Salisbury,  A.  M.,  M.  D.,  Professor  of  Medicine, 
Chicago  Clinical  School.  Series  1006.  The  Year  Book  Publishers. 
40  Dearborn  St.,  Chicago,  Cloth.  Octavo.  $1.25  (Series  of  ten  vol- 
umes, $10.00.) 

This  volume  is  one  of  an  annual  series  which  is  intended  to  cover  the 
entire  field  of  medicine  and  surgery.  If  each  volume  is  as  complete  as  the 
one  before  us,  the  editor's  intentions  are  fulfilled.  The  abstracts  upon  the 
various  affections  are  classified  according  to  the  system  of  the  body  which 
is  involved.  Of  the  entire  360  pages,  the  section  upon  the  diseases  of  the 
respiratory  system  occupies  half  of  the  space,  and  of  this  half,  tuberculosis 
covers  about  no  pages.  The  year's  literature  is  well  reviewed  and  several 
plates  illustrate  types  of  cottages,  etc.  Diseases  of  the  circulatory  system 
and  of  the  blood  occupy  about  ninety  pages.-  The  remaining  quarter  of 
the  volume  is  given  over  to  general  infectious  diseases,  diseases  of  met- 
abolism and  of  the  ductless  glands,  rheumatoid  diseases  and  diseases  of  the 
kidneys. 

The  abstracts  of  the  articles  are  as  a  rule  well  written  and  the  book  is 
very  useful  as  a  convenient  summary  of  the  year's  literature  in  general 
medicine.  c.  k.  w.,  jr. 


A  Text-Book  of  the  Practice  of  Medicine.  By  James  Anders,  M.  D.,  Ph. 
D.,  L.LD.,  Professor  of  Medicine  and  Clinical  Medicine  at  the 
Medico-Chirurgical  College;  Physician  to  the  Medico-Chirurgical 
Hospital ;  Formerly  Physician  to  the  Philadelphia  and  to  the  Protest- 
ant Episcopal  Hospitals,  Philadelphia;  Fellow  of  the  College  of 
Physicians ;  Member  of  the  Academy  of  Natural  Sciences,  Philadel- 
phia, Etc.  Illustrated.  Seventh  Edition.  Thoroughly  Revised. 
Philadelphia  and  London.    W.  B.  Saunders  &  Company,  1905. 

So  well  known  and  so  deservedly  popular  is  Anders'  text-book  that  a 
lengthy  review  of  this  seventh  edition  is  not  necessary;  in  fact  it  is  almost 


CURRENT  MEDICAL  LITERATURE 


603 


enough  to  say  that  it  fully  comes  up  to  the  standard  set  by  other  editions. 
However,  a  few  points  of  excellence  and  several  changes  must  be  noted. 

Differential  Diagnosis  is  one  of  the  most  prominent  features,  separate 
headings  being  used  and  many  diagnostic  tables  given.  The  greatest  num- 
ber of  changes  in  the  text  are  in  the  Treatment  of  Diseases  in  order  to 
keep  the  work  up  to  the  great  advances  made  in  that  direction  and  the 
rewriting  of  the  sections  on  beriberi,  paratyphoid  fever  and  trypanosomiasis. 
The  new  subjects  introduced  are  Rocky  Mountain  spotted  fever;  exami- 
nation of  patients  for  the  diagnosis  of  diseases  of  the  stomach,  splanch- 
noptosis ;  Camidge's  tests  for  glycerose  in  the  urine ;  myasthenia  gravis, 
pseudotuberculosis,  benign  cirrhosis  of  the  stomach;  intestinal  lithiasis; 
intestinal  calculi;  red  light  in  variola,  emulsion  albuminuria;  sequelae  of 
valvular  lesions  and  Adams-Stokes'  syndrome.  This  text-book  is  recom- 
mended at  the  Albany  Medical  College.  spencer  l.  dawes. 


Bovee's  Gynecology.  The  Practice  of  Gynecology  by  Eminent  Authorities, 
Edited  by  J.  Wesley  Bovee,  M.  D.,  Professor  of  Gynecology  in 
George  Washington  University,  Washington,  D.  C.  In  one  very 
handsome  octavo  volume,  containing  838  pages,  with  382  engravings 
and  60  full  page  plates  in  colors  and  monochrome.  Cloth,  $6.00  net; 
leather,  $7.00  net ;  half  morocco,  $8.00  net.  Lea  Brothers  &  Co.,  Pub- 
lishers, Philadelphia  and  New  York,  1906. 

This  work  is  the  first  of  three  companion  volumes  dealing  respectively 
with  Gynecology,  Obstetrics  and  Pediatrics  and  is  offered  to*  the  profession 
as  a  practical  treatise  on  the  diseases  of  the  generative  organs  of  women 
and  on  those  of  the  neighboring  organs,  the  urinary  system  and  rectum. 
The  work  has  been  prepared  by  seven  contributors. 

J.  Wesley  Bovee  has  written  the  chapters  on  the  Developmental  Anom- 
alies of  the  Female  Generative  Organs,  Sterility,  Diseases  of  the  Rectum, 
Anus  and  the  Urinary  Tract ;  J.  Riddle  Goff e,  Menstruation,  Displacements 
of  the  Uterus,  The  Vaginal  Method  of  Operating  and  the  After-Treatment 
and  Complications  of  Abdominal  Operations;  G.  Brown  Miller,  Uterine 
Conditions ;  George  H.  Noble,  Fistutae,  Lacerations  of  the  Perineum  and 
Diseases  of  the  Vulva  and  Vagina;  Benjamin  R.  Schenck,  Diseases  of  the 
Tubes  and  Ovaries  Exclusive  of  Infections  and  Tubal  Pregnancy;  Thomas 
J.  Watkins,  Infections  of  the  Tubes  and  Ovaries ;  X.  O.  Werder,  The  Ex- 
amination of  Pelvic  Contents,  The  Technique  of  Abdominal  Operations  and 
Extrauterine  Pregnancy. 

Pathology  and  bacteriology  have  been  chosen  as  the  chief  guides  in  the 
classifications  of  diseases.  The  classification  of  endometritis  by  Miller  on 
this  basis  seems  most  rational.  He  regards  only  those  cases  which  show 
actual  inflammation,  as  endometritis,  and  does  not  apply  the  term  loosely  to 
the  hypertrophies  and  other  changes  in  the  endometrium  due  to  misplace- 
ments, pelvic  tumors,  etc.  As  bacteria  are  the  cause  of  uterine  inflamma- 
tion in  the  vast  majority  of  the  instances,  he  considers  endometritis  and 
metritis  as  some  stage  of  infection,  either  acute  or  chronic.   He  therefore 


7 


604 


CURRENT  MEDICAL  LITERATURE 


classifies  them  according  to  the  various  agents  infecting  the  genital  tract: 
(i)  gonorrhoeal,  (2)  those  conditions  caused  by  pyogenic  or  saprophytic 
bacteria  (essentially  a  wound  infection)  and  (3)  tuberculosis. 

The  illustrations  are  mostly  original  but  the  editor  has  not  hesitated  to 
use  those  from  other  sources  when  it  appeared  that  no  improvement  could 
be  made,  many  having  been  chosen  from  Dudley's  Gynecology. 

The  feature  which  particularly  recommends  the  book  is  that  it  presents 
the  latest  ideas  in  each  branch  of  the  subject  as  exhaustively  as  is  consis- 
tent with  the  scope  of  the  work,  by  one  especially  interested  in  that  branch. 

J.  a.  s. 


Reference  Handbook  of  the  Diseases  of  Children.  By  Prof.  Dr.  Ferdinand 
Fruhwald,  Chief  of  Clinic  in  the  Vienna  Polyclinic.  Edited  with 
additions  by  Thompson  S.  Westcott,  M.  D.,  Associate  in  Diseases  of 
Children  in  the  University  of  Pennsylvania.  With  176  illustrations. 
W.  B.  Saunders  and  Company,  Philadelphia  and  London,  1906. 

This  excellent  work  is  a  close  translation  of  the  "  Kompendium  der 
Kinderkrakheiten "  of  Prof.  Dr.  Fruhwald  a  work  which  has  already 
achieved  marked  success  abroad.  The  different  subjects  are  classified 
alphabetically,  which,  though  a  novel  arrangement  and  one  not  to  be  en- 
tirely commended  from  some  standpoints,  renders  a  general  index  unneces- 
sary, especially  as  the  cross  references  are  numerous. 

The  subjects  are  treated  briefly,  but  the  principal  points  are  well  empha- 
sized and  details  are  given  in  proportion  to  the  importance  of  the  disease 
or  condition  in  question.  Especial  stress  is  laid  upon  diagnosis,  and  the 
paragraphs  upon  the  therapeutic  and  diatetic  management  of  the  different 
conditions  are  as  comprehensive  as  possible.  Some  of  the  remedies  sug- 
gested are  however  so  purely  German  that  they  are  not  available  for  many 
practitioners  in  this  country. 

The  illustrations  are  on  the  whole  excellent,  and  are  for  the  most  part 
taken  from  photographs  or  sketches  from  nature.  A  few  illustrations 
have  been  added  to  this  edition  from  accredited  American  sources,  but 
the  large  majority  of  them  are  from  the  original  German  edition. 

This  book  ought  to  prove  most  useful  to  the  student  and  practitioner  as 
a  convenient  clinical  guide,  and  though  the  author  does  not  intend  to  have 
it  take  the  place  of  larger  text-books,  it  might  well  be  substituted  for 
some.  c.  w.  k.,  jr. 


Food  and  Diet  in  Health  and  Disease.  By  Robert  F.  Williams,  M.  A.,  M. 
D.,  Professor  of  the  Practice  of  Medicine  in  the  Medical  College 
of  Virginia.  Lea  Brothers  &  Co.,  Philadelphia  and  New  York,  1906. 

This  manual  of  about  four  hundred  pages  furnishes  a  fairly  complete 
and  very  convenient  practical  guide  for  modifying  the  diet.  Part  I,  "  Food 
in  Health,"  includes  a  discussion  of  the  chemistry  of  foods,  a  brief  con- 
sideration of  the  processes  of  digestion,  and  the  changes  brought  about  by 
cooking,  and  a  detailed  discussion  of  the  individual  foods  grouped  accord- 
ing to  the  predominating  alimentary  substance,  proteid  foods,  carbohydrates 


CURRENT   MEDICAL  LITERATURE 


605 


and  fats  being  taken  up  separately.  This  part  of  the  work  is  largely  based 
upon  the  results  of  investigations  in  the  Experiment  Station  of  the  United 
States  Department  of  Agriculture  and  contains  a  considerable  number  of 
authoritative  tables.  Part  I  also  contains  chapters  on  beverages,  food  in 
infancy,  and  certain  general  hygienic  principles  regarding  the  regulation 
of  diet  in  health. 

In  Part  II,  "  Food  in  Disease,"  there  is  a  preliminary  chapter  in  which 
methods  of  preparing  and  serving  food  for  the  sick  are  described  and  the 
relation  of  medicines  to  foods,  especially  as  regards  time  of  administra- 
tion, is  discussed.  In  the  succeeding  chapters  details  of  management  of  the 
diet  in  various  diseases  are  considered.  In  the  last  chapter  a  number  of 
diet  lists  and  recipes  in  use  at  the  Memorial  Hospital  in  Richmond,  Va., 
are  given. 

While  Dr.  Williams'  book  does  not  contain  a  great  deal  that  is  new  or 
original  he  has  succeeded  in  "  presenting  concisely  the  principles,  at  present 
known,  upon  which  rests  the  intelligent  use  of  food  in  health  and  in 
disease."  a.  t.  l. 


International  Clinics.  A  Quarterly  of  Illustrated  Clinical  Lectures  and 
Especially  Prepared  Original  Articles  on  Treatment,  Medicine, 
Surgery,  etc.  Edited  by  A.  O.  J.  Kelly,  M.  D.,  Philadelphia,  Pa. 
Volume  I,  Sixteenth  Series,  1906. 

The  volume  contains  the  usual  number  of  original  essays  and  instructive 
clinical  lectures.  The  article  upon  "  The  Causation  and  Treatment  of 
Eclampsia,  with  special  reference  to  the  methods  of  accomplishing  rapid 
Delivery  of  the  Fetus  "  by  Joseph  B.  De  Lee,  is  worthy  of  special  mention 
as  it  deals  very  completely  with  a  subject  of  vital  import.  The  six  plates 
illustrating  the  text  add  much  to  its  value. 

Progress  of  medicine  during  1905  occupies  a  large  part  of  the  volume. 
It  is  divided  into  three  sections,  namely :  Treatment,  medicine  and  surgery. 
Abdominal  Surgery  and  Surgery  of  the  Stomach  appear  to  be  the  fields  in 
which  the  greatest  progress  has  been  made  during  the  past  year,  for  which 
the  Mayo  brothers  are  largely  responsible.  h.  d.  c. 


A  Pocket  Formulary.  By  E.  Quinn  Thornton,  M.  D.,  Assistant  Professor 
of  Materia  Medica  in  the  Jefferson  Medical  College,  Philadelphia. 
New  (Seventh)  Edition,  Revised.  Lea  Brothers  &  Co.,  Philadelphia 
and  New  York. 

As  its  name  indicates,  this  little  book  consists  in  the  main  of  formulae 
for  the  treatment  of  about  all  the  ills  that  flesh  is  heir  to,  prescriptions  both 
ancient  and  modern;  good,  bad,  and  indifferent.  It  also  contains  tables  of 
weights  and  measures,  comparisons  of  the  Apothecaries  and  Metric  Sys- 
tems, Incompatibles,  Poisons  and  Antidotes  and  a  table  of  doses  in  accord- 
ance with  the  new  United  States  Pharmacopoeia.  All  doses  are  given  in 
both  the  Metric  and  Apothecaries  Systems.  spencer  l.  dawes. 


6o6 


CURRENT   MEDICAL  LITERATURE 


MEDICINE 

Edited  by  Samuel  B.  Ward,  M.  D.,  and  Hermon  C.  Gordinier,  M.  D. 

Palpation  of  the  Bronchial  Lymph  Glands  by  Means  of  Sounds  in  Cases 
of  Mild  Tubercular  Infection.  (Uber  Sondcn-palpation  der  Bron- 
chialdriisen  bei  leichtestcn  Formen  der  Tubcrkulose.) 

Ernst  Neisser.  Deutschcs  Archiv  fur  klinischc  Mcdizin,  1905,  LXXXVI, 
28. 

As  the  work  of  Nageli,  Franz  and  others  has  shown,  there  are  many 
persons  whose  bodies  at  autopsy  show  evidences  of  tuberculosis  who  never 
in  their  lives  have  shown  any  symptoms  of  the  disease  and  other  living 
persons  who  react  positively  to  tuberculin  without  showing  any  other 
signs  of  the  infection.  The  author  has  previously  reported  a  series  of 
cases  reacting  positively  to  tuberculin  without  having  demonstrable  lesions 
in  the  lungs.  These  people  underwent  no  course  of  treatment  and  yet 
were  apparently  still  perfectly  healthy  two  years  after  the  test.  He  has 
now  observed  thirty-four  additional  cases  giving  positive  reactions  and 
remaining  healthy  for  a  period  of  from  one  to  three  years  without  treat- 
ment. He  has  made  a  special  study  of  these  cases  in  order  to  determine 
if  possible,  the  location  of  the  tubercular  infection  and  to  discover  clinical 
symptoms  which  might  be  of  use  in  doing  this.  There  was  present  in 
nearly  all  of  this  series  of  patients  a  number  of  subjective  symptoms 
which  had  awakened  the  suspicion  of  incipient  tuberculosis  and  had  led 
to  the  use  of  the  tuberculin  reaction.  They  were  mostly  young  people, 
workmen  and  servants,  who  lived  in  more  or  less  unhealthy  environment, 
their  appearance  rather  weak,  their  type  of  build  often  suspicious.  The 
face  pale,  hemaglobin  generally  low.  There  were  however  practically  no 
ether  objective  signs  of  disease.  In  marked  contrast  were  their  subjective 
symptoms,  nearly  all  of  them  complained  of  pains  in  the  back  and  breast 
and  of  stitches  between  the  shoulders,  of  slight,  dry  cough,  of  weakness, 
and  of  occasional  night  sweats. 

Almost  all  of  them  were  strong  enough  to  work  and  would  have  con- 
tinued their  customary  occupations  had  not  suspicion  of  the  presence  of 
incipient  tuberculosis  led  them  to  come  to  the  hospital. 

The  most  constant  and  most  typical  symptom  of  almost  all  the  cases 
was  the  characteristic  pain:  Pain  in  the  back,  pain  in  the  breast,  and  the 
stabbing  pain  or  stitch  between  the  shoulders.  This  was  often  especially 
well  brought  out  when  pressure  was  made  with  one  hand  between  the 
shoulders  and  with  the  other  on  the  sternum. 

The  question  arises,  what  organ  in  the  chest  can  be  the  origin  of  this 
pain  which  is  not  one-sided,  but  is  either  in  the  median  line  or  distributed 
symmetrically  over  the  entire  chest.  It  is  a  natural  supposition  that  swollen 
bronchial  lymph  glands  may  be  responsible  for  it.  By  swollen  glands  the 
author  does  not  mean  the  large  caseous  lymph  glands,  such  as  are  found 
sometimes  in  children.  The  mildness  of  the  symptoms  and  the  favorable 
progress  of  the  cases  is  against  such  a  supposition.  He  means  rather  an 
acute  inflammatory  swelling,  in  reaction  to  the  infectious  process.   To  dem- 


CURRENT  MEDICAL  LITERATURE 


607 


onstrate  such  a  swollen  condition  of  the  bronchial  glands  there  has  been 
up  to  the  present  time  no  practical  method.  One  method,  too  little  used, 
to  be  sure,  has  been  available,  namely,  the  testing  of  spinal  tenderness. 
The  author  uses  this  method  but  has  devised  besides  a  more  direct  means 
for  testing  tenderness  of  the  bronchial  lymph  glands.  He  makes  the 
test  by  direct  pressure  on  the  glands  through  the  walls  of  the  esophagus. 
One  group  of  the  bronchial  lymph  glands  which  lie  under  the  angle 
between  the  main  bronchi  just  below  the  bifurcation  of  the  trachea  are 
directly  accessible  to  palpation  through  the  esophagus.  The  author  employs 
for  this  purpose  an  ordinary,  soft,  hollow  esophageal  sound,  over  the  end 
of  which  he  has  drawn  a  soft  rubber  finger  cot  or  shield.  There  is  an 
opening  on  the  side  of  the  sound  near  the  end  and  the  glove  finger  is 
tied  down  tightly  above  and  below  this  opening,  but  left  loose  over  it. 
The  other  end  of  the  sound  is  connected  with  an  ear  syringe.  If  one 
forces  some  air  into  the  sound  by  means  of  the  syringe  there  appears 
around  the  opening  near  the  end  a  soft  rubber  ring  filled  with  air  the 
size  of  which  can  be  readily  regulated.  When  the  sound  is  introduced 
into  the  esophagus  of  a  cadaver  with  the  ring  in  a  collapsed  condition, 
the  heart  and  pericardium  having  been  previously  removed,  it  will  be 
seen  that  the  air-filled  ring  when  about  twenty-five  centimetres  from  the 
teeth,  presses  upon  the  group  of  bronchial  lymph  glands  previously  men- 
tioned, through  the  esophageal  wall.  Such  a  simple  instrument  as  this 
suffices  as  the  author  thinks,  to  distinguish  between  healthy  and  painfully 
swollen  bronchial  glands.  Possibilities  of  error  are  overstretching  of 
the  esophagus,  slight  tenderness  of  the  esophagus  itself,  and  pressure 
on  the  left  vagus  nerve.  To  entirely  exclude  these  he  devises  a  modified 
sound  in  which  the  pressure  is  exerted  only  in  one  direction,  and  not 
on  all  sides.  This  however,  he  does  not  consider  as  satisfactory  as  the 
simple  form. 

In  using  the  sound  certain  precautions  are  necessary.  It  is  important 
that  the  test  be  made  some  hours  after  a  meal,  as  vomiting  renders  it 
difficult  to  apply.  Moreover,  the  inflation  should  not  be  made  suddenly 
as  sometimes  a  spasmodic  contraction  of  the  esophagus  can  follow  which 
causes  some  pain.  The  sound  should  not  be  inflated  to  its  fullest  extent 
and  then  slowly  withdrawn,  but  the  pressure  should  vary,  just  as  it  would 
if  it  were  exerted  by  a  palpating  finger.  The  patient  should  be  questioned 
as  to  whether  the  pain  elicited  is  the  same  as  that  of  which  he  has  com- 
plained. The  pain  is  sometimes  felt  more  in  the  front  of  the  chest, 
sometimes  in  the  back  between  the  shoulders.  With  nervous  patients, 
young  people,  especially  young  women,  the  investigation  will  often  give 
no  satisfactory  results.  On  the  other  hand,  very  frequently,  convincing 
data  are  obtained.  In  the  course  of  a  year  the  author  had  the  opportunity 
of  making  control  tests  on  a  great  many  non-tuberculous  people,  including 
surgical  patients  and  healthy  persons,  such  as  doctors  and  nurses,  in  all 
about  two  hundred  and  fifty  people.  In  all  of  them  there  was  a  complete 
absence  of  tenderness.  In  the  majority  of  the  cases  which  he  reports 
in  this  article  the  sound  test  was  positive,  that  is,  tenderness  of  the 
characteristic  sort  was  elicited  with  very  little  pressure.  In  a  great 
majority  also,  of  these  cases,  there  was  spinal  tenderness. 


6o8 


CURRENT   MEDICAL  LITERATURE 


The  author  thinks  that  this  sign,  together  with  the  pains  in  the  chest, 
the  spinal  tenderness,  the  positive  tuberculin  reaction  when  accompanied 
by  negative  physical  signs  referable  to  the  lungs,  and  by  the  continuance 
of  good  health  are  evidence  of  a  localized  tuberculosis  in  the  bronchial 
lymph  glands.  He  does  not,  however,  call  such  a  condition  incipient 
phthisis,  as  he  believes  the  majority  of  cases  showing  these  symptoms 
become  entirely  well  again.  He  has  found  the  gland  tenderness  to  be 
absent  in  many  of  the  cases  of  advanced  phthisis  which  he  has  tested. 


Unusual  Dilatation  of  the  Heart  with  Suspended  Functions  of  the 
Auricles  (Ungczubhnlichc  Dilatation  des  Hcrzens  und  Ausfall  der 
Vorhofsf  unction.) 

G.  Muller.    Zcitschrift  fur  klinischc  Medicin.  Band.  56.  heft  5  and  6. 

The  patient  was  a  man  aged  twenty-nine  years  at  death.  His  condition 
in  January,  1905,  was  as  follows:  Well  nourished,  slightly  cyanosed, 
some  dyspnoea,  no  oedema.  The  heart  dulness  extended  three  finger 
breadths  to  the  right  of  the  sternum  and  began  above  at  the  third  rib. 
The  apex  beat  was  in  the  sixth  interspace;  it  was  diffuse  and  a  finger 
breadth  outside  of  the  mammillary  line.  Auscultation  disclosed  at  the 
apex,  a  loud  systolic  and  presystolic  murmur.  The  aortic  second  sound 
was  sharply  accentuated,  the  pulmonic  slightly  accentuated.  Lungs  were 
normal.  Abdomen  negative.  Liver  two  finger  breadths  below  the  costal 
margin.  In  1902  the  apex  beat  reached  the  anterior  axillary  line.  The 
dulness  above  reached  the  second  intercostal  space.  To  the  left  of  the 
sternum  a  well  defined  diastolic  shock  existed.  There  was  systolic 
pulsation  of  the  veins  of  the  neck.  The  presystolic  murmur  was  absent 
but  in  its  place  a  clear  diastolic  murmur  was  present.  The  heart's  action 
was  regular.  One  week  before  death  the  following  changes  were  detected. 
In  the  region  of  the  left  lung  a  dulness  was  disclosed  which  passed 
forward  and  was  continuous  with  the  heart's  dulness.  The  dulness 
extended  upward  from  the  angle  of  the  scapula,  and  forward  to  the  first 
and  second  ribs.  From  the  second  rib  the  dulness  extended  in  a  slightly 
curved  direction  to  the  anterior  axillary  line  where  in  the  seventh  inter- 
space at  the  posterior  axillary  line  the  diffuse  apex  beat  was  located. 
Over  this  entire  dull  area  a  systolic  thrill  could  be  palpated.  A  loud 
systolic  and  diastolic  murmur  was  heard.  The  heart  occupied  the  com- 
plete circumference  of  the  thorax  with  the  exception  of  the  parts  from  the 
left  posterior  axillary  line  to  the  spine. 

The  pulse  was  regular  and  eighty  per  minute.  The  spleen  was  negative. 
The  urine  normal.  There  was  no  ascites.  Three  weeks  prior  to  death 
ruptured  compensation  with  all  its  manifestations  ensued. 

Autopsy. — From  the  third  rib  downwards  the  thorax  was  occupied  by 
the  heart.  Under  the  manubrium  the  lungs  were  seven  centimeters  apart. 
The  heart  was  twenty-eight  centimeters  at  its  widest  part.  The  heart  meas- 
ured full  of  blood  twenty-nine  centimeters  in  width  by  twenty-eight 
centimeters  in  height;  auricles  together  measured  twenty  centimeters 
in  diameter.   Both  auricles  greatly  distended.    The  "right,  size  of  the  closed 


CURRENT  MEDICAL  LITERATURE 


609 


fist,  the  left,  size  of  child's  head.  Their  walls  were  very  thin.  The  mitral 
valve  was  stenosed.  The  right  ventricle  was  distended,  and  its  wall 
was  five  millimeters  thick.  The  left  ventricle  appeared  normal,  walls  nine 
millimeters  thick.  The  aorta  and  left  coronary  arteries  were  sclerosed. 
Atheromatous  ulcer  found  in  the  left  auricle.  The  microscopic  study  of  the 
heart  showed  general  fibroid  myocarditis.  The  left  auricle  was  a  mere 
bag,  absolutely  devoid  of  muscle  fibres.  The  right  was  in  about  the  same 
condition. 

The  interesting  features  of  this  almost  unique  case  as  cited  by  the 
author  are  the  following:  1.  The  enormous  dilatation  of  the  left  auricle. 
2.  The  normal  size  of  the  left  ventricle.  3.  Dilatation  of  the  right  heart. 
4.  The  general  fibroid  myocarditis.  5.  The  absence  of  arrythmia.  6.  The 
full  and  regular  pulse.  7.  The  entire  absence  of  muscular  fibre  cells  in 
the  auricles. 

The  fibroid  myocarditis  he  explains  by  the  coronary  artery  sclerosis. 
The  author  states  that  it  is  very  remarkable  that  a  heart  which  could 
contain  about  one-half  of  the  entire  blood  of  the  economy  should  have 
been  able  to  have  carried  on  the  circulation  almost  undisturbed  for  so  many 
years.  From  a  study  of  this  case  the  author  has  brought  forth  the  follow- 
ing points :  1.  That  the  left  auricle  and  atrium  and  probably  the  right  took 
no  part  in  the  exciting  in  this  case  of  the  rythmic  contraction  of  the 
ventricles.  He  believes  this  case  proves  that  the  ventricles  are  capable 
of  independent  rythmic  contractions,  whether  of  neural  or  muscular 
origin  he  does  not  say.  2.  The  circulation  through  the  crippled  left  auricle 
he  explains  first  by  a  vis  a  tergo  excited  by  the  aspiratory  force  of  the 
lungs  coupled  by  the  right  ventricle  hypertrophy  favoring  the  pulmonic 
circulation.  Chiefly,  however,  by  the  suction  excited  by  the  diastol  of  the 
left  ventricle.  This  he  states  is  a  very  important  compensatory  means  of 
assisting  the  circulation  in  mitral  stenosis.  The  author  leaves  unexplained 
the  almost  complete  absence  of  arrythmia  together  with  the  full  regular 
pulse  both  of  which  symptoms  are  so  uncommonly  present  in  mitral  stenosis 
and  myocarditis. 


As  to  the  Cause  of  Haemophilia.    (Ucber  das  Wesen  der  Hamophiiia.) 
H.  Sahli.    Zeitschrift  fur  klinische  Medicin,  Band  56,  Heft  1-4. 

The  author  reports  four  characteristic  cases  of  haemophil  vhich  he 
has  attended  together  with  a  review  of  the  various  opinion;  elative  to 
the  causation  of  this  strange  anomaly. 

The  author's  cases  were  all  typical.  They  suffered  from  rf  seated 
almost  uncontrollable  hemorrhages  with  and  without  slight  trau:  lata. 
Spontaneous  hemorrhages  from  the  mucous  surfaces  were  often  n  ted. 
Acute  swellings  of  the  joints  which  were  followed  by  chronic  aianges 
so  characteristic  of  the  haemophilics  joint  occurred.  Lastly  pinhead  size 
to  very  large  cutaneous  hemorrhages  were  frequently  observed.  The 
enlargement  of  the  heart  in  case  one  was  due  according  to  Sahli  to  the 
marked  anemia.  In  his  first  case  the  haemophilia  appeared  as  usual  in 
the  second  year  of  life.  In  the  third  case  it  began  at  the  eleventh  month 
and  in  the  fourth  case  it  began  at  the  third  or  fourth  year.    In  case 


6io 


CURRENT  MEDICAL  LITERATURE 


two  no  history  of  the  exact  time  of  the  beginning  could  be  obtained.  It 
was  interesting  to  know  in  case  two  that  with  the  eruption  of  each  tooth 
very  severe  hemorrhage  occurred. 

Very  interesting  for  all  the  cases  was  the  heredity  affecting  in  all 
branches  of  the  family  tree  the  male  members,  the  females  escaping  but  the 
latter  in  turn  begetting  male  children  that  were  bleeders. 

The  author  cites  the  following  theories  now  in  vogue  explanatory  of 
this  strange  disease : 

(i.)  Virchow's.  That  the  haemophilia  is  due  to  an  abnormal  brittleness 
and  permeability  of  the  blood  vessels,  owing  to  the  thinness  of  their  walls, 
the  result  of  fatty  degeneration. 

(2.)  Schonlein's.  The  hemorrhage  being  due  to  the  high  blood  tension 
excited  by  the  powerful  action  of  the  enlarged  left  ventricle. 

(3.)  Immerman's  theory  is  to  the  effect  that  the  hemophilia  is  the 
result  of  an  abnormal  relation,  the  result  of  mal-development  between  the 
volume  of  the  blood  and  the  capacity  of  the  bloodvessels,  resulting  in  high 
blood  tension. 

(4.)  Oertel's  theory  is  that  it  is  due  to  an  abnormal  hydraemia. 

(5.)  Koch.  Who  believes  the  disease  is  due  to  an  exquisite  hereditary 
anomaly,  the  result  of  chronic  toxaemia. 

The  following  are  the  results  and  conditions  of  Sahli's  studies  into  the 
causation  of  the  disease. 

The  examination  of  the  blood  of  haemophiliacs  from  three  different 
families  showed  a  diminution  in  the  percentage  number  of  neutrophiles 
with  an  increased  number  ot  lymphocytes.  The  general  leucocyte  count 
was  normal.  The  blood-plates  showed  a  slight  diminution  from  the 
normal. 

The  alkalinity  of  the  blood  was  normal,  as  was  the  freezing  point  of 
the  blood  serum. 

In  one  case  the  amount  of  fibrin  was  estimated  and  found  normal. 

The  coagulation  time  estimated  in  all  four  cases  during  the  intervals 
free  from  hemorrhage  was  found  greatly  delayed.  This  delay  is  so 
constant  that  Prof.  Sahli  states  that  it  is  of  great  diagnostic  value. 

During  the  severe  hemorrhages  the  coagulation  time  estimated  from 
blood  taken  directly  from  the  bleeding  points  flowing  over  coagula  showed 
a  very  rapid  coagulation. 

The  continuance  of  the  hemorrhage  despite  the  rapidity  of  the  coagu- 
lability of  the  blood  coming  from  the  bleeding  point,  Sahli  explains  on  the 
supposition  of  an  abnormal  condition  of  the  walls  of  the  bloodvessels 
with  an  improper  amount  of  any  kind  of  fibrin  ferment  passing  into  the 
vessel's  lumen. 

The  delay  of  the  coagulability  of  the  blood  in  the  interim  he  explains 
on  the  supposition  of  an  abnormal  chemical  condition  of  the  vessel  walls. 
This  changed  condition  of  the  vessel's  walls  together  with  an  abnormal 
brittleness  of  them  or  increased  porosity  favoring  diapedesis  causes  in 
his  opinion  the  haemophilia. 

Therapeutically  he  believes  a  good  generous  mixed  diet  should  be  used. 
Against  the  hemorrhages  he  has  advised  compression  with  sterile  bandages 
soaked  in  two  per  cent  sterile  gelatine. 


CURRENT  MEDICAL  LITERATURE 


6ll 


PATHOLOGY  AND  BACTERIOLOGY 

Edited  by  Richard  Mills  Pearce,  M.  D., 
Assisted  by  Charles  K.  Winne,  Jr.,  M.D.,  and  Leon  K.  Baldauf,  M.  D. 

A  Study  of  the  Dejecta  of  Normal  Children  and  of  Those  Suffering  from 
Acute  and  Subacute  Diarrhea  with  Reference  to  B.  Dysenteriae. 

Katharine  R.  Collins.    Journal  of  Infectious  Diseases,  1905,  II,  620. 

This  article  gives  a  summary  of  the  important  work  on  the  relation  of 
the  dysentery  bacilli  to  the  diarrheas  of  children;  together  with  the  results 
of  some  work  now  carried  on  by  the  author. 

Up  to  the  present  time  the  dysentery  bacillus  has  been  found  in  the 
dejecta  of  but  a  very  limited  number  of  normal  individuals,  or  those 
suffering  from  diseases  other  than  dysentery.  Shiga,  Flexner,  Drigalski, 
did  not  find  them  in  normal  stools  while  Duval,  Wollstein  and  Charlton 
and  Jehle,  in  Vienna,  found  them  in  the  stools  of  only  a  few  out  of  many 
normal  persons  whose  faeces  were  examined. 

The  author  and  her  colleagues  have  examined  at  different  times,  and  in 
several  well  separated  localities,  the  stools  from  fifty-seven  normal  children, 
all  but  ten  of  whom  had  been  in.  contact,  to  a  greater  or  less  extent,  with 
cases  of  true  dysentery.  In  only  three  of  these  children  were  bacilli  of  the 
dysentery  group  isolated,  although  very  thorough  methods  for  their  isola- 
tion were  followed. 

The  stools  from  twenty-one  children,  in  three  New  York  hospitals,  all  of 
whom  were  suffering  from  either  acute  or  subacute  diarrhea,  were  thor- 
oughly examined,  and  the  dysentery  bacillus  was  not  found  in  any.  Weaver, 
and  Charlton  and  Jehle  did  not  find  any  of  the  dysentery  bacilli  in  the  cases 
of  summer  diarrhea  examined  by  them. 

The  author  concludes  that  the  failure  to  find  bacilli  of  the  dysentery 
group  in  infants  suffering  from  so-called  acute  and  subacute  summer 
diarrhea,  even  though  the  symptoms  were  severe  and  repeated  examina- 
tions were  made,  would  lead  us  to  suspect  some  cause  or  combination  of 
causes  other  than  this  organism  as  the  etiological  factor  in  these  conditions. 


The  Role  of  the  Typhoid  Bacillus  in  the  Pulmonary  Complications  of 
Typhoid  Fever. 

G.  Canby  Robinson.    The  Journal  of  Infectious  Disease,  1905,  II,  498. 

The  fact  that  typhoid  bacilli  are  not  infrequently  found  in  the  lung  during 
an  attack  of  typhoid  fever  has  long  been  known,  nor  can  it  be  considered 
an  unexpected  finding  when  one  remembers  the  constancy  with  which  the 
organisms  enter  the  general  circulation  during  life.  Although  it  has  been 
frequently  recovered  at  autopsy,  and  even  ante-mortem  by  means  of  lung 
puncture,  there  are  in  the  literature  but  few  cases  in  which  it  has  been 
undoubtedly  the  cause  of  a  definite  pulmonary  lesion,  as  usually  the  pneu- 
mococcus  or  some  of  the  ordinary  progenic  cocci  are  found  in  associa- 
tion with  it.  B.  typhosus  has  been  found  in  the  lung  in  cases  of  lobar 
and  lobular  pneumonia,  in  abscess  and  gangrene  following  the  former 
condition,  in  infarcts  and  even  in  simple  congestion  or  bronchitis.  Robin- 


6l2 


CURRENT  MEDICAL  LITERATURE 


son  well  summarizes  the  literature  and  reports  several  cases  from  the 
Pennsylvania  Hospital  which  illustrates  these  various  conditions. 

Case  i — After  remaining  in  the  hospital  twenty-seven  days  with  a  typical 
attack  of  typhoid  fever,  the  patient  developed  suddenly  the  signs  and 
symptoms  of  a  pulmonary  infarct  from  which  he  died  a  week  later.  At 
autopsy  the  main  artery  leading  to  the  lower  lobe  of  the  right  lung  was 
found  thrombosed,  and  that  lobe  was  almost  entirely  converted  into  an 
abscess  cavity.  A  broncho-pneumonia  was  found  in  other  portions  of  the 
right  lung,  as  well  as  in  the  left  lung.  A  pure  culture  of  typhoid  bacillus 
was  found  in  the  lung  abscess  and  in  both  lungs,  and  bacillus-like  bodies 
alone  were  seen  in  sections  stained  by  methylene  blue,  but  no  bodies 
resembling  organisms  were  seen  in  sections  stained  by  the  Gram-Weigert 
method.    In  the  other  organs  the  lesions  were  typical  of  typhoid  fever. 

As  no  other  causative  agent  was  found  in  the  sections  or  in  the  smears, 
Robinson  feels  justified  in  regarding  the  case  as  one  of  lung  abscess, 
due  to  B.  typhosus,  secondary  to  pulmonary  thrombosis  and  infarct ; 
he  considers  the  broncho-pneumonia  also  as  due  to  this  organism. 

In  another  case  of  pulmonary  thrombosis  and  infarction  occurring  dur- 
ing the  course  of  typhoid  fever,  but  not  followed  by  abscess  formation, 
typhoid  bacilli  were  isolated  from  the  infarcted  area  but  not  from  the 
normal  lung  tissue.  Sections  through  the  pulmonary  artery  at  the  site  of 
the  thrombosis  stained  with  methylene  blue  showed  in  several  places  rod- 
like bodies  lying  between  the  thrombus  and  the  wall  of  the  pulmonary 
artery.   No  such  bodies  could  be  found  in  the  normal  lung  tissue. 

The  first  case  here  mentioned  is  the  only  one  of  six  broncho-pneumonias 
from  which  Robinson  was  able  to  recover  the  typhoid  bacillus  in  culture, 
thus  leaving  this  division  of  the  subject  in  much  the  same  state  of  con- 
fusion as  before. 

The  role  played  by  the  typhoid  bacillus  in  lobar  pneumonia  complicating 
typhoid  fever  has  been  much  discussed.  Although  there  is  no  doubt  that 
the  usual  cause  of  this  complication  is  the  pneumococcus,  yet  there  is 
abundant  evidence  that  the  organism  may  also  be  the  causative 
agent.  In  six  cases  of  lobar  pneumonia  complicating  typhoid  fever  at  the 
Pennsylvania  Hospital,  Robinson  reports  the  pneumoccoccus  as  having  been 
found  three  tmes  and  the  typhoid  bacillus  but  once,  a  case  in  which  both 
organisms  were  found.  In  another  similar  case  both  organisms  were 
simutaneously  isolated  in  blood  culture,  and  in  another  the  typhoid  bacillus 
was  isolated  in  pure  culture  in  a  blood  culture  taken  during  life,  but  at 
autopsy  four  days  later  the  pneumococcus  only  was  found  in  the  heart's 
blood.  Here  no  doubt  the  organisms  were  co-existent  in  the  general  cir- 
culation during  life. 

He  also  reports  a  case  of  lobar  pneumonia  from  the  lung  of  which  was 
obtained  a  pure  culture  of  B.  paratyphosus  (type  B).  The  man  died  on 
the  eighth  day  of  the  disease  in  which  typical  physical  signs  of  pneumonia 
were  found ;  he  had  bloody  expectoration  and  a  low  leucocyte  count.  At 
autopsy  there  was  found  a  haemorrhagic  type  of  lobar  pneumonia.  No 
organisms  other  than  B.  paratyphosus  could  be  found  in  the  tissues  though 
smears  from  the  lungs  showed  pneumococcus-like  organisms. 

Robinson  calls  attention  to  the  marked    haemorrhagic  condition  of  the 


CURRENT  MEDICAL  LITERATURE 


613 


pulmonary  lesion  in  these  cases,  a  condition  first  emphasized  by  Polguere, 
although  noted  at  autopsy  by  several  observers.  The  sputum  in  cases 
of  typhoid  solidification  of  the  lung  is  almost  always  haemorrhagic,  and 
from  it  the  typhoid  bacillus  has  frequently  been  isolated  and  occa- 
sionally in  pure  culture.  Robinson  reports  fourteen  such  cases  from  the 
literature  and  one  of  his  own,  in  four  of  which  the  organism  was  found 
pure.  The  occurrence  of  the  typhoid  bacillus  in  the  sputum  shows  the 
importance  of  taking  proper  means  to  prevent  infection  from  this  source. 
Robinson  concludes  as  follows: 

The  typhoid  bacillus  not  infrequently  invades  the  lung  during  typhoid 
fever. 

It  may  invade  areas  of  the  lung  already  the  seat  of  haemorrhagic 
infarction  and  there  produce  abscess  formation  and  gangrene. 
The  organism  may  cause  broncho-pneumonia. 

Lobar  pneumonia  as  a  complication  of  typhoid  fever  is  usually  due  to 
the  pneumococcus.  This  organism  may  be  present  as  a  general  infection 
in  the  circulating  blood  simultaneously  with  B.  typhosus. 

It  is  probable  that  both  B.  typhosus  and  B.  paratyphosus,  type  B,  can 
produce  a  massive  pneumonia,  lobar  in  type.  When  these  organisms  are 
the  causative  factors,  the  pneumonia  is  of  a  peculiar  haemorrhagic  char- 
acter, which  may  be  recognized  clinically  from  the  bloody  nature  of  the 
sputum. 

The  typhoid  bacillus  is  not  infrequently  found  in  the  sputum  of  typhoid 
fever  patients  with  pulmonary  complications.  This  fact  should  be  empha- 
sized in  order  that  the  spread  of  the  disease  by  this  means  may  be  pre- 
vented. 


I 

MATERIA  MEDICA  AND  THERAPEUTICS 

Edited  by  Spencer  L.  Dawes,  M.  D. 

Concerning  the  Treatment  of  Scarlet  Fever  with  Antistreptococcic  Serum. 
(Ueber  die  Behandlung  des  Scharlach  mit  Antistreptococcen- 
serum.) 

F.  Ganghofner.  Deutsche  medicwische  IVochenschrift,  1905,  31,  p.  529, 
592. 

The  author  reports  the  results  of  the  use  of  both  Aronson's  and  Moser's 
antistreptococcic  serum  in  a  small  series  of  cases  of  scarlet  fever. 

The  Aronson  antistreptococcic  serum  was  administered  to  fifteen  cases, 
all  but  two  of  which  were  of  a  very  severe  type.  The  first  few  patients 
of  this  series  were  given  the  small  doses  of  from  10  to  30  c.  c,  which 
Aronson  at  first  recommended.  Later  these  amounts  were  increased 
to  60  c.  c  and  over  at  Aronson's  suggestion,  and  better  results  were 
obtained  by  so  doing. 

There  were  seven  fatal  terminations.  While  a  fall  in  temperature  fol- 
lowed the  administration  of  the  serum  in  some  cases,  the  fall  was  usually 
followed  by  a  subsequent  rise,  and  the  author  doubts  whether  it  could  be 
said  that  the  decline  was  due  to  the  serum  injections.    He  also  states 


614 


CURRENT   MEDICAL  LITERATURE 


that  it  was  not  possible  to  come  to  any  definite  conclusion  as  to  the  value 
of  Aronson's  serum  in  scarlet  fever. 

The  author  follows  the  above  by  a  detailed  history  of  each  of  the 
eight  cases  of  scarlet  fever  in  which  he  used  the  Moser  antistreptococcic 
serum  in  doses  varying  from  100  to  200  c.  c.  each. 

These  cases  were  very  severe  in  character,  and  of  the  eight,  five  died, 
one  within  twelve  hours  of  the  injection.  Only  two  were  injected  on  the 
first  or  second  days,  and  both  of  these  recovered. 

Some  improvement  was  noticed  in  the  first  and  fourth  cases,  which 
received  200  c.  c.  on  the  first  and  second  days  of  the  disease  respectively, 
and  both  finally  recovered.  The  temperature  curves  were  not  greatly 
influenced  by  the  injections. 

The  course  of  the  disease  in  the  other  ca,ses  was  not  definitely  altered, 
nor  were  the  complications  prevented  by  the  serum.  Some  improvement 
in  the  direction  of  a  lessened  frequency  of  the  pulse  occurred  after  the 
use  of  the  serum  in  some  cases. 

Concerning  the  temperature  changes  the  author  states  that  he  observed 
no  such  sudden  falls  as  have  been  described  by  Moser,  Escherich  and 
others  who  have  used  the  Moser  serum  in  these  large  doses.  In  fact  the 
slight  declines  in  temperature  he  observed  were  no  greater  than  those 
occurring  after  the  use  of  the  small  doses  of  Aranson's  serum. 

He  concludes  that  he  cannot  say  definitely  from  the  small  number  of 
cases  treated  by  him  with  the  Moser  serum  that  it  has  a  definitely  bene- 
ficial influence  on  the  scarlet  fever  processes. 


The  Treatment  of  Epilepsy.    Prize  Essay. 

Norman  G.  Harry.    The  Practitioner,  August,  1905,  p.  245. 

In  treatment,  the  first  question  should  always  be,  "Can  the  attacks  be 
ascribed  to  any  cause  which  can  be  removed?"  The  reply  is  seldom  in 
the  affirmative  but  occasionally  some  peripheral  irritation  may  be  found 
capable  of  exciting  reflex  convulsions.  Intestinal  worms  are  often  excit- 
ing agents,  but  the  attacks  do  not  always  cease  when  the  worms  have  been 
expelled;  undigested  food  or  an  irritating  cicatrix  may  be  causative, 
but  here  too  the  removal  of  the  cause  does  not  always  do  away  with 
the  effect.  Other  causes  may  be  dentition,  adherent  prepuce,  foreign 
bodies  in  the  ear  or  nose,  fright,  masturbation,  and  toxic  agents. 

Medicinal  Treatment. — Bromides  were  first  used  in  epilepsy  in  1857  and 
their  action  may  be  divided  into  three  classes;  First,  a  small  one,  (prob- 
ably much  larger  than  is  apparent),  which  results  in  a  permanent  cure; 
Second,  one  in  which  there  is  no  influence  for  good;  Third,  a  class  much 
larger  than  both  of  the  others  in  which,  while  the  frequency  and  severity 
of  the  attacks  are  lessened,  there  is  no  permanent  cure.  It  is  not  known 
precisely  how  the  bromide  acts,  but  it  lessens  the  tendency  to  spontaneous 
"discharge,"  due  to  escape  of  nerve  atoms  to  combine  with  the  oxygen 
of  the  plasma,  this  being  restrained  by  the  chemical  action  of  the  bromide. 

Of  the  various  preparations  of  bromides  the  lithium  contains  the 
largest  amount  of  bromide  and  strontium  the  least,  the  former  therefore 


CURRENT  MEDICAL  LITERATURE 


would  seem  to  be  most  effective,  but  this  is  not  so,  the  most  generally 
effective  being  the  bromide  of  potassium.  Combinations  of  the  different 
salts  are  often  used,  but  there  is  nothing  to  prove  their  superiority  over 
some  single  one. 

Administration. — First  find  the  dose  which  arrests  all  attacks,  slight 
and  severe,  and  which  the  patient  can  stand,  continuing  this  until  it  is 
supposed  that  stability  is  established,  then  discontinue  by  gradual  diminu- 
tion. Most  relapses  are  due  to  the  patient's  allowing  the  treatment  to 
stop  when  the  attacks  are  arrested. 

The  best  results  are  obtained  by  from  twenty  to  thirty  grain  doses 
three  times  a  day.  Larger  doses  than  the  latter  are  seldom  successful. 
It  is  best  exhibited  after  meals  to  prevent  too  rapid  absorption  and  to 
allow  of  combining  with  it  some  arsenic  to  prevent  acne.  Night  attacks 
may  be  prevented  by  one  dose  of  thirty  or  forty  grains  at  bedtime.  An 
early  morning  dose  (without  arsenic)  will  usually  prevent  the  attacks 
which  come  on  shortly  after  rising.  Children  take  a  proportionately 
larger  dose  than  adults,  less  than  five  grains  being  useless.  This  treat- 
ment should  be  continued  for  at  least  two  years,  never  being  suddenly, 
but  gradually  discontinued  during  the  third  year,  most  cases  of  "status 
epilepticus"  being  due  to  a  too  sudden  discontinuance.  The  bromide  of 
stronium  is  reputed  to  produce  less  acne,  but  has  no  other  superiority 
and  large  doses  are  not  well  borne.  The  bromides  of  nickel  and  camphor ; 
bromalin;  bromipin;  and  hydrobromic  acid  have  their  advocates  but 
have  little  to  recommend  them. 

Disadvantages  of  Bromides. — Mental  and  physical  depression;  this  is 
due  to  a  greater  dose  than  the  patient  can  stand  and  should  be  regulated 
accordingly. 

The  bromide  rash ;  this  can  readily  be  overcome  by  combining  small 
doses  of  arsenic  with  the  bromides. 

The  status  epilepticus  following  the  omission  of  the  drug  should  be 
treated  by  chloral,  chloroform,  hyoscine  hydrobromate  or  morphine. 

Treatment  of  attacks. — If  the  aurae  are  definite,  an  attack  may  be  aborted 
by  ligation  of  a  limb  (if  the  convulsion  commences  there),  application 
of  a  blister,  olfactory  or  gustatory  stimulus  or  inhalation  of  nitrite  of 
amyl. 

All  indigestible  foods  should  be  avoided,  meat  taken  sparingly,  and 
epileptic  children  should  not  be  pushed  as  to  education  and  some  useful 
occupation  should  be  given.  So  far  as  the  individual  is  concerned,  mar- 
riage has  but  little  influence.  If  either  patient  is  suffering  from  idiopathic 
epilepsy  or  there  is  any  history  of  hereditary  taint  there  is  danger  of 
transmission  to  the  offspring. 


Concerning  a  New,  Active  Constituent  of  Ergot,  Soluble  in  Water.  (Ueber 
einen  neuen,  wirksamen,  wasserloslichen  Bestandteil  des  Mutter- 
korns.) 

Vahlen.   Deutsche  medizinische  Wochenschrift,  August  10,  1905,  p.  1263. 

The  early  part  of  this  article  is  taken  up  with  a  history  of  the  growth 
of  the  art  of  isolating  the  active  principles  of  plants  as  a  preliminary  to 


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CURRENT  MEDICAL  LITERATURE 


a  detailed  account  of  the  active  principles  contained  in  ergot,  arjd  especially 
.  a  new  one  which  he  claims  to  have  isolated.  At  first  he  calls  attention 
to  the  fact  that  Prescott  in  1813  demonstrated  that  the  power  of  accelerat- 
.  ing  labor,  possessed  by  ergot,  was  much  enhanced  if  the  powdered  drug  was 
dissolved  in  water.  He  then  describes  in  detail  the  two  forms  of  ergot- 
ism, the  gangrenous  and  convulsive,  the  first  produced  by  sphacelenic 
acid  and  the  second  by  cornutine,  bojh  constituents  of  ergot  and  notes 
the  long  known  fact  that  neither  of  them  are  chemically  single  bodied 
nor  soluble  in  water.  After  this  preliminary  he  states  that  he  has  dis- 
covered or  rather  isolated  a  constituent  which  possesses  several  properties 
which  neither  of  the  other  two  does ;  namely  that  it  is  soluble  in  water 
and  that  it  produces  neither  gangrene  nor  convulsions.  This  substance 
he  calls  clavin  and  he  states  not  only  that  it  is  a  chemically  pure  sub- 
stance, but  that  it  is  the  principle  in  ergot  which  makes  it  when  powdered 
and  dissolved  in  water  much  more  efficacious  as  well  as  safe  as  an 
ecbolic  than  when  administered  in  any  other  form. 

He  has  experimented  with  it  in  large  doses  on  dogs  and  cats,  both 
intravenously  and  per  os  and  never  with  harmful  results  and  he  found 
that  its  direct  effect  upon  the  pregnant  uterus  was  both  prompt  and 
energetic.  His  argument  is  that  these  results -justify  its  use  on  man  and 
he  reports  four  cases  in  which  it  was  used  by  Bumm,  and  two  in  which 
he  used  it  himself.  A  two  per  cent,  solution  was  used  hypodermatically 
in  doses  of  from  0.010  gram  to  0.020  gram  and  it  is  shown  that  the  drug 
apparently  has  the  power  of  quickly  inducing  or  increasing  the  uterine 
contractions  where  the  pains  have  either  ceased  entirely  or  have  become 
infrequent  and  ineffectual.  There  seems  to  be  no  irritating  effect,  so 
that  its  use  subcutaneously  is  without  the  unpleasant  results  frequently 
attending  the  use  of  the  fluid  preparations  of  ergot. 

While  prolonged  boiling  and  the  addition  of  various  antiseptic  prepara- 
tions fail  to  alter  it,  it  is  recommended  that  only  fresh  solutions  be  used 
in  order  to  ensure  activity. 

When  clavin  is  dissolved  in  water  and  evaporated  to  dryness  it  is 
seen  to  consist  of  a  powder  which  under  the  microscope  is  crystalline ;  if 
precipitated  from  a  hot  concentrated  solution  of  alcohol  it  presents  pris- 
matic crystals  about  seven  to  eight  millimeters  in  length  and  its  formula 
is  C1X  H22  N2  O  .    Thus  far  it  has  been  impossible  to  form  salts. 


CLINICAL  MICROSCOPY 

Edited  by  Arthur  T.  Laird,  M.  D. 

Concerning  Variations  in  the  Aggulutinating  Power  of  the  Blood  Serum 
in  the  Course  of  Typhoid  Fever.  {Ueber  die  Schwankungen  des 
Agglutinationsvermbgens  des  Serums  in  Verlaufe  des  Typhus  ab~ 
dominalis.) 

Jul.  G.  Iverson.   Zeitschrift  fur  Hygiene,  1905,  XLVl,  1. 

During  the  winter  of  1901-1902  the  author  had  the  opportunity  of  study- 
ing more  than  sixty  cases  of  typhoid  fever  at  the  Obuchow  hospital  in  St. 


CURRENT  MEDICAL  LITERATURE  617 

Petersburg,  and  reports  in  this  article  the  results  of  his  work.  A  review 
of  the  literature  showed  that  certain  variations  in  the  Widal  reaction  were 
not  understood,  and  the  biological  significance  of  the  reaction  was  still  a 
matter  of  dispute.  The  writer  hoped  by  clinical  observation  to  throw  some 
light  on  these  problems. 

His  method  of  investigation  was  as  follows :  the  ear  lobe  was  rubbed 
with  benzine  and  punctured  with  a  fine  pointed  lancet.  The  blood  was 
collected  in  a  sterile  glass  pipette,  tapering  at  one  end  to  a  point  and 
having  the  other  open  end  filled  with  a  cotton  plug.  Separate  pipettes 
of  this  sort  were  prepared  for  each  case.  After  the  blood  was  collected  the 
small  end  of  the  pipette  was  sealed  in  the  "flame  and  the  specimen  was  laid 
aside  at  room  temperature  for  an  hour  or  two ;  then  the  clot  was  removed 
with  a  sterile,  platinum  loop.  A  drop  of  the  serum  was  placed  in  a  watch 
glass  and  diluted  with  nine  drops  of  sterile  bouillon.  A  drop  of  the  serum 
now  diluted  ten  times  was  added  to  10,  20,  30,  or  100  drops  of  a  culture  of 
typhoid  bacilli.  The  various  dilutions  were  pjaced  in  "  hanging  drop " 
preparations  and  observed  after  half  an  hour.  If  at  this  time  no  reaction 
was  seen  in  the  preparation  of  lowest  dilution  (1-100)  a  drop  of  undiluted 
serum  was  added  to  5,  10,  20,  and  50  drops  of  typhoid  culture..  If  no  re- 
action was  observed  at  the  end  of  one-half  hour  in  the  one-fifth  dilution 
the  agglutinating  capacity  of  the  serum  was  represented  by  the  mark  (0). 
The  measuring  of  the  drops  was  done  by  means  of  a  glass  pipette  similar 
to  the  one  in  which  the  blood  was  collected.  If  agglutination  was  very 
marked  in  the  1-100  dilution  still  higher  dilutions  up  to  1-20,000  were  pre- 
pared. The  reaction  was  considered  positive  if  clumps  were  seen  consist- 
ing of  four  or  five  bacilli  still  showing  some  movement.  The  cultures 
used  were  sixteen  to  twenty  hours  old,  and  all  were  derived  from  the 
same  stock  culture.  Every  day  five  to  ten  sera  were  examined  in  dilution 
varying  from  0  to  20,000.  The  test  was  repeated  every  three  or  four  days 
in  the  case  of  each  patient.  The  patients  were,  so  far  as  possible,  under 
the  same  conditions ;  they  were  nearly  all  working  people  of"  St.  Peters- 
burg living  in  similar  environment,  were  between  fifteen  and  thirty  years 
of  age  and  were  not  natives  of  the  city,  but  contracted  the  disease  during 
their  first  year  of  residence  there.  The  treatment  was  uniform.  Light 
cases  received  special  diet  and  baths.  In  severe  cases  stimulants  and 
symptomatic  measures  were  also  used. 

The  cases  studied  were  classified  in  three  groups : 

(I)  Including  (a)  simple  uncomplicated  cases  and  (b)  cases  having 
relapses;  (II)  fatal  cases;  (III)  Cases  of  typhoid  fever  not  included  un- 
der (I)  and  (II)  e.  g.:  mild,  atypical  cases  and  severe,  complicated  and 
protracted  cases;  (IV)  cases,  not  of  typhoid,  but  of  other  diseases.  (Ia) 
Mild  uncomplicated  cases;  21  cases  are  reported;  complete  histories  and 
charts  showing  temperature  and  agglutination  curves  are  given.  All  of 
these  cases  showed  a  marked  increase  in  the  agglutinating  power  of  the 
serum  at  the  end  of  the  febrile  period  about  the  20th  day  of  the  disease. 
In  the  first  week  the  agglutinating  power  was  slight,  or  in  many  cases  en- 
tirely lacking,  at  the  end  of  the  second  week  it  began  to  increase,  and  in  the 
first  part  of  the  third  week  showed  a  more  or  less  sudden  further  increase, 
reached  a  maximum,  and  fell  just  as  suddenly  in  the  course  of  three  or 


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CURRENT  MEDICAL  LITERATURE 


four  days  and  remained  at  the  lower  level,  with  a  very  gradual  tendency 
to  diminish  throughout  convalescence.  The  curve  representing  these  vari- 
ations is  called  the  steeple  curve,  or  "  courbe  en  clocher  "  of  Courmant. 

(lb)  In  the  majority  of  the  nine  cases  showing  relapse  the  agglutinating 
power  of  the  serum  was  represented  by  a  curve  similar  to  that  of  primary 
cases,  but  the  agglutinating  power  was  higher  during  the  relapse  than  in 
the  first  illness,  and  sometimes  appeared  first  in  the  relapse,  having  been 
entirely  absent  previously. 

Group  II.  Fatal  cases.  Twelve  cases  were  studied.  These  showed  a 
rapidly  increasing  agglutinating  power  of  the  blood  serum  up  to  the  end, 
in  some  cases  reaching  a  strength  requiring  the  1-20,000  dilution. 

Group  III.  (a)  Mild  atypical  cases,  ten  showed  a  low  atypical  curve. 
(b)  Severe,  complicated  and  protracted  cases.  Eight  of  these  showed  com- 
plications with  pneumonia,  otitis  media,  empyema,  etc.,  and  lasted  from 
six  to  ten  weeks.  The  agglutination  curve  in  these  cases  was  not  uniform 
or  regular.  Diplo-  and  streptococcus  pneumonia  occurring  as  complica- 
tions diminished  the  agglutinating  power  of  the  serum  or  at  least  pre- 
vented any  increase. 

Group  IV.  The  author  obtained  a  positive  widal  reaction  in  one  case 
of  diphtheria,  one  case  of  military  tuberculosis,  two  cases  of  pulmonary 
tuberculosis  (in  some  of  these  cases  even  with  a  dilution  of  1-250)  ten 
cases  of  diseases  in  which  jaundice  occurred,  including  croupous  pneu- 
monia, hypertrophic  cirrhosis  of  the  liver,  catarrhal  jaundice  and  in  one 
case  of  Addison's  disease. 

Twenty-one  cases  that  had  had  typhoid  fever  and  recovered  were 
studied  by  the  author.  In  thirteen  cases  a  positive  Widal  reaction  was  ob- 
tained, in  many  of  them  it  was  very  marked.  It  was  most  often  found 
in  the  first  year  after  the  attack,  but  in  individual  cases  it  was  present 
ten  or  more  years  after  recovery. 

The  author  believes  the  Widal  reaction  is  specific,  in  that  it  occurs 
sooner  or  later  in  all  cases  of  typhoid  fever.  On  the  other  hand,  it  is 
not  patnognomonic  since  it  may  appear  in  the  course  of  other  diseases, 
though  rarely  when  sufficiently  high  dilutions  are  used.  The  reaction  has 
considerable  diagnostic  value  from  the  second  week  on,  and  must  be  con- 
sidered one  of  the  cardinal  symptoms  of  the  disease ;  the  absence  of  the 
reaction  is  of  value  in  excluding  the  diagnosis  of  typhoid  fever,  especially 
if  low  dilutions  are  used  in  making  the  test.  The  reaction  has  no  prognos- 
tic value.  There  is  apparently  no  relation  between  the  degree  of  agglu- 
tinating power  or  its  duration  and  the  severity  of  the  illness.  The  re- 
action is  apparently  a  protective  one  and  may  even  perhaps  represent  a 
condition  preceding  the  establishment  of  immunity.  The  high  value  of  the 
agglutinating  power  of  the  serum  in  severe  and  relapsing  cases  supports 
this  view. 


Vol.  xxvii  SEPTEMBER,  1906 


No.  9 


ALBANY 

MEDICAL  ANNALS 


Original  Communications 

SUBACUTE  AND  CHRONIC  SEMINAL  VESICULITIS. 
(Catarrhal  Form.) 

The  President's  Address  to  the  Medical  Society  of  the  County  of  Albany, 
read  at  the  Annual  Meeting  of  the  Society,  May  8,  igo6. 

By  JAMES  W.  WILTSE,  M.  D. 

In  1889  Jordan  Lloyd,  in  an  article  published  in  the  British 
Medical  Journal,  first  described  the  disease  chronic  seminal 
vesiculitis  as  a  distinct  entity.  Previous  to  that  time  the  con- 
dition had  been  considered  as  an  irritation  about  the  vesicle 
neck,  or  prostatitis. 

As  illustrative  of  the  comparative  recent  recognition  of  con- 
ditions now  accepted  as  almost  everyday  occurrences,  may  be 
quoted  the  opening  paragraphs  of  Lloyd's  paper.  After  refer- 
ring to  the  fact  that  only  a  short  time  had  elapsed  since  disease 
of  the  Fallopian  tubes  had  been  accepted  as  a  not  infrequent  con- 
dition while  a  few  years  before  the  most  erudite  pathologists  had 
considered  salpingitis  as  only  a  morbid  possibility,  he  continues: 
"Whether  time  will  prove  that  the  analogous  structures  in  males 
are  similarly  prone  to  affections  I  do  not  know,  but  I  am  already 
convinced  that  inflammatory  diseases  of  the  sexual  apparatus 
lying  at  the  base  of  the  male  bladder  are  far  from  uncommon,  and 
that  in  seminal  vesiculitis  the  key  is  to  be  found  to  much  that  is 
puzzling  in  many  of  the  so-called  prostatic  disorders." 

In  a  second  paper  published  in  the  London  Lancet  in  1891, 
Lloyd  further  elaborated  upon  seminal  vesiculitis  as  a  distinct 
disease  and  pointed  out  that  while  epididymitis  had  long  been 
established  as  one  of  the  more  common  complications  of  gon- 
orrhoea, yet  the  infection  in  order  to  reach  the  epididymis  must 


620  SUBACUTE  AND  CHRONIC  SEMINAL  VESICULITIS 


travel  through  the  vas  deferens,  a  tube  about  eighteen  inches  in 
length,  while  to  infect  the  vesicles  it  was  only  necessary  that  it 
should  travel  about  two  inches. 

Eugene  Fuller  in  the  Journal  of  Cutaneous  and  Genito -urinary 
Diseases,  for  September,  1893,  published  his  observations  of 
twenty  cases  extending  over  a  year  and  a  half,  with  the  details  of 
seven  cases;  four  of  these  cases  or  57  per  cent,  were  non- 
gonorrhoeal  in  origin.  Since  that  time  Fuller  has  carried  on 
investigations  which  make  his  name  more  prominently  associated 
with  the  disease  than  that  of  any  other  investigator,  although 
all  genito-urinary  surgeons  recognize  the  prevalence  of  the 
condition  to-day. 

It  is  not  my  purpose  to  do  more  than  touch  upon  that  form  due 
to  gonorrhoea  because  this  disease  is  well  recognized  by  all  prac- 
titioners, but  rather  upon  the  simple  or  catarrhal  form  which  I 
believe  is  often  overlooked  or  passed  along  as  a  neurosis  without 
a  proper  examination  being  made  to  determine  whether  or  not  a 
demonstrable  lesion  is  present. 

It  is  well  recognized  and  admitted  by  most  genito-urinary 
surgeons  that  many  cases  exist  in  which  no  history  of  a  former 
gonorrhoea  can  be  elicited.  In  fact  the  two  cases  cited  by  Lloyd, 
in  his  first  paper  alluded  to  above,  gave  no  history  of  a  former 
gonorrhoeal  infection  although  both  were  of  a  very  severe  grade, 
one  requiring  aspiration  through  the  rectum  before  being  relieved. 
Again  in  the  seven  cases  cited  by  Fuller,  in  his  first  paper,  three 
had  had  a  previous  gonorrhoea  while  four  were  due  to  other  causes. 

An  analysis  of  these  four  cases  shows  that  one  occurred  in  a 
man  who  had  masturbated  between  the  ages  of  nine  and  twenty- 
two.  In  a  second  no  cause  is  assigned ;  this  case  had  been  under 
treatment  for  nine  months  and  the  author  says  the  patient  will 
probably  never  be  well.  In  a  third  there  was  no  history  of  a 
former  venereal  disease  or  sexual  abuses,  but  the  patient  had 
worked  excessively  and  had  been  under  severe  nervous  strain. 
The  fourth  was  a  case  of  tuberculous  disease  of  the  vesicle. 

Pathology. — In  subacute  vesiculitis  the  inflammatory  process 
is  largely  confined  to  the  mucous  coat,  penetrating  the  muscular 
coat  only  to  a  slight  extent,  if  at  all.  The  character  of  the  secre- 
tion is  not  altered  to  the  degree  seen  in  the  chronic  form,  being 
largely  mucoid  and  containing  comparatively  few  leucocytes. 
In  this  form  of  the  disease  the  contents  of  the  vesicles  are  not 
much  increased  and,  as  a  rule,  the  vesicle  is  not  greatly  distended. 


JAMES  W.  WILTSE 


621 


Subacute  vesiculitis,  according  to  Fuller,  is  often  found 
associated  with  an  atonic  condition  of  the  vesicle  wall  and  in 
these  instances  the  sac  is  found  much  distended,  as  a  result  of  the 
atony  and  not  of  the  inflammation  per  se. 

In  chronic  vesiculitis  the  deeper  structures  of  the  vesicle  are 
involved  and  the  pathological  changes  extend  to  the  muscular 
coat  and  may  even  extend  beyond  the  walls  constituting  peri- 
vesiculitis.  The  vesicles  in  this  form  of  the  disease  are  usually 
considerably  distended  and  the  walls  thinned  and  fibrous.  The 
vesicle  usually  contains  a  considerable  amount  of  muco-purulent 
secretion.  In  come  cases  granulations  form  over  parts  of  the 
cavity  of  the  sac,  causing  distinct  haemorrhage,  while  in  others 
only  traces  are  seen  after  stripping  or  in  the  semen  where  pol- 
lutions occur. 

According  to  Fuller  where  a  peri -vesiculitis  occurs  distention 
of  the  sac  rarely  takes  place,  for  the  outside  inflammation,  if  of 
long  standing,  contains  fibrous  tissue  enough  to  prevent  the 
necessary  expansion  and  in  some  cases  to  actually  cause  ob- 
struction of  the  vesicular  sac.  The  disease  may  be  unilateral  or 
bilateral,  but  in  the  latter  case  one  side  may  be  more  severely 
involved  than  the  other. 

Guillot,  who  investigated  the  subject  of  stricture  of  the  ejacula- 
tory  duct,  was  unable  to  find  an  instance  of  such  a  lesion.  Fuller 
ascribes  this  to  the  fact  that  the  ducts  do  not  lie  in  connective 
tissue,  but  in  the  infundibulum  of  the  prostatic-lymph  space  as 
it  were.  Consequently  the  greater  part  of  an  inflammatory  in- 
filtration would  enter  the  lymph  space  and  would  not  remain 
packed  about  the  ducts  in  a  loose  connective  tissue,  eventually 
to  create  a  connective  tissue  proliferation.  The  ducts  do, 
however,  often  become  plugged  by  inflammatory  products  and 
by  thickened  and  altered  secretion.  The  damming  back  of  the 
contents  consequent  upon  such  obstruction  of  the  duct  may 
cause  atony  of  the  vesicle  wall  and  finally  distention. 

Etiology.  The  inflammation  may  arise  in  the  sac  or  may 
originate  in  the  urethra  and  reach  the  sac  through  the  ejaculatory 
duct.  The  latter  is  much  the  more  common  way  of  infection. 
In  a  few  cases  where  the  infection  has  been  found  to  be  due  to 
the  presence  of  the  colon  bacillus  there  is  probably  a  direct 
migration  of  this  organism  through  the  tissues  separating  the 
vesicle  from  the  bowel.  Staphylococci  and  other  pyogenic 
organisms  are  constantly  found  in  the  contents  of  these  diseased 


62  2   '        SUBACUTE  AND  CHRONIC  SEMINAL  VESICULITIS 


vesicles  too,  and  whether  they  enter  by  the  urethra  and  duct  or 
by  other  routes  is  difficult  of  definite  determination. 

Fuller  claims  that  when  inflammation  begins  within  the  duct 
it  is  preceded  by  atony  of  the  vesicle  walls  and  is  due  to  abuse 
of  the  function  of  ejaculation.  No  doubt  that  abuse  of  the 
sexual  function  in  one  form  or  another  is  an  important  exciting 
cause  in  many  of  these  cases.  That  simple  catharrhal  vesi- 
culitis however  does  occur  in  fairly  continent  men,  men  who 
are  neither  vicious  nor  ignorant  and  who  are  anxious  to  be  cured 
and  from  whom  therefore  we  may  expect  a  straightforward 
history,  is  the  experience,  I  think,  of  most  practitioners  who 
have  done  much  work  in  this  field.  Many  men  suffering  from 
this  form  of  disease  are  highly  intelligent,  but  of  very  nervous 
temperament.  Many  of  them  are  in  positions  of  trust  or  great 
responsibility  where  the  nervous  energy  expended  each  day  is 
excessive.  In  the  past  many  of  the  cases  have  been,  without 
proper  examination,  passed  along  as  sexual  neurasthenics. 

Ultzman  in  his  work  on  "Genito-urinary  Neuroses,"  says  of 
nervous  impotence:  "Seminal  vesiculitis  is  present  in  a  large 
proportion  of  these  cases  of  neurasthenia,  and,  unless  remedied, 
will  seriously  retard,  if  not  prevent,  recovery." 

In  one  case  already  cited  from  Fuller  no  assignable  cause 
could  be  found  except  hard  work  and  nervous  strain. 

A  second  class  of  cases  is  found  in  men  who  are  addicted  to 
excesses  in  alcohol  and  tobacco.  It  is  well  known  that  alcohol 
is  an  irritant  to  the  genito-urinary  tract  and  particularly  to 
that  portion  about  the  so-called  vesicle  neck  or  in  the  prostatic 
urethra.  This  is  well  illustrated  not  only  in  the  acute  infections 
of  the  tract,  but  also  in  chronic  conditions  such  as  hypertrophy 
of  the  prostate. 

The  third  and  last  factor  which,  in  my  judgment,  is  responsible 
for  many  of  these  cases,  I  have  only  found  mentioned  by  three 
authors — Lydston,  Fuller  and  Lloyd.  They  recognize  the 
influence  of  bicycle  riding  in  contributing  to  the  production  of 
the  disease.  In  a  case  cited  by  Lloyd  suppuration  occurred 
which  was  only  relieved  by  aspiration.  The  patient  gave  a 
history  of  having  ridden  a  bicycle  for  five  or  six  years  and  had 
noticed  that  whenever  he  rode  the  saddle  pressed  upon  the 
perineum  in  such  a  manner  as  to  cause  frequent  desire  to  urinate. 
Here  there  was  undoubtedly  a  badly  fitting  saddle,  but  even 
where  this  is  not  the  case,  the  repeated  slight  shocks  received 


JAMES  W.  WILTSE 


623 


upon  the  perineum,  when  riding  upon  pavements  or  over  uneven 
country  roads,  continued  over  several  years,  is  sufficient  to 
produce  a  low  grade  of  inflammation.  Horseback  riding,  too, 
is  a  prolific  cause,  although  not  so  often  seen  because  fewer  can 
afford  this  form  of  recreation. 

The  following  is  a  summary  of  eight  cases  of  chronic  catarrhal 
vesiculitis  occurring  recently  in  my  practice.  The  patients  were 
all  single.  Their  ages  ranged  from  22  to  30  years.  One  case 
gave  a  history  of  masturbation  five  or  six  years  previously 
Six  of  the  eight  cases  were  bicycle  riders.  One  of  the  latter 
also  frequently  rode  horseback,  and  one  other  in  addition  to 
the  slight  and  frequent  traumatism  produced  by  the  ordinary 
bicycle  riding  gave  a  history  of  a  violent  trauma  to  the  perineum 
produced  by  his  wheel  running  into  the  curb,  and  it  was  only 
after  this  accident  that  symptoms  were  noticed. 

Sexual  History. — Complete  impotence,  one  case;  partial 
impotence,  two  cases.    Decreased  sexual  power  in  all. 

Urinary  History. — Frequent  urination,  three  cases;  urination 
unaffected,  three  cases;  urination  inhibited  (reflex),  one  case. 

Venereal  History. — No  history  of  gonorrhoea  or  syphilis. 

The  history  of  these  cases  vary  so  little  that  a  detailed  report 
of  three  willl  suffice  to  illustrate  the  condition. 

Case  I. — Male.    Single.    Aged  22.    Occupation  barber. 

Family  history,  negative.  Personal  history,  has  never  had  any  vene- 
real disease;  has  not  had  intercourse  during  past  six  months.  Has 
never  masturbated  excessively.  Four  years  ago  began  to  ride  a  bicycle. 
Rode  a  great  deal  during  two  years.  For  past  two  years  has  not  ridden. 
Last  summer  began  to  notice  he  had  to  urinate  more  frequently  than 
normal  and  the  desire  was  very  urgent.  There  was  inability  to  retain 
urine  when  desire  was  present.  About  two  months  ago  noticed  purulent 
discharge  from  meatus  and  also  that  undergarments  were  stained  by 
discharge.  Discharge  was  rather  thin  and  mucoid.  Occasionally  has  to 
rise  at  night  to  urinate,  especially  if  he  drinks  a  glass  of  beer  during  the 
evening.  Examination  per  urethra  shows  strong  spasm  of  compressor 
urethrae.  Prostatic  urethra  exquisitely  tender.  Examination  per  re  ctum 
shows  left  seminal  vesicle  considerably  enlarged,  and  very  sensitive. 
Pain  referred  to  bladder  neck  and  patient  feels  as  though  urination  were 
imminent.  Right  vesicle  involved  to  a  lesser  degree.  Diagnosis: 
Chronic  catarrhal  seminal  vesiculitis. 

Case  II.    Male.    Single.    Aged  26.    Occupation,  electrical  inspector. 

Family  history,  negative.  Personal  history:  never  had  any  venereal 
trouble  nor  any  constitutional  disease.  About  six  or  seven  years  ago 
began  to  ride  a  bicycle.  Rode  a  good  deal  for  two  years.  Then  did  not 
ride  until  last  year,  when  he  rode  moderately. 


624  SUBACUTE  AND  CHRONIC  SEMINAL  VESICULITIS 


Present  trouble  dates  back  four  or  five  years  when  he  began  to  lose 
power  of  erection  although  he  had  never  been  immoderate  in  his  sexual 
relations.  With  loss  of  erection  he  had  occasional  nocturnal  emissions 
without  dreams.  He  believes  he  unconsciously  masturbates  while  asleep. 
Emissions  occur  about  twice  a  week.  Has  given  up  all  effort  at  coitus, 
because  when  he  has  tried  penis  remained  flaccid  although  desire  was 
present.  Examination  per  urethra — no  stricture.  Prostatic  urethra 
sensitive.  Examination  per  rectum  shows  both  vesicles  enlarged  and 
tender.  Left  more  affected  than  the  right.  Diagnosis:  Chronic  catar- 
rhal vesiculitis. 

Patient  improved  rapidly  under  stripping  of  vesicle.  Emissions  abated, 
erections  firm  and  cure  nearly  perfected. 

Case  III.    Male.    Single.    Aged  23. 

Family  history,  mother  living  and  well,  aged  56.  Father  died  at  37  of 
pneumonia.  One  brother  and  sister,  both  well.  Father,  brother  and 
patient  all  had  varicocele.  Personal  history:  never  had  any  acute 
disease.  No  venereal  disease.  Masturbated  from  twelve  to  fifteen,  then 
learned  the  evils  of  it  and  stopped.  Soon  after  began  riding  horseback 
(rode  for  one  and  one-half  years).  Since  then  has  ridden  a  bicycle  more 
or  less.    Formerly  had  nocturnal  emissions  frequently. 

Status  Praesens.  Now  has  nocturnal  emissions  once  in  two  or  three 
weeks.  Feels  better  after  emissions.  Has  no  intercourse  or  does  not 
masturbate.  Feels  some  indefinite  unpleasant  feeling  when  urinating. 
Examination  per  urethra  shows  hypersensitive  prostatic  urethra.  No 
stricture.  Examination  per  rectum  shows  both  vesicles  somewhat 
enlarged  and  sensitive;  the  right  more  involved  than  the  left;  prostate, 
too,  somewhat  enlarged  in  this  case.  Diagnosis:  Chronic  catarrhal 
seminal  vesiculitis  and  prostatitis. 

Symptomatology.  Briefly  the  symptoms  may  be  grouped 
under  three  heads:  first,  those  referable  to  inflammation  in 
general;  second,  those  referable  to  the  sexual  sphere;  third, 
those  affecting  the  urinary  function. 

Pain  or  a  sense  of  discomfort  and  uneasiness  is  present  in 
almost  all  cases.  In  many  cases  pain  is  a  distinct  symptom 
and  is  referred  by  the  patient  to  the  vicinity  of  the  disease, 
that  is,  to  the  neck  of  the  bladder.  In  other  cases  the  pain  is 
reflex  and  may  be  referred  to  points  far  distant  from  the  seat 
of  the  disease.  It  may  be  located  by  the  patient  at  the  end  of 
the  penis  or  over  the  region  of  the  spermatic  cords,  in  the  groin, 
or  again  to  the  testicle  and  in  some  cases  to  the  back  at  a  point 
corresponding  to  the  vesicle  neck.  In  some  cases  the  pain 
does  not  seem  to  be  commensurate  with  the  amount  of  disease 
found  upon  examination,  while  in  others,  where  the  pain  is 
greatest,  the  amount  of  distention  and  involvement  seems  less. 

In  many  cases  the  disturbance  is  not  sufficient  to  be  pro- 


JAMES  W.  WILTSE 


625 


nounced  a  distinct  pain,  but  consists  of  discomfort  and  uneasi- 
ness which  is  not  easily  referable  by  the  patient  to  any  particular 
location.  These  are  the  cases  very  often  diagnosed  as  a  sexual 
neurosis ;  a  careful  examination  per  rectum  will,  however,  reveal 
a  distended  or  sclerosed  vesicle. 

Besides  pain,  the  other  signs  of  inflammation  present  are, 
thickening  or  sclerosis  of  the  vesicle  wall,  distention  of  the  sac, 
a  feeling  of  boginess  to  the  examining  finger,  fluctuation  when 
the  sac  is  distended  and  the  ejaculatory  duct  blocked  by  inflam- 
matory products.  Increased  heat  in  the  part  is  not  a  prominent 
symptom  of  this  form  of  vesiculitis. 

In  the  sexual  sphere  many  disorders  are  noted;  in  general 
though  it  may  be  stated,  that  in  the  earlier  stages  erection  and 
erotism  are  increased.  During  this  stage,  if  the  patient  remains 
continent,  pollutions  are  apt  to  be  frequent,  or  if  he  indulges 
his  abnormal  sexual  desires,  he  is  unsatisfied  no  matter  how 
frequently  repeated.  In  other  cases  coitus  may  ease  the  sense 
of  discomfort  over  a  short  period,  but  it  soon  returns  again. 
When  pollutions  occur  they  may  be  mixed  with  blood,  and  at 
any  rate  they  always  contain  pathological  elements.  In  one 
case  referred  to  me  by  a  life-insurance  examiner,  many  dead 
spermatozoa  had  been  found  in  the  urinary  sediment.  They  are 
present  in  greater  or  smaller  numbers  in  the  majority  of  cases. 

As  the  disease  pursues  its  course  the  symptoms  of  irritation 
on  the  part  of  the  sexual  apparatus  subsides  and  the  sexual 
powers  decline.  Finally,  a  condition  of  partial  or  complete 
impotency  supervenes.  Ejaculation  may  still  take  place  and 
is  often  premature,  but  erection  fails  and  the  penis  remains 
flaccid. 

In  many  cases  the  patient  does  not  seek  relief  until  this  con- 
dition has  been  established. 

Urinary  symptoms.  Urination  may  be  more  frequent;  the 
urgency,  when  the  desire  is  felt,  may  be  greater  or  it  may  be 
inhibited.  Frequently  a  sense  of  smarting  or  burning  is  felt  at 
the  vesicle  neck  when  urine  is  passed.  Tenesmus,  too,  is  often 
felt  in  the  deep  urethra.  On  the  other  hand,  if  during  sleep  or 
from  some  other  cause,  the  patient  has  acquired  a  full  bladder, 
inhibition  amounting  to  retention  for  a  considerable  period  may 
ensue.  In  one  of  my  cases  the  patient  had  gone  to  bed  thor- 
oughly exhausted  and  slept  for  twelve  hours.  When  he  at- 
tempted to  empty  the  bladder,  the  inhibition  was  so  complete 


626  SUBACUTE  AND  CHRONIC  SEMINAL  VESICULITIS 

that  actual  retention  was  present  for  over  an  hour.  This  might 
be  put  down  as  retention  due  to  over-distention,  if  it  were  not  for 
the  fact  that  he  is  similarly  troubled,  but  in  a  slighter  degree, 
whenever  he  is  so  situated  that  he  cannot  promptly  empty  the 
bladder  when  the  desire  is  felt,  and  that  concomitant  with  the 
bladder  symptoms  he  had  undoubted  vesicular  disease. 

As  the  vesicle  is  closely  attached  to  the  bladder  wall  extending 
from  the  point  where  the  ureter  enters  the  bladder  down  behind 
the  prostate,  finally  to  enter  that  organ  through  its  ejaculatory 
duct,  it  is  probable  that  an  over-distended  or  even  moderately 
distended  bladder  puts  the  vesicle  on  the  stretch,  and  the  sym- 
pathetic nerve  supply  for  the  bladder  sphincter  and  the  vesicle 
being  practically  the  same  reflex  action  from  nerves  supplying 
the  inflamed  vesicle,  causes  spasm  of  the  bladder  sphincters. 

The  urine  often  contains  pathological  material  emptied  from 
an  inflamed  vesicle  into  the  posterior  urethrae  at  the  end  of  uri- 
nation by  the  contraction  of  the  bladder  sphincters. 

There  are  many  other  symptoms  mainly  of  the  psychic  or 
neurotic  character  which  might  be  enumerated,  but  those  already 
noted  I  consider  the  essentials  and  will  not  go  further  into  details. 

Diagnosis.  The  diagnosis  is  based  upon  a  history  giving  in 
part  or  wholly  the  symptoms  set  down  above  or  possibly  many 
others  added,  and  to  digital  examinations  per  rectum.  The  main 
reliance  is  of  course  to  be  placed  upon  palpation  through  the 
rectum,  as  prostatitis  and  cystitis  when  confined  to  the  bladder 
font  and  neuroses  of  the  genito-urinary  tract  may  give  a  similar 
history.  With  the  patient  in  the  proper  position  and  under 
proper  conditions  the  vesicles  can  be  readily  palpated,  and  any 
difference  in  size  or  consistency  can  easily  be  made  out.  Usually, 
too,  a  complaint  of  pain  or  soreness  will  be  made  by  the  patient 
even  upon  the  most  gentle  manipulation.  Pain  is  not,  however, 
always  complained  of,  and  the  physician  should  rely  more  upon 
what  he  feels  than  upon  complaint  or  non-complaint  of  the 
patient.  As  in  the  massage  or  stripping  of  the  vesicles,  so  in 
their  examination  the  patient  should  have  a  full  bladder;  then 
when  the  physician  has  satisfied  himself  as  well  as  possible,  by 
palpation,  as  to  the  condition,  some  of  the  contents  of  the  vesicle 
may  be  expressed.  The  secretion  collected  at  the  meatus  if 
enough  runs  forward  through  the  urethra  for  that  purpose  or 
collected  from  the  urine  passed  after  massage,  if  this  is  necessary, 
to  complete  the  diagnosis  microscopically. 


JAMES  W.  WILTSE 


627 


The  technique  of  examination  for  diagnostic  purposes  and  for 
the  stripping  of  the  vesicles  in  the  treatment  is  so  nearly  the  same 
that  I  shall  pass  on  to  the  treatment  and  speak  of  it  there. 

Treatment.  To  Eugene  Fuller  of  New  York  belongs  the  credit 
of  instituting  and  advocating  the  stripping  of  the  vesicles  in 
chronic  seminal  vesiculitis.  In  an  article  (referred  to  in  an 
earlier  part  of  this  paper)  published  in  the  Journal  of  Cutaneous 
and  Genito-U rinary  Diseases  for  September,  1893,  Fuller  gave 
his  experience  extending  then  over  a  period  of  about  one  and  a 
half  years  in  the  study  and  treatment  of  twenty  cases  and 
advocated  this  method  of  treatment. 

I  can  remember  several  years  after,  hearing  skepticism  ex- 
pressed as  to  whether  it  was  possible  to  reach  and  strip  the 
vesicle  in  the  manner  described  or  not.  To-day,  however.it  is 
generally  admitted  and  recognized  as  the  only  rational  procedure 
in  this  class  of  cases ;  not  that  it  cures  them  all  as  Fuller  readily 
concedes.  In  a  small  percentage  the  vesicles  are  so  badly  dam- 
aged that  operative  measures  must  be  resorted  to  and  in  still 
others,  where  so  grave  a  procedure  does  not  seem  warranted, 
massage  does  not  entirely  cure,  but  it  may  be  safely  said  that 
where  indicated  all  are  improved  and  many  cured.  Again,  as  he 
has  noted,  the  sense  of  touch  must  be  as  highly  developed  in  the 
examining  finger  of  the  genito-urinary  surgeon  as  in  the  gyne- 
cologist in  order  that  he  may  know  what  he  feels  or  whether  it  is 
diseased.    This  is  acquired  only  after  considerable  experience. 

The  patient  should  be  massaged  with  a  full  bladder,  the  vesicles 
standing  out  more  prominently  and  being  more  accessible  to  the 
massaging  finger  when  the  bladder  is  in  that  condition.  The 
patient  is  then  placed  with  the  feet  slightly  separated  and  the 
hands  resting  upon  a  stool  or  seat  of  a  chair  so  that  the  back  is  in 
the  horizontal  position.  Then  the  operator,  standing  behind  the 
patient  with  the  left  hand  over  the  abdomen  above  the  pubis, 
inserts  the  right  index  finger  into  the  rectum  and  with  counter- 
pressure  over  the  lower  abdomen  forces,  so  far  as  possible  with- 
out the  use  of  too  much  force,  the  contents  of  the  pelvis  down 
toward  the  perineum.  The  examining  finger  first  feels  the  base 
of  the  prostate  and  is  then  pushed  forward  and  to  the  side  of  the 
prostate  until  the  junction  of  the  vesicle  and  prostate  is  felt.  The 
vesicle  is  then  followed  as  far  toward  the  posterior  extremity  as 
possible.  Then  with  gentle  force  the  stripping  is  done ;  the  con- 
tents of  the  sac  being  forced  ahead  of  the  finger  through  the 


628       A  BRACE  TO  AID  IN  THE  TREATMENT  OF  FLAT  FEET 

ejaculatory  duct  into  the  prostatic  urethra.  This  motion  is're- 
peated  several  times,  depending  somewhat  upon  the  degree  of 
tenderness  and  pain  produced.  As  improvement  takes  place  the 
force  used  may  be  increased  and  the  duration  of  sittings  length- 
ened. In  my  experience  the  period  elapsing  between  treatments 
should  range  from  three  to  five  days. 

Many  patients  will  need  no  other  treatment.  Others  may  need 
tonics  or  other  internal  medicine,  according  to  indications.  No 
treatment  applied  through  the  urethra  is  of  any  value,  and  may 
do  distinct  harm  if  of  an  irritating  character. 


A  BRACE  TO  AID  IN  THE  TREATMENT  OF  FLAT  OR 
WEAKENED  FEET. 
By  JOHN  M.  BERRY,  M.  D., 

Troy,  N.  Y. 

In  an  article  appearing  in  the  Albany  Medical  Annals  for 
April,  1906,  I  discussed  the  flat-foot  series  of  disabilities  and 
deformities  of  the  foot  and  their  treatment.  I  also  showed  the 
drawings  of  a  brace  which  I  had  found  useful  in  the  treatment  of 
weakened  conditions  of  the  foot.  In  the  present  article,  after  a 
brief  discussion  of  the  indications  for  and  the  requirements  of  a 
flat-foot  brace ;  I  wish  to  present  some  of  the  advantages  of  the 
above  mentioned  special  brace  over  other  braces  in  use  and  also 
to  describe  the  manner  of  making. 

It  is  not  the  purpose  of  this  paper  to  discuss  fully  the  indica- 
tions for  the  use  of  a  foot  brace.  Not  every  case  of  flat  or 
weakened  foot  need  be  treated  by  a  brace  and  in  nearly  all  cases 
the  brace  should  not  be  the  only  method  of  treatment.  In  the 
vast  majority  of  cases  the  foot  brace  is  simply  an  aid  to  treatment. 
The  great  variety  of  flat-foot  braces  on  the  market  is  an  excellent 
proof  of  the  inability  to  cure  all  cases  of  weakened  foot  by  the 
simple  use  of  a  brace.  The  aim  of  all  treatment  should  be  first, 
to  reduce  deformity ;  second,  to  keep  the  deformity  reduced ;  and 
third,  to  strengthen  and  build  up  the  foot  so  that  it  will  be  able 
to  support  itself  and  not  relapse  into  deformity.  The  use  of  a 
brace  to  reduce  actual  bony  deformity  is  a  practice  to  be  con- 
demned ;  its  chief  use  is  to  keep  the  foot  supported  and  prevent 
the  recurrence  of  deformity.  A  brace  plays  but  a  small  part  in 
strengthening  a  foot. 


JOHN  M.  BERRY 


629 


It  is  manifest  therefore  that  the  conditions  of  the  foot  in  which 
the  use  of  a  brace  would  be  beneficial  are  as  follows: 

(1)  Cases  of  flat-foot,  non-rigid,  after  the  deformity  has  been 
reduced  and  pain  relieved  by  the  use  of  adhesive  strapping  or 
plaster  paris  casts;  (2)  cases  of  rigid  flat-foot  that  have  been 
reduced  by  operative  means;  (3)  all  cases  of  weakened  arch 
of  the  foot  which  need  support  of  the  arch  until  the  foot  itself 
can  be  strengthened;  (4)  paralytic  cases;  (5)  cases  of  weakened 
foot  where  there  may  be  no  actual  falling  of  the  arch  yet  a  proper 
brace  is  beneficial  in  that  it  tends  to  make  the  foot  assume  such 
a  position  as  will  throw  the  weight  of  the  body  on  the  outer  side 
of  the  foot,  that  part  of  the  foot  which  is  normally  adapted  to  it ; 
(6)  cases  of  pronated  foot,  a  condition  most  frequently  seen 
in  young  people  where  there  is  a  rolling  in  of  the  ankles  (a  con- 
dition formerly  diagnosed  as  weak  ankles) ;  in  these  cases  the 
use  of  a  brace  throws  the  foot  into  a  proper  position  in  relation 
to  body  weight  and  progression. 

I  have  used  a  brace  with  benefit  when  there  was  a  painful  con- 
dition of  the  metatarso-phalangeal  joint  of  the  big  toe,  as  in 
gout.  Here  the  brace  relieves  the  pressure  of  the  body  weight  on 
the  joint  and  throws  the  weight  more  onto  the  outer  side  of  the 
foot. 

A  brace  acts  by  exerting  corrective  force  with  the  body  weight 
as  a  counterforce.  The  chief  requirement  of  a  brace  should  be 
that  it  supports  the  foot  in  a  proper  position  and  that  it  exerts 
pressure  not  only  under  the  internal  longitudinal  arch  of  the 
foot  but  also  laterally  in  such  a  way  as  to  restore  the  normal 
contour  of  the  foot  and  also  prevent  recurrence  of  deformity. 
In  many  cases  of  weakened  arch  the  deformity  seems  to  be  as 
much  a  lateral  displacement  inward  as  a  falling  of  the  arch.  A 
most  important  requirement  of  a  brace  should  be  that  while  it 
is  supporting  the  foot  both  on  the  plantar  surface  and  laterally 
it  should  not  splint  the  foot,  thus  not  interfering  with  the  normal 
motion  and  hindering  the  foot  from  strengthening  itself  by  use. 
Still  another  most  important  requirement  is  that  it  be  a  com- 
fortable brace.  Any  foot  brace  is  uncomfortable  enough,  but 
when  to  a  painful  foot  and  nervous  irritable  temperament,  a 
combination  often  found,  is  added  the  constant  pressure  and 
irritation  of  an  uncomfortable  brace,  a  condition  of  affairs  results, 
which  is  well-nigh  unbearable.  Of  course  every  brace  should 
be  a  brace  for  the  individual  foot.     The  use  of  ready-made 


630       A  BRACE  TO  AID  IN  THE  TREATMENT  OF  FLAT  FEET 


braces  and  supports  of  any  sort  should  be  discouraged.  The 
work  necessary  to  be  gone  through  with  in|taking  castings  for 
braces  is  an  item  of  more  interest  to  the  surgeon  than  to  the 
patient,  but  of  two  braces  equally  good,  even  the  patient  would 
prefer  the  one  which  required  the  least  trouble  to  make. 

Some  braces  support  the  arch,  but  exert  no  lateral  pressure 
on  the  foot  to  prevent  lateral  recurrence  of  deformity.  Some 
braces  do  both  of  these  things  but  splint  the  foot.  Other  braces 
are  objectionable  on  account  of  their  uncomfortableness.  No 
attempt  will  be  made  to  mention  or  describe  all  the  flat-foot 
braces  that  have  been  devised.  I  will  simply  present  outline 
sketches  of  some  of  the  more  commonly  used^braces. 


Fig.  3  Fig.  6 


Figure  1  shows  a  type  of  brace  in  common  use.  The  brace 
figured  is  known  as  the  Bradford  and  Lovett  brace. 

Figure  2  is  a  brace  used  by  Dr.  Young  of  Philadelphia. 

Figure  3  shows  a  very  common  type  of  brace;  the  brace 
figured  being  known  as  the  Arrow-Smith  brace. 

Figure  4  represents  what  is  known  as  the  Whitman  brace. 

Figure  5  is  the  cut  of  a  brace  made  by  Gustof  Gefvert  and 
Sons  of  Philadelphia.    The  upper  portion  marked  (A)  by  means 


JOHN  M.  BERRY 


631 


of  the  hinge  (C)  shuts  down  on  the  block  (B)  and  so  makes  a 
support  to  the  under  surface  of  the  arch.  The  height  of  the  arch 
can  be  regulated  by  the  height  of  the  block  (B).  The  same 
spring  can  be  applied  to  either  foot. 

Most  of  the  braces  in  use  are  simple  in  structure.  The  sim- 
plest of  all  braces  are  graduated  sizes  of  soft  rubber  pads  which 
are  supplied  by  some  instrument  houses.  Other  forms  of  braces 
are  incorporated  into  the  shoe.  Ochsner  has  a  brace  which  is 
made  into  the  shoe  and  by  turning  a  thumb  screw  at  the  heel  the 
height  of  the  arch  can  be  raised  or  lowered  at  will. 

Figure  6  shows  a  complicated  brace  devised  by  Nicoladoni. 
This  brace  swings  on  a  pivot  marked  (A).  The  brace  as  a  whole 
can  tip  forward  in  walking  but  cannot  tip  backward  on  account 
of  the  peg  (B). 

None  of  these  braces  meet  all  the  requirements  for  a  brace. 
Some  support  the  arch  on  the  under  surface  but  not  laterally. 
Some  splint  the  foot.  Some  do  not  allow  of  normal  motion  in 
the  foot  and  some  are  uncomfortable. 

A  sketch  of  the  brace  which  I  have  used  and  found  very 
satisfactory  in  fulfilling  the  requirements  of  a  brace  is  shown  in 
figure  7.    It  consists  of  two  parts,  a  supporting  portion  (A)  and 


Fig.  7 


a  base  piece  (B).  (C)  represents  the  tongue  portion  of  the  sup- 
port which  fits  into  the  slot  in  the  base  piece  marked  (D).  The 
supporting  portion  is  made  of  No.  16,  18  or  20  (depending  on 
the  weight  of  the  patient)  tempered  galvanized  steel  fitted  over  a 
plaster-of -Paris  model  of  the  arch  of  the  foot.  It  supports  the 
arch  of  the  foot  and  it  projects  high  up  on  the  inner  side  of  the 
foot  so  that  when  worn  with  a  properly  constructed  laced  shoe 
it  exerts  firm  lateral  pressure  on  the  foot,  thus  preventing 
lateral  deformity.  It  does  not  cover  any  of  the  weight -bearing 
portion  of  the  heel  or  ball  of  the  foot  and  is  attached  to  the  base 
piece  in  such  a  manner  that  it  is  movable  in  every  direction,  thus 
allowing  all  motions  of  the  foot  to  take  place.    In  other  words 


632       A  BRACE  TO  AID  IN  THE  TREATMENT  OF  FLAT  FEET 

it  supports  and  holds  in  position  the  arch  of  the  foot  with  the 
smallest  amount  of  splinting.  The  base  piece  serves  simply  to 
hold  the  supporting  portion  in  place.  It  is  made  of  flexible 
spring  brass  so  that  it  readily  conforms  to  the  shape  of  the 
bottom  of  the  shoe,  and  when  it  slips  into  place  in  the  heel  of  the 
shoe  the  arch  supporter  is  in  its  correct  position. 

As  has  been  previously  mentioned  the  trouble  to  the  surgeon 
and  patient  attendant  upon  getting  a  brace  is  an  important 
consideration.  Plaster  casts  of  the  entire  foot  which  is  neces- 
sary in  the  making  of  some  braces  is  a  procedure  requiring  con- 
siderable use  of  time  and  plaster.  The  method  of  taking  the 
plaster  cast  for  the  brace  in  question  is  as  follows. 

The  patient  sits  with  the  knee  flexed  and  resting  on  a  support 
in  such  a  way  that  the  outer  surface  of  the  foot  rests  on  a  flat 
surface  while  the  plantar  surface  of  the  foot  rests  against  an 
upright  support.  In  this  position  the  pressure  of  the  flat  sur- 
face makes  the  outer  edge  of  the  foot  straight  and  gives  an  ad- 
ducted  position  to  the  foot.  The  foot  presses  closely  but  not 
too  firmly  against  the  upright  support,  thus  leaving  a  space 
between  the  foot  and  the  support  corresponding  to  the  arch  of 
the  foot.  The  support  is  tilted  somewhat  to  allow  the  position 
to  be  assumed  by  the  patient  more  comfortably.  The  support 
and  the  position  assumed  by  the  patient  is  shown  in  figure  8. 

The  arch  of  the  foot  is  first  coated  with  vaseline  to  prevent 
the  plaster  adhering  and  with  a  dermatographic  pencil  the 
outline  of  the  brace  is  drawn  on  the  foot,  special  care  being  used 
in  marking  out  the  anterior  and  posterior  limits  and  the  height 
to  which  the  brace  rises  laterally.  The  foot  is  now  put  in 
position  on  the  support  and  the  space  represented  by  the  arch 
of  the  foot  filled  with  plaster  cream.  The  plaster  hardens  in  a 
few  moments  and  on  removal  the  outline  made  with  the  der- 
matographic pencil  will  be  found  to  have  been  transferred  to  the 
plaster,  as  shown  in  figure  9. 

Any  imperfection  in  this  "negative"  cast  can  be  filled  out 
with  plaster  cream  and  after  this  has  hardened,  the  surface  is 
coated  with  vaseline,  the  outline  of  the  brace  freshened,  and  a 
"positive"  cast  made,  as  shown  in  figure  10.  Here  again,  as  in 
making  the  "negative "  cast  from  the  foot  itself,  the  outline 
made  by  the  dermatographic  pencil  is  transferred. 

If  it  is  deemed  necessary  the  arch  on  the  positive  model  can 
be  deepened  or  modified  by  cutting  away  the  plaster.    This  is 


To  illustrate  Dr.  Berry's  article  on  "A  Brace  to  Aid  in  the  Treatment 
of  Flat  or  Weakened  Feet." 


Albany  Medical  Annals,  September,  iqo6. 


Fig.  8 


PROFESSIONAL  CIRCUMSrECTION 


633 


especially  necessary  in  cases  where  the  arch  is  very  low  or  where 
oedema  or  swelling  has  partially  obliterated  the  arch. 

The  cast  is  now  sent  to  the  instrument  makers  and  the  steel 
plate  filled  to  the  outline. 

In  making  the  base  piece  it  is  my  custom  to  leave  the  portion 
posterior  to  the  support  much  longer  than  necessary,  then  on 
fitting  the  support  into  the  arch  of  the  foot,  the  outline  of  the 
heel  is  traced  on  the  base  piece  and  the  base  piece  cut  to  conform 
to  the  outline  and  accurately  fitted  to  the  inner  sole  of  the  shoe. 


Fig.  9  Fig.  10 


The  advantages  of  a  brace  made  as  above,  can  be  summed  up 
as  follows: 

It  is  light.  It  fits  the  foot  accurately  and  supports  it  in  a 
proper  position.  It  does  not  splint  the  foot  but  allows  free 
motion.  It  is  comfortable  and  easily  adjusted  to  the  shoe. 
Its  use  has  been  followed  by  excellent  results.  The  best  results 
can  be  obtained  only  when  this  brace  is  used  in  combination  with 
a  properly  constructed  shoe.  A  description  of  the  shoe  can  not 
be  given  here  but  it  should  have  a  stiff  steel  shank  and  a  firm 
heel  counter. 

PROFESSIONAL  CIRCUMSPECTION. 

The  President's  Address  to  the  Medical  Society  of  the  County  of  Columbia, 
on  its  Centennial  Anniversary,  May  8,  iqo6. 

By  ELLWOOD  OLIVER,  M.  D.. 

Ancrara,  N.  Y. 

A  century  of  medicine  has  passed  and  we  of  to-day  stand,  much 
as  our  fathers  stood,  on  the  threshold  of  the  newer  things  to  come. 
The  dark  empiricism  of  the  past  has  become  the  clearer  empiri- 
cism of  the  present,  and  we  have  been  and  are  developing  and 
broadening  with  mighty  strides  toward  the  great  eternal  truths 

<4 


634 


PROFESSIONAL  CIRCUMSPECTION 


of  life'and  health  and  longevity;  yet  the  goal  of  absolute  knowl- 
edge for  us  is  still  afar  off. 

We  have  accepted  the  therapeutics  of  Hahnemann  and  of 
Beach  and  Scudder  as  equally  rational  and  efficient  with  our  own 
in  combating  disease  and  to-day  the  homeopath  and  the  eclectic 
have  an  equal  rating  with  any  and  every  regular  physician.  In 
fact  it  may  with  truth  be  said  that  the  physician  of  the  old  school, 
the  homeopath  and  the  eclectic  are  all  rapidly  merging  in  one 
common  class,  the  regular  physician  of  to-day,  and,  together,  all 
are  pushing  forward  and  seeking,  with  most  arduous  efforts, 
a  more  positive,  a  more  scientific  and  a  truer  therapeutic  knowl- 
edge. 

With  us  there  is  much  apparent  foundation  for  the  saying  that 
the 4  'medicine  of  to-day  lies  in  the  personality  of  the  man  as  much 
as  in  the  remedies  he  employs;"  for  we  cannot  but  confess  that 
as  yet  we  have  but  few  specifics  for  disease  and  the  great  mass  of 
our  functional  remedies  are  looked  upon  as  of  doubtful  value, 
if  not  often  of  positive  harm  to  the  lasting  integrity  of  the 
economy;  while  we  all  now  realize  that  sunlight,  pure  air, 
cleanliness,  pure  water,  wholesome  food,  a  pleasing,  hopeful  and 
hygienic  environment  and  the  "simple  life"  prove  oftenest  the 
truest  specifics  for  life's  varied  ills.  These  facts  are  but  too 
patent  to  us  all  and  lead  us  to  clearly  perceive  that  the  medicine 
of  the  future  is  yet  to  be  written  and  the  therapeutics  of  to- 
morrow are  but  in  their  formative  stage.  These  things,  however, 
should  not  discourage  us  nor  make  us  halt  or  lose  faith  in  the 
positive  and  abiding  value  of  medicine.  Our  past  glorious  his- 
tory of  mighty  achievement  should  give  us  a  more  forceful  in- 
centive to  hasten  our  future  perfection.  We  fully  believe  and 
feel  that  the  science  of  medicine  alone  is  the  true  guardian  of  the 
physical  well-being  of  the  race,  and  as  such  we  who  claim  its 
fatherhood  should  ever  search  without  ceasing  for  absolute 
truth,  knowing  that  from  a  truer  knowledge  of  disease  we  must 
eventually  evolve  a  truer  therapy. 

To  clear  away  the  debris  and  difficulties  and  make  straight  the 
way  to  this  end  means  for  each  of  us  toil,  sacrifice  and  consum- 
mate wisdom ;  for  we  all  fully  know  that  during  this  process  of 
evolution  we  are  and  will  be  continually  surrounded  by  strange 
beliefs.  New  fanaticisms  are  and  will  ever  be  springing  up  about " 
us,  constantly  antagonizing  us  with  their  spurious  creeds,  oft- 
times  gaining  considerable  foothold  with  mankind;  to  evidence 


ELL  WOOD  OLIVER 


635 


which  I  need  but  mention  the  strenuous  and  almost  successful 
efforts  being  put  forth  by  the  osteopath  to  have  a  legal  rating 
with  us.  We  cannot  but  fully  realize  the  great  danger  such 
recognition  would  work  to  the  progressively  high  standard  we  are 
aiming  at  in  our  profession,  and  we  must  even  now,  more  fully 
than  ever,  awaken  to  the  fact  that  we  are  the  great  educators  of 
mankind  in  the  matters  of  health  and  disease ;  and  that  our  part 
in  the  universal  division  of  labor  has  for  its  primal  object  not 
pecuniary  gain  but  rather  the  mental  and  physical  well-being 
and  material  uplifting  of  humanity.  We  therefore  do  and  must 
stand  as  its  teachers,  and  as  such  the  burden  rests  with  us  to 
demonstrate  and  lay  bare  before  the  great  cosmopolitan  world 
the  truth  and  error,  the  wisdom  and  folly ,  of  osteopathy,  Christian 
science,  faith  healing,  vegetarianism,  cold-water  curists  and  every 
other  cult,  creed,  fad  and  fancy  now  present  or  that  may  here- 
after find  lodgment  in  the  universal  mind.  This  means  to  us 
labor,  hard,  wise  and  unselfish.  We  cannot  dissolve  error  by 
ignoring  it;  neither  will  silent  contempt  or  open,  wholesale  and 
unthinking  ridicule,  condemnation  and  persecution  rid  us  of 
fallacies  and  false  prophets,  but  will  often  prove  the  very  means 
of  spreading  and  supporting  them.  To  sift  the  wheat  from  the 
chaff  and  establish  truth  means  for  us  earnest,  honest  effort,  and 
a  liberal  unbiased  breadth  of  thought.  To  this  end  I  purpose  to 
call  your  attention  to  certain  things  that  you,  with  your  larger 
minds,  may  broaden  and  add  to  the  same  for  our  mutual 
benefit. 

First:  Hidebound,  fossilized  orthodoxy  is  untenable;  for 
with  all  our  knowledge  and  all  our  accepted  truth,  the  great 
comprehensive  mind  of  man  is  after  all  fallible,  and  human  truth 
is  only  relative,  not  absolute.  All  of  us,  from  the  least  to  the 
greatest,  are  but  students  till  we  reach  the  grave;  while  even  the 
wisest  of  us  but  "see  through  a  glass  darkly."  We  should, 
therefore,  discard  fixed  skepticism  and  think  and  reason  always 
with  open,  receptive  minds,  striving  ever  to  keep  abreast  of  the 
modern  progress  of  thought;  proving  all  things  and  holding 
fast  to  that  which  is  good  till  something  better  comes  to  take  its 
place.  We  should  not  hesitate  to  accept  newer  truths  if  their 
demonstration  be  clear,  for  we  know  that  the  accepted  truths  of 
to-day  ofttimes  prove  but  the  errors  of  to-morrow,  because  they 
have  been  established  from  false  premises  or  through  faulty 
reasoning  or  both. 


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PROFESSIONAL  CIRCUMSPECTION 


Second:  We  should  no  longer  hold  medicine  a  mystery,  but 
we  should  take  mankind  into  our  confidence  and  strive  to  educate 
the  masses  along  the  lines  of  truth  as  we  know  it;  freeing  their 
minds  from  deceptions  and  superstitions  and  giving  them  a 
truer  conception  of  our  relations  to  them  in  this  intricate  and 
complex  round  of  life.  We  do  not  hold  the  keys  of  life  and 
death,  and  to  seek  to  maintain  such  position  is  gross  deception. 
To  declare,  for  instance,  to  the  family,  at  the  death-bed  of  a 
patient;  "Had  I  been  called  earlier  he  would  not  have  died," 
is  absurd  and  antagonistic  to  every  concept  of  our  God.  Ex- 
pressions of  this  sort  are  unwise,  for  they  too  often  demonstrate 
their  own  falsity,  and  did  we  but  think  twice  before  we  spoke 
such  errors  would  be  fewer  and  our  worth  more  great.  Again 
we  should  discard  obsolete  terms  and  phrases.  Their  name  is 
legion.  Hereareafew:  "  bad  blood,"  "blood  turned  to  water," 
"milk  leg,"  "bad  kidneys,"  "bad  liver,"  "stomach  out  of  order," 
"kidney  rash,"  "measle  rash,"  "black  measles,"  "typhoid 
pneumonia,"  "typhoid  malaria,"  "threatened  with  a  fever  but 
broke  it  up."  Such  terms  are  often  meaningless,  and  always 
deceiving  and  misleading.  They  savor  only  of  the  darker 
empirical  past,  link  us  to  its  proven  errors  and  leave  us  therefore 
without  excuse  for  using  them.  Still  further  on  this  theme 
I  might  mention  the  important  subject  of  preventive  medicine 
and  the  great  necessity  for  educational  work  along  this  line. 
Someone  has  said  that  "the  medicine  of  to-day  lies  between 
the  surgeon  and  the  health  officer."  With  so  sweeping  a  declara- 
tion we  could  none  of  us  but  take  sharp  issue ;  that  surgery  has 
surpassed  medicine  in  achievement  in  the  last  century  is  an 
acknowledged  truth;  but  that  the  health  officer  has  absorbed 
medicine  is  a  "pipe  dream";  and  yet  we  cannot  gainsay  this 
fact,  that  personal  hygiene,  general  intelligent  sanitation,  rapid 
and  effective  isolation  of  contagious  diseases  and  wise  observ- 
ance and  instruction  in  all  other  things  which  go  to  make  up 
the  sum  total  of  "preventive  medicine"  are  worthy  of  more 
thorough  and  earnest  consideration  than  the  past  has  given 
them.  I  shall  dwell  here  but  a  moment  to  call  your  attention 
to  contagious  diseases.  For  the  year  1905,  New  York  State 
registered  137,234  deaths  from  all  diseases.  Out  of  this  number 
there  were  14,078  deaths  from  tuberculosis,  2,296  from  diph- 
theria, 988  from  measles,  848  from  whooping  cough,  and  729 
from  scarlet  fever.    The  statistics  for  1904  show  practically 


ELL  WOOD  OLIVER 


637 


the  same  conditions.  The  figures  show  all  too  plainly  that 
greater  energy  is  demanded  of  us  in  wrestling  with  the  difficult 
problem  of  the  great,  white  plague  which  is  now  causing  yearly 
more  than  ten  per  cent,  of  all  deaths.  Stronger,  bolder  and 
more  positive  means  should  be  inaugurated  to  eradicate  this 
disease,  which  is  met  with  to-day  in  practically  every  home  in 
the  land.  To  deceive  a  tuberculous  patient  of  his  disease  or 
to  neglect  to  show  him  and  his  family  clearly  the  great  menace 
his  disease  is  to  his  environment  should  be  counted  by  us  to-day 
an  unpardonable  sin.  With  diphtheria,  in  our  present  enlight- 
enment, it  is  a  grave  mistake  for  any  physician  to  hesitate  or 
delay  in  using  Antitoxine;  because:  first,  its  superior  remedial 
efficiency  marks  it  practically  a  true  specific  for  the  disease; 
second,  its  immunizing  power  on  individuals  exposed  to  the 
contagion  is  universally  positive;  and  third,  its  employment 
under  proper  care  is  assuredly  free  from  the  slightest  danger  of 
evil  effects. 

Concerning  measles  and  whooping  cough,  their  death  rates 
are  exceeding  that  of  scarlet  fever,  and  furthermore,  too  often 
both  these  diseases  leave  their  victims  ripe  subjects  for  tuber- 
culous infection;  it  would,  therefore,  seem  but  greatest  wisdom 
to  show  the  masses  the  true  status  and  danger  of  these  diseases 
and  to  practice  with  them  the  same  universal  quarantine  that 
we  now  place  on  diphtheria,  scarletina  and  the  like. 

Third:  With  every  patient  who  comes  under  our  observa- 
tion, we  should,  regardless  of  anything,  always  exercise  delib- 
erate care  and  honest  candor;  for,  in  the  last  analysis,  the 
people  themselves  are  the  great  moulders  of  the  opinions  of  our 
worth  and  necessity;  and  we  hold  our  progressively  high  place 
and  are  able  to  check  and  choke  out  false  creeds  and  charlatans 
according  as  we  prove  ourselves  worthy  of  their  composite 
favorable  opinion,  faith  and  trust. 

Mankind,  in  this  age  of  progressive  intelligence,  demands  of 
us  as  much  of  truth  about  disease  as  we  know,  and  we  are  neglect- 
ing our  duty  when  we  give  less.  Hasty,  careless  examinations 
and  equally  careless,  hasty  diagnostic  guesses  should  never  be 
indulged  in.  The  patient  who  goes  to  several  physicians, 
receives  a  hasty  examination  from  each  and  from  each  a  different 
opinion  of  his  case  will,  from  sheer  necessity,  begin  to  distrust 
us  as  a  mass;  lose  faith  in  the  former  high  ideals  which  he 
entertained  of  us,  and,  in  his  accumulated  mental  unrest,  perhaps 


638 


PROFESSIONAL  CIRCUMSPECTION 


seek  some  other  creed  which  seems  to  him  an  equally  sure  or 
mayhap,  even  surer  way  to  health.  Whereas,  had  each  con- 
sultant sought  the  truth  for  him  with  diligence  and  care  and 
expressed  the  same  to  him  with  unbiased  candor,  he  would  be 
compelled  to  hold  all  honest,  and  his  ultimate  judgment  would 
but  prove  the  true  value  and  standing  of  the  science  of  medicine 
which  has  for  its  great  objects,  the  relief  of  suffering,  the  aiding 
of  nature  in  the  healing  of  diseases,  the  promotion  of  health 
and  well-being  and  the  prolongation  of  life  to  the  individual 
and  therace. 

Fourth:  Within  our  own  body,  self-interest,  misrepresenta- 
tion, sectarian  dissension;  individual  or  collective  antagonism; 
ridicule  or  derision;  unjust,  unnecessary  or  malicious  criticism, 
are  the  height  of  folly.  They  breed  disrespect  among  us;  im- 
part a  dangerous  uncertainty  to  our  knowledge  and  methods; 
destroy  confidence  in  us  as  an  effective  and  necessary  unit ;  lower 
the  standard  of  our  real  value  to  the  world's  general  uplifting  and 
well  being;  and  furnish  a  very  fertile  soil  for  the  growth,  de- 
velopment and  spread  of  every  occult  creed  and  morbid 
belief  that  may  germinate  in  the  versatile  mind  of  man.  If  we 
quarrel  with  ourselves  and  prove  each  other  fool,  pray  tell  me 
how  humanity  will  know  the  truth  of  our  individual  and  col- 
lective worth? 

Selfishness,  egotism,  bigotry,  deceit,  envy  and  jealousy  are  but 
the  baneful  landmarks  of  an  unlearned,  superstitious  past  and 
should  find  no  place  among  us  in  this  progressive  age  of  Christian 
intelligence  and  ethics.  Selfishness  in  its  broadest  sense  is 
probably  the  worst  evil  of  the  human  race,  and  surely  the  worst 
evil  that  can  creep  within  our  profession,  and  therefore  each  of  us 
should  continually  struggle  with  it  till  every  last  atom  shall  be 
destroyed.  We  should  realize  that  the  practice  of  medicine  is  one 
of  the  noblest  labors  of  our  progressive  complex  life.  No  line  of 
human  activity  calls  for  greater  self-sacrifice  or  purer  altruism. 
In  this  great  whirl  of  humanity  we  are  but  instruments  in  divine 
hands  to  show  forth,  clearly,  the  danger  signals  along  the  track 
of  life's  swift  rush,  and  in  the  discharge  of  that  trust,  each,  with 
the  knowledge  he  commands,  labors  in  the  way  which  seems  to 
him  safest  and  best.  Each,  therefore,  if  he  be  honest  and  faithful, 
is  worthy  of  recognition,  respect  and  praise.  Superior  knowledge 
and  superior  merit  alone  should  mark  our  standing  and  should 
be  the  only  means  of  competition  among  us.    He  who  takes  a 


ELL  WOOD  OLIVER 


639 


mean  advantage  of  his  fellows  or  tacitly  listens  to  the  world's 
abuse  of  them  is  not  only  foolish,  but  is  also  most  hurtful  to  the 
whole  body ;  for  whatever  affects  the  individual  must  of  necessity 
be  felt  by  the  whole  organization  of  which  he  is  a  part.  It  would 
advantage  each  of  us  greatly  to  memorize  and  use  as  the  rule  and 
guide  of  our  faith  and  practice  the  code  of  ethics  as  set  forth  by 
the  American  Medical  Association. 

Finally  we  must  never  lose  sight  of  the  dual  nature  of  man. 
It  is  a  sad  and  regrettable  fact  that  the  average  physician,  uncon- 
sciously or  by  inclination  or  otherwise,  quickly  drifts  into  ma- 
terialism and  is  branded  by  the  laity  (sometimes  with  justice) 
as  rough,  cruel,  heartless  and  unsympathetic.  He  comes  to  view 
the  individual  with  whom  he  comes  in  contact  as  a  mere  physical 
structure,  and  loses  sight  of  or  entirely  ignores,  in  his  hard  reason- 
ing, the  fact  that  he  has  a  soul,  an  infinite  spiritual  nature.  The 
physical  life  has  so  absorbed  him  that  he  neither  sees  nor  cares  for 
aught  beyond.  The  five  senses  must  prove  every  concept  he 
will  ever  entertain.  He  thus  loses  faith  in  the  intangible,  the 
higher  eternal  principles,  and  renders  himself  a  dead  weight  to 
the  spiritual  uplifting  of  society.  Lest  we  forget  the  insidious 
presence  and  growth  of  this  attribute  of  our  makeup,  we  should 
give  sharper  heed  to  the  cry  of  humanity  sounded  by  ex-President 
Cleveland  at  the  Centennial  Anniversary  of  the  New  York  State 
Medical  Society:  "Tread  lightly,  gentlemen,  for  you  have  to 
deal  with  temples  of  the  Holy  Ghost." 

As  we  stand  to-day  on  the  threshold  of  future  medicine  you  will 
I  trust,  pardon  my  indulgence,  in  conclusion,  in  this  hopeful, 
inspiring,  prophetic  inquiry:  A  hundred  years  of  medicine  have 
passed  and  to-day  the  man  with  the  knife  is  king.  We  of  the 
companion  craft  stand  as  his  willing  vassals  to  do  his  bidding; 
rejoicing  at  his  smile  and  trembling  at  his  frown.  Yet,  in  the 
light  of  our  present  knowledge  and  progress,  may  it  not  be  possi- 
ble and  probable  that  when  another  hundred  years  of  medicine 
have  rolled  away  the  man  with  the  pill  and  the  personality  and 
the  broader,  clearer,  truer,  and  nobler  concept  of  universal  life, 
will  find  some  way  to  circumvent  the  knife  and  be  himself  by 
truer  right  crowned  king  ? 


640 


MODERN  SCIENTIFIC  MEDICINE 


MODERN  SCIENTIFIC  MEDICINE  AND  ITS  RELATION 
TO  UNION  UNIVERSITY. 

An  Essay  Representing  the  Medical  Department  in  a  Symposium  on  the 
Relation  of  Modern  Education  to  the  Several  Departments  of  Union 
University. 

By  JOSEPH  DAVIS  CRAIG,  A.  M.,  M.  D., 

Professor  of  Anatomy,  Albany  Medical  College. 

Science  in  each  of  its  constituent  divisions  is  advancing  at  the 
beginning  of  the  twentieth  century  with  most  persistent  energy. 
In  none  is  there  more  rapid  evolution  than  in  the  physical  and 
biological  departments  of  exact  knowledge.  Atoms  are  dis- 
solving into  electrons ;  electricity  is  revealing  new  principles, 
useful  in  their  application  to  the  practical  arts;  physics  is  pene- 
trating further  and  further  into  the  depths  of  the  heretofore 
unknown;  scientific  medicine  is  daily  disclosing  some  marvelous 
new  discovery.  Each  member  of  the  scientific  family  is  in  process 
of  rapid  evolution — therefore  no  one  is  to  be  regarded  as  finished 
and  complete.  Medicine  once  a  pretender  in  the  ranks  of  science, 
has  acknowledged  in  these  later  days  its  errors  and  imperfec- 
tions and  now  diligently  seeks  the  truth. 

Like  all  other  sciences  great  epochs  have  marked  the  progress 
of  medicine.  There  were  at  times  years  of  idle  speculation;  at 
times  periods  of  patient  research  and  then  the  light  of  discovery. 
The  passing  centuries  have  had  Harvey  the  physiologist  and 
Vesalius  the  anatomist;  Bichat  the  histologist  and  Galen  the 
therapeutist.  How  few  during  all  the  preceding  centuries  have 
been  the  workers  in  the  barren  fields  of  scientific  ignorance. 
Then  came  Hunter  a  little  more  than  a  hundred  years  ago.  There 
can  be  no  question  but  that  John  Hunter  was  a  scientific  medical 
genius,  unquestionably  great.  Numerous  and  momentous  as  were 
his  contributions  to  the  aggregation  of  ascertained  facts  it  was 
not  the  discoveries  of  Hunter  that  entitle  him  pre-eminently  to 
the  profound  veneration  of  all  subsequent  medical  investigators. 
It  was  his  intellectual  appreciation  of  the  absolute  essential  of 
successful  exploration  of  the  unknown  and  his  inherent  power 
to  impress  his  contemporaries  and  their  successors  with  the  para- 
mount importance  of  his  scientific  conclusions.  He  subjected  to 
experiment  all  things  and  held  opinion  as  valueless  until  proved 


JOSEPH  DAVIS  CRAIG 


641 


by  inductive  reasoning.  It  was  his  inductive  method  of  research 
that  yielded  him  so  large  a  measure  of  personal  success  in  the 
elucidation  of  new  scientific  problems.  He  taught  the  necessity 
of  the  method  to  his  contemporaries  and  to  his  pupils  in  his,  the 
first,  English  medical  school.  Abernethy  and  the  great  Syden- 
ham, Hunter's  pupils,  recognized  the  intrinsic  value  of  the  logical 
principle,  applied  it  in  the  interpretation  of  the  medical  prob- 
lems of  their  day  and  in  consequence  won  enduring  fame.  Jenner, 
another  pupil  of  Hunter  and  of  them  all  best  known  to  the 
world,  confirmed  his  own  discoveries  by  the  same  means  and 
eventually  enunciated  the  principle  of  protective  vaccination. 
It  is  to  this  "  Hunterian  Method  "  of  reasoning  and  research, 
which  is  the  basis  of  all  enduring  medical  investigation  in  our 
day,  that  modern  medical  science  rests  on  so  secure  a  founda- 
tion. The  importance  of  the  inductive  method  of  research  to 
medical  science  can  not  be  set  forth  too  forcibly.  Its  tremen- 
dous significance  first  securely  grasped  by  Hunter  has  since  his 
day  continuously  appealed  to  all  serious  laboratory  investi- 
gators and  at  the  period  of  its  introduction  modern  scientific 
medicine  may  be  declared  to  have  had  its  birth. 

Rapid  progress  has  marked  the  history  of  medical  science 
since  Hunter's  day.  Innumerable  wopkers  have  contributed  the 
result  of  their  labor  as  opportunity  offered.  To  the  generation 
which  has  just  ceased  from  labor  the  medical  world  owes  the 
epoch-making  discoveries  of  two  earnest  workers  whose  names 
have  passed  into  history  as  those  of  men  pre-eminently  powerful 
in  thought  arid  fertile  in  productive  power.  Their  names  are 
prominently  called  to  mind  in  this  connection  for  the  reason  that 
medical  science  as  it  is  known  to-day  is  builded  by  the  method  of 
Hunter  upon  the  result  of  their  efforts.  The  one  is  Virchow,  who 
gave  the  scientific  world  the  doctrine  of  cellular  integrity  and 
who  demonstrated  that  every  living  cell  of  the  human  body 
comes  from  a  pre-existing  living  cell.  The  other  is  Pasteur, 
whose  years  of  diligent  research  were  finally  rewarded  by  the 
discovery  of  the  causes  of  fermentation  and  the  bacteriological 
genesis  of  infectious  disease. 

Without  detracting  from  the  labors  of  innumerable  other 
workers  whose  contributions  to  medical  progress  have  been  of 
inestimable  value,  these  three  pre-eminent  investigators  of  the 
last  century  have  been  particularly  selected  for  comment  for 


642 


MODERN  SCIENTIFIC  MEDICINE 


the  reason  that  the  whole  system  of  scientific  investigation  in 
recent  years  depends  upon  the  principles  first  enunciated  by  them. 
Their  work  can  be  considered  the  essential  architectural  elements 
in  the  modern  medical  edifice.  ,Without  them  the  whole  system 
falls  into  ruin. 

The  generation  of  men  now  drawing  to  a  close  owe  most  of 
medical  progress  to  Hunter,  to  Virchow  and  Pasteur.  The  mod- 
ern medical  scholar  builds  upon  the  sure  foundation  laid  by  this 
triumvirate.  The  influence  of  these  men  has  been  predominant 
in  shaping  the  course  of  every  present-day  medical  investigator. 
Multitudinous  and  devoted  have  been  the  workers  and  so  numer- 
ous the  contributions  of  abundantly  attested  facts  that  there  has 
resulted  a  vast  and  marvelous  accumulation  of  detailed  informa- 
tion. There  has  in  consequence  developed  an  evolutionary  period 
of  new  ideas  as  to  method  and  means  of  instruction,  a  necessity 
for  the  regrouping  and  reclassification  of  knowledge  and  a  revo- 
lution in  the  art  of  medicine.  The  salient  tendencies  during  the 
last  decade  along  these  lines  may  be  thus  grouped  for  considera- 
tion: the  multiplication  and  growth  of  specialties  in  the  practice 
of  the  art;  clinical  in  contradistinction  to  didatic  teaching  in 
institutions  of  medical  learning;  laboratory  elementary  instruc- 
tion and  advanced  research ;  pathological  specialization ;  institu- 
tional development  and  elaboration  of  medical  and  surgical 
technique. 

The  possibility  of  the  development  of  the  human  mind  is  cir- 
cumscribed by  individual  limitations  and  by  the  general  restric- 
tion of  mental  capacity.  The  necessity  for  a  division  of  mental 
labor  is  imperative  in  recognition  of  these  limiting  qualities.  The 
more  extensive  the  knowledge  to  be  acquired  the  more  minute 
the  divisions  of  labor  must  be.  It  seems  commonplace  to  say 
that  the  primary  groupings  of  human  endeavor  pertaining  to  the 
several  professions,  the  mechanical  arts  and  the  manifold  sciences 
are  due  to  the  necessary  mental  restrictions  imposed  upon  the 
individual.  Not  so  many  years  ago  a  single  individual  could 
acquire  all  the  known  facts  of  medical  knowledge.  It  is  quite 
different  to-day.  So  tremendous  has  the  volume  of  medical 
information  grown  that  division  and  even  subdivision  of  the 
constituent  parts  of  the  human  body  is  now  essential  to  the 
acquisition  of  all  knowledge  in  each  of  the  several  groups.  This 
is  specialization  of  knowledge  and  specialists  are  a  growing  neces- 


JOSEPH  DAVIS  CRAIG 


643 


sky  in  medicine.  Not  -only  the  science  but  the  art  of  medicine 
justifies  their  existence  and  further  progress  will  undoubtedly 
augment  the  number  of  specialized  groups. 

To  train  every  physical  sense  of  the  aspiring  candidate  for  a 
medical  license  to  the  fullest  degree  is  the  end  sought  in  modern 
medical  education.  To  accomplish  this  has  necessitated  the 
rearrangement  and  readjustment  of  methods  of  teaching.  Not 
to  tell  a  student  but  to  have  him  develop  his  senses  in  finding 
out,  has  become  the  desideratum  of  professors  in  medical  schools. 
To  show  and  to  prove  as  much  of  the  science  as  opportunity 
offers  and  to  tell  the  remainder  has  resulted  in  bringing  the  stu- 
dent to  the  bedside  of  the  sick.  In  all  the  applied  branches  of 
the  healing  art  the  tendency  has  been  away  from  the  college 
lecture  room  to  the  wards  of  the  hospital.  The  recital  ol  dreary 
facts  has  made  way  for  the  vitalizing  results  of  demonstration. 
The  consequence  has  been  an  enlarged  sphere  of  usefulness  for 
men  trained  thereby. 

That  which  the  hospital  teaching  has  done  for  the  practical 
branches  of  medical  science,  the  laboratory  has  accomplished  for 
the  preliminary  subjects  of  instruction  in  medical  colleges.  The 
method  of  procedure  is  the  same  in  each.  To  show  the  object, 
to  develop  the  powers  of  observation,  to  tell  only  the  otherwise 
unknowable,  applies  to  the  one  as  to  the  other.  Chemistry  has 
for  years  supplemented  the  series  of  didactic  lectures  with  labora- 
tory experiences.  Anatomy  has  from  almost  the  beginning  fol- 
lowed the  same  plan,  only  in  the  process  of  evolution  former  hap- 
hazard ventures  in  the  dissecting  room  have  grown  into  a  system- 
atized sequence  of  instruction  in  the  anatomatical  laboratory. 
The  study  of  physiology  has  more  recently  been  vitalized  by  the 
introduction  of  practical  courses  in  experimental  physiology  and 
physiological  chemistry.  So  thoroughly  recognized  has  become 
the  benefits  of  laboratory  investigation  that  opportunity  for  it  is 
being  extended  beyond  simply  undergraduate  instruction.  The 
laboratory  door  under  favoring  conditions  is  being  opened  to 
trained  original  workers  with  the  result  that  the  boundaries  of 
the  unknown  are  growing  more  and  more  circumscribed  to  the 
enduring  benefit  of  the  human  race.  More  noteworthy  even  than 
this  postgraduate  opportunity,  is  the  fact  that  the  laboratory  is 
outgrowing  the  boundaries  of  the  college  and  university.  Inde- 
pendent institutions  specialized  for  expert  research  have  recently 


644  MODERN  SCIENTIFIC  MEDICINE 

marked  the  progress  of  medicine.  The  wide  sphere  of  usefulness 
of  endowed  organizations  of  the  class  of  the  Rockefeller  Insti- 
tution, gladdens  the  heart  of  every  lover  of  his  kind. 

The  clinician  or  hospital  investigator,  like  every  other  scientist, 
has  his  work  circumscribed  by  the  limitations  of  time  and  mental 
quality.  He  must  depend  therefore  upon  the  co-operation  of 
others  for  a  part  of  that  ample  degree  of  knowledge  which  shall 
enable  him  to  offer  the  fullest  measure  of  relief  to  the  disabled 
human  beings  in  his  care.  There  has  thus  developed  another 
variety  of  specialist,  another  kind  of  laboratory  worker,  whose 
field  of  experimentation  is  among  the  elements  of  disease.  These, 
the  pathologists,  are  the  most  recent  of  all  medical  specialists 
and  by  no  means  the  least  important.  Teaching  the  student  the 
methods  of  examination  of  the  blood,  the  sputum,  the  waste 
products  of  the  body,  the  malignant  growths  and  the  bacteria, 
they  go  further  and  become  one  of  the  most  valuable  aids  to  the 
bedside  examiner  in  the  determination  of  the  causes  of  disease. 
Pathologists  have  played  a  conspicuous  part  in  the  development 
of  medical  science  during  the  last  decade.  Working  also  inde- 
pendently of  the  hospitals  and  schools  they  have  given  the  world 
knowledge  of  some  brilliant  discoveries.  Viewed  from  the  stand- 
point of  life-saving  properties  their  most  conspicuous  contribu- 
tion has  been  the  discovery  of  antitoxin.  The  discovery  by  them 
of  the  agglutinating  power  of  blood  serums  emphatically  mani- 
fests the  depths  of  their  research.  No  specialty  has  contributed 
more  to  the  advance  of  medicine  than  pathology  and  none  exists 
for  which  there  is  greater  justification. 

It  follows  of  necessity  that  if  the  student,  in  the  broad  sense 
of  that  term,  is  to  learn  at  the  bedside  of  the  hospital  patient,  if 
the  college  is  to  give  adequate  laboratory  instruction  and  if  the 
causes  of  disease  must  be  sought  by  special  methods,  that  the 
hospital,  the  college  and  the  pathological  buildings  must  develop 
and  keep  pace  with  the  demands  of  the  time.  The  institutional 
development  of  the  hospital  to  primarily  provide  the  latest  means 
for  the  differentiation  and  treatment  of  disease  and  to  secondarily 
furnish  adequate  instruction  to  medical  men;  of  the  college  to 
respond  to  the  ever-increasing  demand  for  practical  laboratory 
experience  and  of  the  pathological  institution  to  inquire  into  the 
causes  of  disease,  have  been  among  the  conspicuous  tendencies 
of  modern  medical  progress. 


JOSEI-H  DAVIS  CRAIG 


64S 


The  last  of  the  series  of  striking  modern  advances  in  medicine 
to  claim  attention  in  this  essay  is  the  improvement  in  medical  and 
surgical  technique.  Technique  is  a  new  word  in  the  literature 
of  medicine.  It  is  however  a  most  significant  ©ne.  In  so  far  as 
it  implies  approximate  perfection  and  unusual  skill  in  the  art,  it 
is  not  misapplied.  Accuracy  and  thoroughness  of  thought  and 
action  both  in  the  differentiation  of  diseases  and  the  application 
of  remedial  measures  demand  the  closest  attention  to  detail.  The 
modern  doctor  of  medicine  considers  worthy  of  attention  all 
agencies  of  whatever  character  which  point  the  way  to  a  success- 
ful termination  of  disease.  The  educated  senses  of  touch  and 
sight  and  hearing,  the  stethoscope,  the  sphygmograph,  the  re- 
flexes, the  signs,  the  surgical  cleanliness,  the  sequence  of  events 
in  surgical  operations,  the  purity  of  agents,  the  tactile  skill  be- 
gotten of  experience,  contribute  to  that  manifest  essential  of 
success  in  the  modern  practice  of  the  healing  art — medical  and 
surgical  technique. 

In  conclusion  the  inquiry  is  naturally  made  as  to  what  the 
teaching  colleges  are  doing  to  keep  pace  with  all  the  exacting 
tendencies  in  modern  medicine.  Our  concern  at  this  time  is  with 
the  medical  department  of  Union  University.  With  no  impair- 
ment of  her  usefulness  the  Albany  Medical  College  has  met  every 
requirement  of  a  progressive  age.  Enterprise,  energy,  sacrifice, 
have  made  the  name  enviable  among  medical  institutions  and 
high  scholarship  an  honor  to  the  university.  Among  the  fifty 
instructors  connected  with  the  medical  department  are  found  able 
representatives  of  all  the  medical  specialties,  the  leading  surgeons, 
physicians  and  professors  of  special  subjects  in  the  locality  of  the 
college.  In  clinical  teaching  a  wise,  progressive,  thorough  sys- 
tem has  been  evolved.  Available  for  clinical  purposes  is  the 
recently  erected  Albany  Hospital,  a  model  of  hospital  construc- 
tion and  teaching  administration.  St.  Peter's  and  the  Child's 
Hospitals  are  also  suitably  arranged  for  the  purpose  of  instruc- 
tion, and  are  so  used.  In  laboratories,  the  college  has  well 
equipped  departments  in  chemistry,  anatomy  and  physiology. 
The  laboratory  of  physiological  chemistry-,  recently  opened,  is 
new  and  a  model  in  every  way.  In  pathology  the  college  is 
especially  fortunate  in  being  able  to  work  in  harmony  with 
Bender  Hygienic  Laboratory.    There  is  no  better  furnished  insti- 


646 


EDITORIAL 


tution  of  its  kind  to  do  the  work  which  comes  within  the  sphere 
of  its  usefulness. 

The  Albany  Medical  College  has  had  an  enviable  history  since 
its  birth  in  1838.  Great  names  have  been  found  associated  with 
its  teaching  functions.  Its  aspirations  have  been  for  the  best,  its 
achievements  commendable,  scholarly  and  honorable.  The  past 
is  an  inspiration  for  present  and  future  exertion  to  accomplish 
excellent  results.  For  its  present  meritorious  reputation  there 
is  abundant  cause  for  congratulation.  For  adequate  and  fitting 
compensation  for  honorable  endeavor  no  other  reward  is  expected 
or  desired  beyond  the  consciousness  of  unselfish  contributions  to 
the  sublime  cause  of  human  progress. 


EMtorlal 

The  first  stimulus  to  an  inquiry  into  the  human  frame 
arose,  naturally,  in  medicine.  As  it  was  usually  prac- 
ticed by  the  priests  in  the  older  civilizations,  we  may 
assume  that  these  highest  representatives  of  the  educa- 
tion of  the  time  had  already  acquired  a  certain  amount 
of  anatomical  knowledge  two  thousand  years  before 
Christ,  or  even  earlier.  We  do  not,  however,  find 
more  exact  observations  founded  on  the  dissection 
of  mammals,  and  applied,  by  analogy  to  the  human 
frame,  until  we  come  to  the  Greek  scientists  of  the 
sixth  and  fifth  centuries  before  Christ — Empedocles 
(of  Agrigentum)  and  Democritus  (of  Abdera),  and 
especially  the  most  famous  physician  of  antiquity, 
Hippocrates  (of  Cos).  It  was  from  these  and  other 
sources  that  the  great  Aristotle,  the  renowned  "  father 
of  natural  history,"  equally  comprehensive  as  investi- 
gator and  philosopher,  derived  his  first  knowledge. 
After  him  only  one  anatomist  of  any  consequence  is 
found  in  antiquity,  the  Greek  physician  Claudius 
Galenus  (of  Pergamus),  who  developed  a  wealthy 
practice  in  Rome  in  the  second  century  after  Christ, 
under  the  Emperor  Marcus  Aurelius.  All  these 
ancient  anatomists  acquired  their  knowledge,  as  a 
rule,  not  by  the  dissection  of  the  human  body  itself — 
which  was  then  sternly  forbidden — but  by  a  study  of 
the  bodies  of  the  animals  which  most  closely  resembled 
man,  especially  the  apes;  they  were  all,  indeed,  com- 
parative anatomists. 

The  Riddle  of  the  Universe  Ernst  Hakckbl. 


EDITORIAL 


647 


To  the  passion  for  exactness  in  medical  prac- 
The  Antiquity    **cc»  ^rec^  °*  t^le  desire  to  rescue  the  science 

of  Medicine  from  the  doubt  of  centuries,  must  be  attributed 
the  current  passion  for  medical  history.  It 
is  well  appreciated  that  thorough  knowledge  can  only  come 
with  an  understanding  from  its  beginning  of  any  fact,  and 
great  energy  is  now  displayed  in  tracing  the  incidents  and 
beliefs  of  medicine  to  their  source.  The  student  who  under- 
takes this  line  of  investigation  is  surprised  at  the  wealth  of 
information  opened  to  his  grasp,  and  his  wonder  grows  as 
the  intimate  relation  of  medical  thought  with  human  life  is 
revealed  in  the  dim  mists  of  antiquity.  That  this  most  agree- 
able means  of  diversion  has  taken  a  firm  hold  upon  the  pro- 
fession is  revealed  in  the  rapid  increase  of  historical  litera- 
ture. In  this  country  the  publication  of  a  special  journal  of 
elaborate  and  ornate  form,  the  Medical  Library  and  Historical 
Journal,  has  been  undertaken,  and  this  in  three  years  of 
existence,  has  had  ready  acceptance  and  encouragement. 

Modern  medical  knowledge  is  too  generally  regarded  as  of 
recent  growth.  The  various  branches  of  medical  investiga- 
tion are  rarely  traced  to  an  origin  of  more  than  a  century 
ago.  But  it  has  been  found  that  the  ancients  possessed  cer- 
tain analogous  information,  which  makes  comparison  of  the 
two  civilizations  inevitable. 

Now  comes  the  voice  of  Egypt,  and  back  we  go,  not  hun- 
dreds, but  thousands  of  years,  to  a  period  of  grandeur  and 
culture,  not  unreasonably  regarded  as  even  greater  than  our 
own.  It  appears  that  the  work  of  a  physician  was  mentioned 
as  far  back  as  the  Fifth  Dynasty,  not  less  than  three  thousand 
years  before  Christ,  and  in  the  Ebers  Papyrus  (about  1550 
b.  c.)  are  many  interesting  discussions  of  the  methods  of 
healing. 

An  anonymous  writer  in  The  Sphinx,  a  periodical  published 
at  Cairo,  for  a  copy  of  which  the  Annals  is  indebted  to  Dr. 
Cyrus  S.  Merrill,  reviews  this  interesting  topic,  and  cites  some 
of  the  facts  of  the  "Land  of  Prehistory,"  which  seem  "to  show 
that  in  medical  Art  and  Science  Egypt  was,  in  the  very  earliest 
times,  a  leader  and  a  guide."  And  he  carries  his  investigations 
still  further  along  the  evolutionary  line  by  citing  Pliny's 
description  of  the  medical  practice  of  animals,  as  that  "  The 
Hippopotamus  finding  himself  plethoric  goes  out  on  the  banks 
of  the  Nile  and  there  searches  out  for  a  sharp  pointed  reed 


648 


EDITORIAL 


which  he  runs  into  a  vein  in  his  leg,  and  having  thus  got  rid  of  a 
sufficient  quantity  of  blood  closes  the  wound  with  clay." 
Furthermore,  this  writer  recalls  that  "  The  use  of  emetics  is 
said  to  have  been  learnt  from  the  dog,  of  hellebore  from  the 
goat,  and  Aristotle,  among  other  writers,  says  that  stags  healed 
their  wounds  by  the  use  of  Dittany.  And  there  are  evidences 
of  a  more  scientific  practice  of  medicine  in  prehistoric  times, 
for  among  the  ruins  of  the  Swiss  Lake  Dwellings  we  find 
cakes  made  of  poppy  seeds,  showing  that  opium  was  known 
and  used  as  a  drug  by  those  who  dwelt  there,  and  it  is  now 
generally  known  that  the  operation  of  trephining  was  fre- 
quently performed  in  the  stone  age,  sometimes  for  the  cure 
of  disease,  sometimes  doubtless  as  a  religious  rite  rendering 
those  who  underwent  it  proof  against  evil  spirits,  sometimes, 
too,  to  allow  the  spirit  to  escape  from  the  body. 

"  The  first  practitioners  of  scientific  medicine,  and  especially 
those  in  Egypt,  were  Priests,  and  even  Egyptian  Kings  ap- 
proved of  the  examination  of  the  Dead.  A  College  of  Physi- 
cians was  in  existence  in  Egypt  in  the  eleventh  century  before 
Christ,  its  members  were  paid  by  the  public  and  the  nature 
and  extent  of  their  practice  was  regulated  by  law.  They 
belonged  to  the  sacerdotal  caste  and  women  were  allowed  to 
practice.  As  state  servants  they  treated  the  poor  gratuit- 
ously but  saw  them  only  in  consultation  in  their  rooms.  They 
were  allowed  to  take  fees  from  the  rich  whom  they  attended. 
Medical  science  had  attained  so  high  a  development  in  those 
days  that  its  art  was  specialised  and  physicians  were  allowed 
to  practice  only  their  own  branch  of  medicine. 

"  Material  is  still  extant  on  which  to  build  in  Egypt  and  in 
India  a  system  of  medicine  existing  thousands  of  years  ago. 
Prescriptions  have  been  handed  down  to  us  as  they  were  used 
for  diseases  of  the  eyes  and  for  bloody  flux.  The  mention  of 
hospitals  is  rare  in  ancient  records  and  it  is  difficult  to  say 
what  place  they  occupied  in  remote  ages.  We  must  hesitate 
to  accept  the  statement  of  Pinel  that  asylums  existed  in  the 
temples  of  Saturn,  but  it  seems  clear  that  there  were  medical 
schools  in  connection  with  temples  from  the  dawn  of  civilisa- 
tion, that  Priests  were  the  depositaries  of  medical  knowledge, 
and  that  the  sick  and  infirm  went  for  advice  to  the  temples  or 
slept  beneath  some  healing  shrine.  The  Ebers  Papyrus,  com- 
posed about  1 550-1 547  B.C.,  more  complete  in  its  information 


EDITORIAL 


649 


than  any  other,  says  that  the  ancient  Greeks  as  well  as  the 
Egyptians  were  in  the  habit  of  laying  their  sick  in  the  temples. 
This  in  Egypt  was  done  especially  in  the  temples  of  Serapis, 
in  the  renowned  Serapeum  of  Canopus  near  Alexandria,  and 
at  Memphis.  It  records  that  when  Alexander  was  sick  several 
of  his  friends  slept  in  the  Serapeum  at  Alexandria  that  they 
might  learn  from  the  Deity  whether  to  take  him  to  the  temple 
or  not — and  the  voice  of  the  God  said  No.  Ancient  inscrip- 
tions and  Papyri  are  almost  silent  on  the  subject,  but  there 
seems  little  doubt  that  there  was  at  least  a  clinique  at  Heli- 
opolis  situated,  the  Ebers  Papyrus  says,  in  a  building  called 
'  The  Great  Hall  of  Heliopolis,'  and  it  is  known  that  there  was 
also  a  medical  faculty  at  Sais.  Seth  and  Horus,  brothers  who 
wounded  each  other  in  battle,  were  taken  to  Heliopolis  and 
Isis  was  the  healing  Goddess  in  their  restoration.  The  chief 
Priest,  called  Urme,  was  probably  the  head  of  the  faculty,  and 
one  of  them,  named  Chey,  (Papyrus  Ebers)  was  owner  of  a 
renowned  eye  ointment.  The  chief  Priest  of  Sais  called 
Ursuanen,  the  great  or  head  doctor,  was  President  of  the 
Medical  Faculty.  Schools  were  connected  with  most  temples, 
and  cliniques  which  probably  passed  over  to  the  Arabs  who, 
like  the  Egyptians,  erected  schools  and  hospitals  in  connection 
with  the  mosques,  with  many.  Ancient  Egyptian  shrines, 
which  were  certainly  seats  of  medical  knowledge  where  the 
sick  went  for  advice,  and  which  appear  to  have  served  as  hos- 
pitals have  been  excavated.  The  great  temple  of  Dendara 
contains  a  series  of  rooms  which  have  been  examined.  Over 
one  door  stands  the  word  '  Laboratory,'  over  another  '  Birth 
House,'  and  it  is  hard  to  say  whether  this  means  that  a  lying-in 
institution  existed  there  some  fifteen  centuries  before  Christ  or 
not.  The  temples  of  Memphis  and  Thebes  sheltered  the  sick 
and  in  the  temples  books  of  Hermes,  works  on  medicine,  were 
stored.  Before  medical  art  existed  in  Babylon  and  Egypt  the 
sick  were  laid  in  the  path  of  passers-by  to  get  the  benefit  of 
their  experience,  and,  in  the  first  named  place,  there  was  a  law 
making  this  help  compulsory.  This  practice  spread  from  East 
to  West  and  it  may  have  been  known  among  the  Jews — cer- 
tain incidents  told  in  the  life  of  Christ  undoubtedly  lend  color 
to  the  belief  that  it  was. 

"Alexandria  was,  in  very  early  times  an  important  medical 
center.    When  Alexander  the  Great's  dominions  were  divided 

6 


EDITORIAL 


Egypt  passed  into  the  hands  of  the  Ptolemies.  They  per- 
petuated existing  institutions  in  Thebes,  Memphis  and  Heli- 
opolis,  and  founded  the  Gymnasium,  Serapeum,  Museum  and 
Libraries  at  Alexandria,  to  the  latter  of  which  an  outpatient 
room  was  attached.  Physicians  trained  there  had  a  high 
reputation  and  their  services  were  valued  in  countries  far  out- 
side Egypt. 

"Among  the  tombs  clustering  round  the  Pyramid  of  Sak- 
karah  there  stands  one,  small  and  unpretending,  but  having 
still  a  beautiful  and  very  perfect  inscription,  which  shows  it 
to  be  the  burial  place  of  Sekhet'enanch,  chief  Physician  to 
Pharaoh  Sahura  of  the  fifth  dynasty.  It  describes  how  the 
Physician  had  healed  the  King's  '  Nostrils  '  and  '  wishes  him 
long  life  in  Holiness.'  '  Then  the  chief  Physician  spoke  before 
Pharaoh : '  '  May  it  please  thy  soul  beloved  of  Ra,  that  there 
be  given  me  a  limestone  slab  like  a  door  for  this  my  tomb  in 
the  west-land.'  1  Then  the  King  commanded  and  they  brought 
him  two  stone  slabs  like  a  double  door  from  the  quarry  Ro'an, 
and  they  were  set  up  in  the  court  of  his  Palace,  Chaurert- 
Sahura.  The  chief  taskmaster  made  the  temple  mason  in- 
scribe them  as  for  the  King  himself.  The  Court  visited  them 
daily.  His  Majesty  ordered  the  inscription  to  be  done  over 
with  blue  stone.'  This  is  apparently  the  first  mention  of  a 
Physician  in  history,  for  the  fifth  dynasty  is  not  of  a  later  date 
than  3000  b.c.  and  thus  the  interval  between  Sekhet'enanch 
and  Hippocrates  is  not  less  than  the  period  that  has  elapsed 
between  the  1  Father  of  Zsledicine  '  and  our  own  times. 

"An  interesting  relic  of  Egyptian  medicine  is  the  Family 
Medicine  Chest  of  Pharaoh  Mentu-Hotep  of  the  eleventh 
dynasty,  about  2500  b.c.  It  contains  six  vases,  one  of  ala- 
baster and  five  of  serpentine  with  dried  remnants  of  drugs, 
two  spoons,  a  piece  of  linen  cloth,  and  some  roots  enclosed  in 
a  basket  of  straw  work,  the  whole  contained  in  a  wooden  chest 
found  in  the  Queen's  tomb  and  now  in  the  Berlin  Museum. 

"  One  of  the  chief  authorities  on  this  interesting  subject  is 
the  Ebers  Papyrus  already  referred  to,  which  its  discoverer 
claims  to  be  not  merely  the  first  known  medical  document  but 
the  oldest  complete  book  in  existence.  It  was  written  about 
1550  b.c,  sometime  before  the  Exodus,  and  on  it  are  marginal 
notes  of  its  owner  recording  his  approval  of  many  of  the  pre- 
scriptions it  contains.    But  it  is  not  only  a  collection  of  pre- 


EDITORIAL 


651 


scriptions,  it  contains  dissertations  on  anatomy  and  diagnosis, 
the  most  important  of  which  is  a  treatise  on  the  heart  written 
by  Ebsect.  Clement  of  Alexandria  says  that  the  knowledge 
of  the  Egyptians  was  contained  in  forty-two  sacred  books 
attributed  to  the  God  Hermes-Thoth,  of  which  the  last  six 
were  medical,  dealing  with  anatomy,  diseases,  instruments, 
drugs,  affections  of  the  eye  and  diseases  of  women,  and  Ebers 
is  of  opinion  that  his  Papyrus  is  really  the  '  Hermetic  '  book, 
on  drugs,  but  there  is  intrinsic  evidence  in  the  nature  of  the 
Papyrus  itself  to  favor  the  idea  that  it  is  rather  a  compila- 
tion than  a  sacred  book.  There  are  other  Medical  Papyri, 
though  perhaps  none  of  so  much  importance  as  this  of  Ebers. 
The  chief  among  them  is  the  papyrus  of  Berlin  of  the  four- 
teenth century  B.C.  It  was  discovered  rolled  up  in  a  case 
under  the  feet  of  Anubis,  in  a  town  called  Sechem.  It  con- 
tains numerous  prescriptions,  many  of  them  enemata,  a  form 
of  medicine  generally  believed  to  have  been  first  used  by  the 
Egyptians.  The  writers  on  Egyptian  medicine  numbered 
among  them  one  Royal  Author,  Nachepsus  of  Sais,  Grand- 
father of  the  Pharaoh  of  the  Bible.  He  is  credited  with  the 
discovery  of  the  medicinal  virtues  of  1  Green  Jasper,'  a  stone 
which,  when  engraved  with  a  '  dragon  of  rays  '  and  hung 
around  the  neck,  was  supposed  to  be  a  certain  remedy  for 
diseases  of  digestion.  Some  fine  specimens  of  these  charms 
are  to  be  found  among  the  Gnostic  gems  of  the  British 
Museum,  and  the  Greek  inscriptions  call  the  dragon  '  Chnou- 
mis  '  the  '  Destroyer  of  Demons/  So  medicine  flourished  in 
the  very  early  days  of  Egyptian  history.  More  than  one  thou- 
sand years  before  Hippocrates  this  wonderful  people  had  a 
knowledge  of  anatomy  and  physiology  equal  to  that  of  the 
'Father  of  Medicine'  himself,  and  they  possessed  a  varied  'Ma- 
teria Medica'  containing  both  vegetable  and  mineral  remedies. 
But  there  came  to  them  a  period  of  stagnation  in  which  no 
progress  was  made  and  in  the  sixth  century  B.C.,  Egyptian 
physicians  having  failed  to  reduce  a  dislocation  of  the  foot  of 
King  Darius,  which  was  eventually  successfully  treated  by 
Greeks,  narrowly  escaped  with  their  lives." 

The  anonymous  writer  who  has  given  this  most  interesting 
synopsis  of  almost  geological  periods  very  properly  infers  and 
concludes  that  "  There  is  nothing  new  under  the  sun."  - 


652 


LITTLE  BIOGRAPHIES 


The  death  of  Dr.  Webster  recalls  Union 
Harrison  E.      College  as  it  was  a  generation  ago.    Then  in 
Webster        his  prime,  Dr.  Webster  exerted  a  strong  per- 
sonal influence  over  the  students  of  both  the 
academic  and  medical  departments.    Later,  as  president  of 
the  University,  he  carried  the  magnetism  of  his  method  of 
thought  and  of  his  friendship  into  his  administration,  which 
was  unfortunately  broken  by  his  loss  of  health.    There  are 
many  physicians  who  sat  under  him  when  a  lecturer  in  the 
Albany  Medical  College  to  recall  with  affection  their  associa- 
tion with  him.    This  appreciation  of  Dr.  Wrebster's  character,  so 
tenderly  expressed  in  the  Union  University  Quarterly,  is  repro- 
duced in  this  issue  of  the  Annals  as  a  slight  token  of  the 
esteem  in  which  he  was  held  by  his  colleagues  and  pupils  in 
this  department  of  the  University. 


Xtttle  ^toatapbtes 

IX.  ANDREAS  VESALIUS. 

ANDREAS  VESALIUS,  father  of  descriptive  anatomy, 
was  born  at  Brussels,  the  last  day  of  the  year,  1514. 
His  was  the  fourth  generation  of  influential  physi- 
cians to  be  intimately  connected  with  the  continental 
courts.  His  father  held  the  position  of  apothecary  to  the  Emperor 
Maximilian,  Charles  V.  At  a  somewhat  early  age  the  precocious 
youth  entered  the  University  of  Louvain,  electing  a  course  in 
philosophy,  the  study  of  which  merely  served  to  whet  his  eager 
appetite  for  the  science  of  his  life.  Turning  to  medicine  he 
studied  at  Montpellier  and  at  Paris ;  at  the  latter  university  the 
celebrated  Tagault  interested  himself  in  the  brilliant  young  pupil 
and  secured  for  him  as  tutor,  Sylvius,  at  that  time  professor  of 
anatomy  in  the  institution.  The  relation  between  tutor  and 
scholar  becoming  somewhat  strained  on  account  of  the  intense 
jealousy  aroused  in  Sylvius  by  the  rapid  advance  of  his  pupil, 
Vesalius  receiving  his  degree  returned  to  Louvain.  His  fame 
as  anatomist  was  in  the  ascendant.  He  was  loved,  admired  but 
feared  since  in  his  zeal  to  secure  material  for  his  profession,  he 
was  detected  stealing  the  remains  of  a  malefactor  hanging  on 
the  gibbet  just  outside  the  town. 


LITTLE  BIOGRAPHIES 


653 


From  Louvain  he  traveled  to  Italy,  serving  as  army  surgeon 
and  taking  active  part  in  the  campaigns  in  the  low  countries  and 
in  France.  Finally,  at  the  call  from  the  faculty  of  the  celebrated 
University  of  Padua,  he  accepted  the  professorship  of  physics 
and  settled  there  in  his  twenty-fourth  year — 1538.  It  was  at 
Padua,  that  the  brilliant  anatomist  collected  the  material  which 
led  finally  to  his  magnum  opus — de  hutnani  corporis  fabrica — 
appearing  in  1543.  The  work  was  printed  at  Basle  by  John 
Oporinus.  The  plates,  approaching  which  nothing  had  been  seen 
before,  were  wonders  of  skill  and  art.  Even  the  great  Titian, 
a  close  friend  of  Vesalius,  was  at  one  time  charged  with  being 
the  author  of  them  ;  but  it  has  finally  been  made  most  probable 
that  the  drawings  came  from  the  hand  of  John  Stephen  de  Calcar, 
who  had  become  such  an  apt  pupil  of  the  master  artist  that  even 
now  his  paintings  are  confused  with  those  of  Titian.  Upon  the 
whole  the  marvellous  accuracy  and  detail  of  the  plates  was  accom- 
panied by  a  good  but  somewhat  commonplace  description.  In 
reading  one  feels  the  lack  of  inspiration  which  would  accom- 
pany new  thought.  The  wonder  grows  that  the  author  could 
have  disclosed  so  much  and  not  discovered  more.  He  described 
the  whole  circulation,  heart,  arteries,  veins  and  valves,  but  they 
explained  nothing  to  him,  they  possessed  no  function  in  his  eyes. 
Of  the  most  notable  plates,  some  of  which  have  descended  to  this 
generation,  may  be  mentioned  that  of  the  complete  pulmonary 
circulation ;  the  interior  of  the  heart  showing  the  valves ;  the 
base  of  the  brain,  from  which,  however,  it  is  seen  that  the 
anatomist  divided  the  cranial  nerves  into  eleven  pairs  and  pos- 
sessed a  defective  knowledge  of  the  relationship  of  the  origin 
of  these  nerves  to  the  medulla ;  the  bones  of  the  middle  ear  ;  and 
lastly  an  extremely  accurate  view  of  the  larynx  and  trachea, 
indicating  the  branching  off  from  the  pneumogastric  and  return 
of  the  left  recurrent  laryngeal.  The  descriptive  portion  of  the 
senses  is  less  perfectly  depicted.  The  lacteals  and  lymphatic  sys- 
tems, although  discovered  some  years  previous,  received  no  notice 
at  the  hands  of  Vesalius. 

The  appearance  of  the  book  called  forth  anew  the  intense 
jealousy  of  Sylvius.  In  this  he  was  joined  in  criticism  by 
Eustachius,  Driander  and  Riolau.  These  savants  instantly  and 
viciously  denied  the  splendor  of  the  achievement,  claiming 
that  most  of  the  work  formed  the  simple  reproduction  of  what 
Galen  had  originally  performed.    They  denounced  Vesalius  for 


654 


LITTLE  BIOGRAPHIES 


not  ascribing  to  Galen  the  credit  of  the  work.  Fallopius  alone 
stood  up  for  his  teacher.  Notwithstanding  all  this  the  fame  of 
the  author  and  his  masterpiece  spread.  In  England  there  appeared 
in  1545  an  edition  in  Latin  dedicated  to  Henry  VIII,  and  a 
second  edition  in  English  dedicated  to  Edward  VI.  In  1554, 
Charles  V.  called  Vesalius  to  his  court  as  Archiatrus,  and  upon 
Charles  abdicating  in  favor  of  his  son  Philip,  the  latter  continued 
the  great  anatomist  in  the  office.  In  1559  Vesalius  was  sent  by 
Philip  to  France  to  attend  Henry  II.,  who  in  the  midst  of  the 
revels  attendant  upon  the  espousals  of  his  daughter  Elizabeth  to 
Philip,  and  of  his  sister  Margaret  to  the  Duke  of  Savoy,  had  in 
a  tilt  in  a  tournament  received  the  shaft  of  a  broken  lance  in  the 
right  eye.    When  Vesalius  arrived  the  king  was  dead. 

Vesalius  followed  Philip  to  Spain  in  1560.  Here  he  succeeded 
in  curing  the  injury  to  the  head  of  the  Emperor's  son  Carlos — a 
feat  which  made  him  famous  and  gave  him  a  fashionable  clientele 
of  the  crowned  families  of  Europe.  Another  event  added  to  his 
notoriety.  D'Egmont,  Count  of  Buren,  lay  very  ill.  Vesalius, 
as  court  physician,  pronounced  his  illness  fatal  and  predicted  that 
life  would  not  continue  after  a  certain  day  and  hour.  The  count 
accepted  the  decree  and  invited  his  friends  to  an  antemortem 
feast.  After  dinner  he  presented  gifts  and  bidding  an  everlasting 
farewell,  like  an  obedient  patient  expired  at  the  very  moment 
named  by  Vesalius  for  his  death. 

At  this  point  in  his  life  the  court  physician  was  at  the  zenith 
of  his  eminence.  Early  in  1562,  for  some  mysterious  reason  he 
suddenly  left  the  court  at  Madrid  and  traveled  to  Venice  via 
Perpignau.  At  this  latter  place,  in  order  to  save  a  small  bribe 
at  the  Spanish  customs,  he  was  delayed  ten  days  at  a  cost  of  fifty 
crowns. 

From  Venice  he  traveled  to  Cyprus,  and  from  there  to  Jeru- 
salem and  the  Holy  Land.  Of  the  many  reasons  advanced  to 
explain  his  sudden  departure,  the  following  is  the  most  accredited. 
Vesalius,  believing  a  young  Spanish  nobleman  to  be  dead,  obtained 
leave  to  perform  an  autopsy.  Upon  opening  up  the  chest  cavity, 
he  saw  the  heart  beating.  The  parents  learning  of  this,  persisted 
in  attempting  to  prosecute  him  for  murder.  The  King  intervened, 
however,  and  saved  his  life  on  the  condition  that  to  atone  for 
his  error,  he  should  make  a  sacred  pilgrimage. 

In  the  latter  part  of  the  year,  Fallopius,  then  but  forty-one 
years  of  age,  died  at  Padua,  leaving  vacant  the  first  chair  in 


SCIENTIFIC  REVIEW 


655 


physic.  The  next  year  the  Senate  of  V enice  sent  after  Vesa- 
lius,  asking  him  to  return  and  assume  the  vacant  chair.  The 
message  was  received  at  Jerusalem  and  in  the  autumn  of  the 
following  year  he  set  sail  from  Joppa  for  Italy.  A  violent  storm 
drove  the  vessel  on  the  Ionian  Islands,  where  it  was  wrrecked 
on  or  near  the  Island  of  Zante.  Here  the  great  anatomist, 
stricken  with  cold  and  hunger,  breathed  his  last,  October  15, 
1564.  He  was  afterward  buried  in  the  Church  of  Our  Lady 
in  Zante. 

His  was  a  mind  analytical  and  peculiarly  fitted  to  unravel  and 
expose  the  secrets  of  descriptive  anatomy,  but  strangely  lacking 
in  the  constructive  and  synthetic  qualities  necessary  to  the  dis- 
covery of  vital  function  as  associated  with  anatomical  structure. 

Holmes  C.  Jackson*. 

Scientific  IReview 

The  Effect  of  the  X-Rays  ox  Living  Tissues. 

An  enormous  number  of  observations  have  been  recorded  of  the 
use  of  the  Rontgen  rays  and  allied  agents  under  almost  every 
conceivable  condition.  In  the  vast  literature  which  has  accu- 
mulated there  is  much  of  little  or  no  permanent  value.  Our 
ignorance  of  the  nature  of  these  so-called  rays,  the  far  reaching 
and  often  fanciful  claims  made  for  their  value  as  therapeutic 
agents,  the  lack  of  any  systematic  correlation  of  the  facts  ob- 
served or  any.broad  generalization  which  might  serve  as  a  working 
hypothesis  have  served  to  produce  in  many  respects  a  veritable 
chaos  of  unrelated  facts  and  records  of  oftentimes  fruitless  in- 
vestigations. By  both  surgery  and  medicine,  however,  their  use 
has  been  definitely  established  as  a  necessary  and  important  aid. 
The  diagnosis  and  treatment  of  injuries  and  diseases  of  bones, 
the  detection  of  tumors  and  foreign  bodies,  and  the  treatment  of 
certain  skin  diseases  and  new  growths  by  the  use  of  either  Ront- 
gen rays  or  radium  have  given  to  these  agents  certain  well  de- 
fined and  well  known  values. 

It  is  also  true  that  carefully  recorded  facts  have  been  observed 
relating  to  the  direct  and  indirect  effects  of  these  rays  on  very 
many  forms  of  living  tissue,  both  animal  and  vegetable,  and  thus 
logical  endeavor  has  been  made  to  place  our  knowledge  of  their 
therapeutic  effect  on  a  scientific  basis  with  definite  reasons  for 


656 


SCIENTIFIC  REVIEW 


accomplishing  definite  ends  by  the  use  of  a  definitely  calculable 
amount  of  a  powerful  agent. 

L  Effect  upon  the  skin.  Stimulus  to  investigation  in  this 
field  was  undoubtedly  first  given  by  the  early  recognition  of  the  in- 
fluence of  the  rays  in  producing  accidental  burns  on  exposed  sur- 
faces of  those  working  with  or  subjected  to  Rontgen  or  radium 
rays.  Carl  Beck  divides  these  lesions  of  the  skin  into  three  degrees. 
The  first  is  characterized  by  redness  and  slight  pigmentation  of 
the  skin,  infiltration  of  the  cutis  (effluvium  capillorum)  and  a 
perceptible  rise  in  temperature.  Exfoliation  may  occur  in 
small  scales.  Subjectively  there  is  often  an  intense  itching. 
A  regressive  metamorphosis  or  atrophy  of  the  differentiated 
elements  of  the  skin  such  as  glands,  hairs,  and  nails  characterizes 
the  chronic  stage.  Lesions  of  the  second  degree  consist  in  the 
formation  of  blisters,  the  clear  or  yellowish  contents  of  which 
raise  the  denser  surface  epithelium  from  the  mucous  stratum  of 
the  rete  Malpighii.  Tension  is  high  and  pain  accordingly 
intense.  After  removal  of  the  blisters  the  corium  is  exposed 
as  a  reddened  surface.  Escharotic  destruction,  variously 
termed  dry  gangrene,  dry  slough,  white  gangrene  or  necrosis, 
marks  the  third  and  gravest  degree.  The  tissues  become 
brownish  black  or  greyish  white  in  color  and  slowly  slough 
leaving  a  granulating,  indolent  ulcer.  The  period  of  onset  after 
exposure  is  generally,  about  two  weeks.  The  chronic  type 
produces  the  so-called  terra-cotta-like  hands.  The  integument 
is  wrinkled,  shrivelled,  and  partially  cracked,  the  nails  are  horny 
and  also  cracked  and  the  phalanges  are  so  much  thickened  that 
there  is  tension  on  movement  of  the  joints.  Elasticity  is  lessened 
and  sensibility  increased.  Effluvium  capillorum  is  an  invariable 
accompaniment.  Beck  believes  these  effects  to  come  from 
impaired  nutrition  of  cells,  especially  those  of  the  bloodvessels, 
which  show  thickening  of  the  intima  of  the  smaller  vessels  and 
narrowing  of  their  calibre  by  a  deposit  of  fibrous  tissue  in  a 
reticular  arrangement.  The  media  and  adventitia  are  usually 
also  affected. 

Newcomet  believes  no  single  form  of  degeneration  is  character- 
istic of  X-rays  and  that  the  form  of  degeneration  observed 
depends  entirely  on  the  tissues  exposed  and  the  method  of  appli- 
cation. He  compares  the  effects  to  those  of  fever  which  produces 
granular  and  then  fatty  changes  in  the  protoplasm,  recovery 
depending  upon  the  amount  of  damage  done  before  the  fever 


SCIENTIFIC  REVIEW 


657 


subsides.  Idiosyncrasy  plays  an  important  part.  The  least 
effect  he  describes  as  a  reddening  of  the  skin  followed  by  slight 
tanning  similar  to  sunburn,  only  deeper.  In  more  severe  forms 
the  period  of  onset  may  be  a  few  hours  or  a  few  months  and  in 
the  meantime  the  patient  complains  of  pain.  A  hyperaemia 
of  the  surface  followed  by  a  slough  resembling  that  of  a  bad 
scald  may  occur.  The  slough  appears  easily  removable,  but  in 
reality  is  adherent  and  comes  away  slowly.  The  base  shows 
healthy  granulations,  but  they  in  turn  may  also  slough. 

Scholtz  in  1902  experimented  on  the  skin  of  pigs  and  rabbits. 
He  found  that  definite  alterations  did  not  appear  in  the  skin  till 
six  or  seven  days  after  exposure  to  the  rays  and  that  about  this 
time  the  hair  began  to  fall  out.  In  the  epidermis  the  cells 
became  swollen  and  oedematous,  vacuoles  appeared  in  their 
protoplasm  and  nuclei  became  clumped  and  shrunken.  Mitoses 
were  rarely  present,  division  apparently  occurring  without 
karyokinesis.  In  the  corium  oedema  was  also  noticeable  and 
the  collagen  fibers  were  swollen  and  stained  imperfectly;  the 
elastin  was  affected,  but  not  to  the  same  extent.  Connective 
tissue  cells  were  swollen  and  their  protoplasm  became  homo- 
geneous and  vacuolated.  In  short,  a  slow  degeneration  of  the 
cells  of  the  epidermis,  hair  follicles  and  glands  occurred, 
affecting  nuclei  as  well  as  cell  protoplasm. 

Codman  states  that  he  agrees  with  the  balance  of  opinion  which 
attributes  these  lesions  to  a  primary  action  on  the  trophic  nerves 
of  the  blood  vessels  and  skin.  The  delay  in  the  appearance  of 
the  lesions  after  exposure,  their  progressive  character,  and  their 
failure  to  react  to  stimulating  treatment  are  the  strongest  reasons 
for  this  view.  The  microscope  shows  occlusion  of  the  smaller 
arterial  branches  not  unlike  that  occurring  in  necrosis  and  inflam- 
mation due  to  other  causes.  The  severe  lesions  are  atrophic 
ulcers  rather  than  burns. 

Rollins  explains  rather  fancifully  this  action  on  the  blood 
vessels  by  assuming  that  X-light  and  radio-active  substances 
produce  ionization  of  the  molecular  complexes  of  the  body. 
The  greater  effect  on  diseased  than  on  normal  tissues  is  due  to 
the  larger  and  less  stable  aggregations  of  molecules  of  the  dis- 
eased tissue  being  more  easily  ionized  than  are  those  of  the 
normal.  In  comparison  he  cites  the  large  molecular  complexes 
of  the  gelatin  dry  plate  which  are  acted  on  when  the  smaller 
molecular  group  of  the  daguerrotype  plate  are  not.    As  fluids 


658 


SCIENTIFIC  REVIEW 


are  continually  passing  in  and  out  through  the  walls  of  the 
blood  vessels  it  is  conceivable  that  some  of  the  ions  produced 
by  the  action  of  the  rays  will  be  constantly  carried  by  the  currents 
through  the  cells  of  the  walls  o£  the  vessels  and  their  destructive 
action  will  there  be  more  marked.  These  ions  exist  for  some 
time  after  their  production  and  may  be  carried  considerable 
distances. 

II.  Effect  upon  bacteria  and  other  low  forms  of  life.  One  of  the 
first  and  most  natural  hypotheses  with  respect  to  the  beneficial 
action  of  the  rays  in  the  treatment  of  lupus  vulgaris  and  other 
skin  affections  due  to  parasites  was  that  they  were  bactericidal. 
This  theory  has  not  received  much  support.  Freund  and  E. 
Schiff  in  1900  concluded  that  direct  discharges  of  invisible  rays 
were  capable  of  inhibiting  the  growth  of,  or  killing  bacterial 
cultures  or  bacteria  suspended  in  liquid  media. 

Wolfenden  and  Forbes  Ross  found  that  it  was  impossible  by 
any  ordinary  long  exposure  to  kill  growths  of  bacteria  by  X-rays. 
Instead  of  inhibiting  the  growth  of  tubercle  bacilli  the  rays 
actually  "stimulated  them  to  excessive  growth  and  only  affected 
them  adversely  by  attenuation  from  overgrowth."  Experi- 
ments with  cultures  of  B.  prodigiosus  gave  similar  results. 

X-rays  stimulate  the  germinations  of  seeds  and  fermentative 
processes  and  these  effects  are  also  produced  in  cultures  of 
bacilli,  the  vegetable  properties  of  which  are  stimulated  to 
excessive  growth  while  they  are  profoundly  altered  in  their 
biologic  and  physiologic  characters.  An  apparent  death  in 
cultures  so  treated,  is  due  only  to  exhaustion  of  vitality  from 
excessive  proliferation  since  rest  alone  is  sufficient  to  enable 
the  organisms  to  again  take  on  active  growth. 

Rieder's  experiments  showed  that  after  even  several  hours  of 
exposure  to  the  Rontgen  rays  no  death  or  inhibition  of  growth 
of  bacteria  could  be  observed.  Abbe  showed  that  radium  kills 
B.  typhosus,  B.  cholerae  and  B.  prodigiosus  when  applied  very 
closely  (0.5  mm.)  for  twenty-four  hours.  Seeds  produced 
stunted  plants  or  failed  to  germinate.  Young  and  growing  cells 
proved  most  susceptible.  Wallen  concluded  that  prolonged 
exposure  of  vinegar  worms  or  protozoa  is  fatal  and  that  on 
growing  plants  there  was  a  stimulating  action,  in  fact  over- 
stimulation, for  they  grew  faster  but  did  not  live  as  long  as 
normal  plants.    Full  grown  plants  were  not  affected. 

Schaudinn  found  that  X-rays  killed  one-fourth  of  Amoebae 


SCIENTIFIC  REVIEW 


659 


prineeps  in  exposed  colonies.  The  following  varieties  were  all 
killed:  Amoeba  lucida,  Pelomyxa  palustris,  Gromia  oviformis, 
Actinosphaerium  eichhorni,  Chilomonas  paramoecium,  Crypto- 
monas  ovata,  Enzlena  acus,  Oxyrrlus  marina  and  Spirostomum 
ambiguum.  Dunham's  results  were  very  similar.  The  Chilo- 
monas, Paramoecium  aurelia,  Paramoecium  bursaria  and  all 
forms  of  single  cell  life  were  killed.  The  Rotifers,  Arcella  and 
Cryptomonas  were  unaffected. 

Bordier  studied  the  effect  of  X-rays  on  the  metamorphosis  of 
the  silkworm  in  its  entire  life  cycle.  The  worms  were  taken  on 
the  day  after  birth  and  exposed  to  the  rays  at  a  distance  of  98 
cm.,  for  a  quarter  of  an  hour  each  day.  They  became  more 
active  than  normal.  The  developmental  changes  were  retarded 
in  the  animals  treated,  taking  36  instead  of  29  days  as  compared 
with  the  untreated  worms,  and  the  transformation  came  about 
in  an  abnormal  manner.  More  of  the  crysalides  died  with 
haemorrhage  from  the  mouth,  and  no  wings  were  formed. 
There  were  less  silk  spun  than  usual. 

III.  Effect  upon  diseased  tissues.  Stewart  assisted  by  Nicker- 
son,  Wilson  and  Man  from  a  study  of  a  squamous  cell  carcinoma 
of  the  hand  exposed  to  X-rays  concluded  (1)  that  characteristic 
histological  changes  do  occur;  (2)  the  important  early  changes 
are  fatty  degeneration  and  vascularization  of  the  epithelial 
pearls;  (3)  leucocytic  infiltration  and  various  degrees  of 
degeneration. 

Sequeira  found  two  changes:  (1)  a  destruction  of  the  epi- 
thelial cell,  the  nucleus  and  protoplasm  undergoing  lysis  and  in 
some  cells  a  definite  fatty  change;  (2)  a  stimulation  of  the 
connective  tissue  to  the  formation  of  healthy  scar  tissue.  • 

Walker  observed  fibromyxomatous  degeneration  occurring  in 
a  rodent  ulcer.  Beck  found  colloid  change  in  an  adenocar- 
cinoma. McCaw  observed  (1)  necrosis  of  cells  and  often  fatty 
degeneration.  (2)  A  tendency  to  occlusion  of  the  vessels  by 
intimal  thickening  with  entire  absence  of  infiltration  of  poly- 
morphonuclear leucocytes  but  with  the  accumulation  of  numer- 
ous lymphoid  cells.  Newcomet  says  that  leucocytes  come 
with  over-stimulation  by  X-ray,  but  do  not  come  where  no 
reaction  is  observed.  Unna  denies  that  epithelioma  ever 
undergo  fatty  change. 

Pernet  in  a  study  of  lupus  vulgaris  exposed  to  fourteen  daily 
treatments  of  ten  minutes  with  removal  at  the  end  of  six  months 


66o 


SCIENTIFIC  REVIEW 


describes  a  degeneration  and  disintegration  of  the  fibrous  ele- 
ments of  the  corium  in  which  the  collagen  is  partly  transformed 
into  collastin  and  all  the  elastin  is  destroyed.  Hair  follicles  and  se- 
baceous glands  had  disappeared,  while  sweat  glands  showed  degen- 
eration and  lymphoid  cell  infiltration.  A  large  blood  vessel 
showed  thickened  walls  and  in  the  corium  there  were  numerous 
areas  of  fibrous  change.  Hodgson  investigated  radium  and 
reported  that  its  effects  were  very  similar  to  those  of  the  Rontgen 
rays. 

Abbe  applied  a  tube  of  radium  in  a  case  of  carcinoma  of  the 
breast;  (i)  to  the  normal  skin  outside  of  the  growth  in  several 
places,  (2)  on  the  growth  itself,  (3)  within  the  growth;  and 
then  excised  the  entire  breast.  Examination  showed  (1)  on 
the  skin  superficial  necrosis  of  the  cuticle ;  the  longer  the  applica- 
tion, the  deeper  the  devitalization;  (2)  leucocytic  infiltration 
around  the  vessels  and  nerves;  (3)  a  softening  and  necrosis 
of  the  central  cells  or  nests  in  the  cancer  area  beneath  the  tube  j 
(4)  where  the  radium  was  buried  a  complete  destruction  of  the 
surrounding  cells  for  a  distance  of  one-fourth  of  an  inch.  Abbe 
concludes  that  the  malignant  cells  which  have  escaped  destruc- 
tion or  retrograde  change  show  a  striking  quiescence  which  may 
mean  that  death  of  the  vital  force  making  the  cell  malignant 
has  occurred. 

Numerous  instances  of  the  development  of  squamous  cell 
carcinoma  in  workers  with  X-rays  have  been  reported.  Three 
well  authenticated  instances  have  recently  received  notice.  A 
worker  in  Edison's  laboratory  developed  carcinoma  of  the 
hand  from  which  he  died.  A  physician  of  Buffalo  was  com- 
pelled to  have  both  hands  amputated.  Dr.  Blacker  of  England, 
who  treated  King  Edward  for  rodent  ulcer,  developed  a  car- 
cinoma of  the  back  of  his  hand  which  metastasized  so  rapidly 
that  radical  operation  was  impossible. 

Wallen  concluded  (1)  that  on  superficial  capillaries  the  effect 
is  like  that  of  an  irritant  producing  vasodilation,  which  might 
account  for  the  relief  of  pain  in  cases  of  deep  seated  malignant 
growths;  (2)  near  the  surface  the  effect  on  malignant  growths 
is  curative,  the  cure  not  necessarily  being  the  result  of  necrosis; 
(3)  on  deep  seated  growths  no  microscopical  change  was  to  be 
found  in  either  pathological  or  normal  cell  elements;  (4) 
immediate  increase  of  leucocytes  in  the  blood. 

Hodgson  records  that  radium  converts  oxyhaemoglobin  into 


SCIENTIFIC  REVIEW 


66l 


methaemoglobin  and  that  red  cells  give  up  their  haemoglobin 
more  readily;  that  emulsin  and  tripsin  are  rendered  more  inert 
and  vaccine  is  said  to  become  useless. 

Heineke  had  previously  shown  that  the  effect  of  the  Rontgen 
rays  on  the  blood  forming  organs,  the  bone  marrow,  spleen, 
lymph  nodes  and  lymph  follicles  of  the  intestinal  canal,  is  to 
cause  a  destruction  of  the  lymphoid  tissue,  a  disintegration  of 
the.  cells  of  the  splenic  pulp  and  the  bone  marrow  and  finally 
an  increase  of  the  pigment  in  the  spleen.  He  now  ascribes 
similar  effects  on  lymphoid  tissue  to  radium.  Within  a  few 
hours  a  disintegration  of  the  nuclei  of  the  lymphocytes  took 
place  in  all  organs  exposed  to  the  radium  rays,  the  lymphoid 
tissue  being  attacked  through  the  unbroken  skin. 

Edsall  in  studying  the  metabolism  of  leukaemic  patients 
treated  by  the  X-rays  observed  that  in  favorable  cases  treat- 
ment was  followed  by  a  remarkable  increase  in  the  excretion  of 
nitrogen,  uric  acid,  purin  bases  and  phosphates,  the  diet  remain- 
ing the  same  as  before  treatment.  The  tissue  break  down  was 
increased  nearly  100  per  cent.  Consequently,  he  concludes  that 
(i)  favorable  cases  for  X-rays  result  from  personal  suscepti- 
bility to  their  influence;  (2)  concerning  the  processes  stimulated 
and  accelerated  by  the  X-ray,  it  is  highly  probable  that  the  action 
is  chiefly  an  autolysis. 

Blauel  says  that  the  cells  which  are  physiologically  less 
resistant  are  the  first  to  succumb  to  the  action  of  radium.  The 
epithelium  of  rabbit's  kidneys  was  the  first  to  display  evidences 
of  injury,  and  in  human  carcinoma  and  sarcoma,  the  specific 
tumor  cells.  These  findings  corroborate  Werner's  suggestion 
that  the  action  of  radium  is  an  intoxication  with  the  products 
of  the  destruction  of  lecithin,  as  the  epithelial  and  tumor  cells 
are  peculiarly  rich  in  lecithin. 

Schaper  exposed  ova  and  embryos  of  frogs  and  other  animals  to 
rays  and  emanations  of  radium.  It  was  found  that  the  effect 
of  the  agent  was  to  inhibit  cell  division  as  well  as  the  embryonal 
differentiation  and  growth,  and  that  regenerative  processes  were 
similarly  affected. 

Van  Allen  found  that  in  cases  of  men  treated  over  the  perineum 
by  X-rays  the  spermatozoa  disappeared  from  the  spermatic 
fluid.  Some  of  these  cases  were  examined  a  year  after  treatments 
had  ceased  and  no  spermatozoa  could  be  found. 

Schwarz  exposed  a  hen's  egg  to  radium  rays  for  from  forty- 


662 


SCIENTIFIC  REVIEW 


four  to  one  hundred  and  forty-four  hours.  He  found  produced, 
in  the  sense  of  a  dry  distillation,  a  decomposition  of  albuminoids 
with  no  marked  changes  in  the  native  albumins.  The  organic 
pigment  lutein,  a  lipochrome  in  the  yolk,  was  decolorized.  An 
important  observation  was  that  lecithin  was  decomposed.  This 
substance,  allied  to  the  fats,  contains  nitrogen  in  the  group 
cholin,  which  is  bound  to  the  phosphoric  acid  constitutent. 
Its  decomposition  takes  place  with  the  addition  of  water  and 
results  in  the  formation  of  stearic  acid,  glycero-phosphoric 
acid  and  cholin,  which  last  splits  off  trimethylamin.  According 
to  Verworm  lecithin  is  a  splitting  product  of  proteid.  It  is  a 
necessary  constituent  of  all  living  cells,  being  united  in  some 
unknown  way  with  the  proteids  of  the  protoplasm.  According 
to  Hoppe-Seyler  the  presence  of  lecithin  in  large  quantities  in 
developing  cells,  or  in  those  capable  of  development,  as  in  the 
yolk  of  the  egg,  spermatozoa,  colorless  red  blood  cells,  rapidly 
growing  pathological  growths  and  in  many  seeds  and  rapidly 
growing  parts  of  plants,  indicates  that  lecithin  bears  a  certain 
relationship  to  the  metabolic  events  of  cellular  development. 
The  influence  of  radium  in  decomposing  lecithin  would  seem  to 
explain  the  peculiar  effects  wrought  by  this  substance  in  the 
cutaneous  and  adjacent  tissues.  The  continual  exfoliation 
and  regeneration  of  the  epidermis  requires  the  presence  of  a 
considerable  quantity  of  lecithin  in  accordance  with  the  rule 
that  this  substance  is  found  in  largest  amounts  in  those  tissues 
undergoing  active  development.  The  necrotic  and  inflam- 
matory changes  in  the  skin  produced  by  radium  can  therefore 
be  explained  upon  the  basis  of  the  loss  of  lecithin  through 
decomposition.  The  action  of  the  Rontgen  rays  in  retarding 
or  arresting  the  growth  of  carcinoma  or  lupus  of  the  skin  would 
therefore  be  accounted  for  by  the  fact  that  the  lecithin,  which  is 
abundant  in  all  neoplasms  and  evidently  plays  an  important 
role  in  their  growth  and  development,  is  destroyed  by  prolonged 
exposures  to  these  radiations. 

Conclusions. 

(1)  X-rays  by  long  continued  exposure  or  in  susceptible 
subjects  produce  degenerations  and  finally  necrosis  in  integu- 
mental  tissues. 

(2)  Ordinary  exposures  have  no  influence  on  bacterial  or 
protozoal  life.    Long  exposures  inhibit  their  growth. 


PUBLIC  HEALTH 


663 


'  (3)  All  protoplasmic  activity  is  in  some  unexplained  way- 
inhibited  or  destroyed  by  continued  action;  highly  specialized 
or  growing  cells  are  more  easily  affected. 

(4)  This  action  may  be  due  to  a  breaking  up  of  the  lecithin  of 
the  cells  thus  removing  a  constituent  which  is  necessary  to 


metabolism. 


H.  E.  Robertson 


REFERENCES 


Beck  N.  Y.  Medical  Journal,  Vol.  lxxv,  p.  881. 

Newcomet  Medical  News,  1904,  lxxiv,  685. 

Co  DMA  N  Pkila.  Med.  Jour.,  Vol.  ix,  p.  438. 

Rollins  Boston  Med.  &  Surg.  Jour.,  Vol.  cliii,  p.  151. 

Scholtz  Archiv.  f.  Derm.  u.  Syph.,  Feb.-Mch.,  1902. 

Freund  and  Schifp  Wiener  klin.  Wochenschrift,  Sept.  13,  1900. 
Wolf  en  den  and  FoRBEs~RossL'Arc/m;es  of  Rontgen  Rays,  Vols,  iii  and  v. 

Abbe  see  Hodgson  N.  Y.  Med.  Jour.,  1905,  p.  62. 

Wallen  Jour.  Med.  Research,  1903,  p.  462. 

Schaudinn  Archiv.  f.  d.  gesammte  Phys.,  1899. 

Dunham,  Johns  Hopkins  Hosp.  Bull,  Feb.,  1904. 

Rieder  Munchener  med.  Wochenschrift,  March  11,  1902. 

StEWART.SNiCKERSON,  iWlLSON 

and  Man  Jour.  A.  M.  A.,  July  18,  1903. 


Sequeira 

McCaw 

Ellis 

Pernet 

Hodgson, 

Heineke 

Edsall 

Blauel 

Schaper 

Van  Allen 

Schwarz 

BORDIER 


British  Med.  Jour.,  Oct.  25,  1902. 
N.  Y.  Med.  Jour.,  Aug.  2,  1902. 
Am.  Jour.  Med.  Sciences,  Jan.,  1903. 
Brit.  Med.  Jour.,  Oct.  25,  1902. 
British  Med.  Jour.,  July  9,  1904. 
Munchener  med.  Woch.,  Aug.  2,  1904. 
Univ.  of  Penna.  Med.  Bull.,  Sept.,  1905. 
Jour.  A.  M.  A.,  November,  1905. 
Deutsche  med.  Woch.,  Sept.  29,  1904. 
Boston  Med.  &  Surg.  Jour.,  March  9,  1905. 
Pflugers  Archiv,  Dec.  17,  1903. 
Annali  di  Elettricita  Medica  e  Terapia  Fisica, 
November.  1905. 


public  fteaitb 

Edited  by  Joseph  D.  Craig,  M.  D. 

Department  of  Health — City  of  Albany,  N.  Y. 
Abstract  of  Vital  Statistics,  June,  1906. 
D  eat  lis. 


1902 

1903 

1904 

1905 

1906 

13 

12 

19 

15 

17 

2 

0 

2 

1 

1 

0 

0 

0 

0 

1 

0 

2 

0 

2 

0 

0 

2 

0 

0 

1 

Diphtheria  and  croup  

0 

2 

0 

2 

11 

0 

2 

0 

1 

1 

3 

4 

4 

2 

6 

4 

3 

2 

2 

4 

664 


PUBLIC  HEALTH 


1902 

1903 

1904 

i9°5 

1906 

r>  •  » 

5 

10 

19 

14 

10 

Apoplexy   

8 

5 

5 

5 

4 

6 

9 

12 

8 

5 

Accidents  and  violence  

6 

7 

8 

7 

6 

15 

18 

18 

26 

Deaths  under  one  year  

13 

17 

10 

13 

15 

Total  deaths    102        119        118        109  137 

Death  rate   12.40     14.47     14.34     H-93  16.60 

Death  rate  less  non-residents   12.77     10.51  15.20 


Deaths  in  Institutions. 

1902            1903         1904             1906  1900 
Non-           Non-           Non-          Non-  Non- 
Reai-  resi-   Reai-    reai-  Re*i-     reei-  Resi-  resi-  Resi-  resi- 
dent  dent   dent   dent  dent     dent  dent  dent  dent  dent 

Albany  Hospital    11      4      6      4    12      7      3      6    10  7 

Albany  County  Jail   o      0      o      o      0      o      0-1      0  0 

Albany  Orphan  Asylum....  0000001010 

County  House    1      1      0      5      2      2      1      0      4  0 

Homeopathic  Hospital  ....  2      2      2      1      0      2      2      1      1  0 

Hospital  for  Incurables...  1  101000010 

House  of  Shelter   0     0      1      0     0     0     0     o     0  0 

House  of  Good  Shepherd..  0000001000 

Home  for  Friendless   0000001  120 

Home  for  Aged  Men   0      0      0      0      0      0      0      0      1  o 

Little  Sisters  of  the  Poor..  0000  100000 

Public  places    0      1      0      o      3      0      1      2      2  0 

St.  Francis  De  Saylcs  Or- 
phan Asylum    0      0      3      0      0      0      0      0      0  0 

St.  Margaret's  House   3100002020 

St.  Peter's  Hospital   1200224273 

Marriages    102 

Births  at  term   95 

Still  births    6 

Premature  births    7 


Bureau  of  Contagious  Disease. 


1902 

1903 

1904 

1905 

1906 

2 

4 

4 

1 

5 

26 

6 

17 

11 

7 

17 

47 

  38 

4 

1 

1 

4 

118 

6 

32 

2 

0 

0 

3 

1 

  1 

I 

1 

0 

2 

Total 


104     141      45      63  74 


PUBLIC  HEALTH 


665 


Contagious  Disease  in  Relation  to  Public  Schools. 

Reported  Deaths 
D.    S.  F.  D,    &  P. 

Public  School  No.  1                                                 5  1  6 

Public  School  No.  2   1    I 

Public  School  No.  6   1   

Public  School  No.  8   1   

Public  School  No.  14   1   

Public  School  No.  15   1    I 

Public  School  No.  21    2   


Number  of  Days  Quarantine  for  Diphtheria. 
Longest   20      Shortest   5      Average   16^4 

Number  of  Days  Quarantine  for  Scarlet  Fever. 
Longest    47      Shortest    12      Average    2711/13 

Fumigations. 

Houses                                      56      Rooms    119 

Antitoxin. 

Cases  of  diphtheria  reported   47 

Cases  of  diphtheria  in  which  antitoxin  was  used   45 

Cases  in  which  antitoxin  was  not  used   2 

Deaths  after  use  of  antitoxin   9 

Bureau  of  Plumbing,  Drainage  and  Ventilation. 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  two 
hundred  fifteen  inspections  made  of  which  one  hundred  fifty-four  were  of 
old  buildings  and  sixty-one  of  new.  There  were  fifty-four  iron  drains  laid, 
twenty-nine  connections  to  street  sewers,  twenty-nine  tile  drains,  twenty- 
nine  cellar  drains,  six  urinals,  thirty-eight  cesspools,  one  hundred  twenty- 
seven  wash  basins,  seventy-two  sinks,  ninety-three  bath  tubs,  thirty-eight 
wash  trays,  fifteen  trap  hoppers  in  yard,  and  one  hundred  sixty-eight. 
There  were  one  hundred  seventy-one  permits  issued,  of  which  one  hundred 
forty-nine  were  for  plumbing  and  twenty-two  for  building  purposes. 
There  were  twenty-four  plans  submitted,  of  which  twelve  were  of  old 
buildings  and  twelve  for  new  buildings.  Three  houses  tested  on  com- 
plaint with  blue,  red  test  and  there  were  thirteen  water  tests  made. 
There  were  thirty-two  houses  examined  on  complaint  and  fifty-four 
reinspections.  Seventeen  complaints  were  found  to  be  valid  and  fifteen 
without  cause. 


7 


666 


PUBLIC  HEALTH 


Department  of  Health — City  of  Albany,  N.  Y. 
Abstract  of  Vital  Statistics,  July,  1906. 
Deaths. 


1902 

1903 

1004 

1905 

1906 

Consumption  

17 

13 

18 

14 

22 

1 

I 

1 

1 

2 

0 

0 

1 

0 

0 

Measles  

2 

2 

0 

0 

0 

Whooping-cough  

1 

I 

0 

1 

2 

1 

0 

2 

0 

2 

Grippe 

0 

0 

0 

0 

0 

4 

15 

9 

0 

2 

Broncho-pneumonia  

0 

I 

2 

2 

1 

7 

12 

15 

19 

1 1 

A 

4 

Q 

0 

T  O 

T  T 
1  I 

Cancer   

5 

10 

7 

9 

8 

Accidents  and  violence  

12 

11 

9 

1 1 

11 

Deaths  over  seventy  years  

IQ 

24 

24 

29 

24 

26 

48 

43 

29 

27 

Total  deaths   

135 

177 

169 

156 

149 

15.88 

20.83 

19.89 

18.36 

17.53 

Death  rate  less  non-residents.. 

13.65 

18.36 

18.00 

16.59 

16.12 

Deaths  in  Institutions. 

1902  1003  1904  1905  1906 


Resi- 
dent 

Non- 

reei-  Resi- 
dent dent 

Non- 
resi- 
dent 

Resi- 
dent 

Non- 
resi- 
dent 

Resi- 
dent 

Non- 
resi- 
dent 

Resi- 
dent 

Non- 
resi- 
dent 

Albanv  Hospital  

4 

8 

8 

13 

15 

6 

9 

9 

13 

5 

Albany  Countv  Jail  

0 

0 

0 

0 

0 

0 

I 

0 

0 

0 

Albany  Orphan  Asylum... 

0 

0 

0 

0 

0 

i 

0 

0 

0 

0 

I 

2 

5 

2 

5 

0 

3 

0 

0 

2 

Homeopathic  Hospital  .... 

2 

I 

i 

2 

4 

2 

0 

0 

I 

I 

Hospital  for  Incurables... 

0 

0 

0 

0 

0 

0 

i 

0 

I 

0 

House  of  Good  Shepherd.. 

I 

0 

0 

0 

i 

0 

0 

0 

0 

0 

Home  for  the  Friendless... 

0 

0 

0 

0 

0 

0 

I 

0 

I 

0 

Public  Places   

0 

6 

5 

2 

I 

2 

0 

0 

0 

I 

St.  Francis  De  Sayles  Or- 

phan Asylum   

0 

0 

3 

0 

I 

0 

0 

0 

0 

0 

St.  Margaret's  Home  

I 

I 

3 

I 

4 

3 

6 

2 

0 

0 

St.  Peter's  Hospital  

2 

I 

2 

I 

4 

I 

2 

3 

3 

3 

St.   Vincent's  Female  Or- 

0 

0 

0 

0 

i 

I 

0 

0 

0 

0 

Home  for  Aged  Men  

0 

0 

0 

0 

2 

0 

0 

0 

0 

0 

46 

Marriages    27 

Still  births    4 

Premature  births   » 


PUBLIC  HEALTH 

Bureau  of  Contagious  Disease. 


667 


Cases  Reported. 


1902 

1903 

1904 

1905 

1906 

Typhoid  fever   

  9 

3 

4 

8 

5 

  4 

7 

7 

0 

4 

Diphtheria  and  croup  

  16 

13 

8 

6 

29 

1 

0 

0 

4 

  7 

38 

1 

4 

10 

Whooping-cough   

0 

0 

0 

7 

1 

2 

2 

2 

Total   

  40 

~3 

22 

20 

61 

Contagious  Disease  in  Relation  to  Public  Schools. 
None  Reported. 

Number  of  Days  Quarantine  for  Diphtheria. 
Longest   47        Shortest   6        Average   2o|g 

Number  of  Days  Quarantine  for  Scarlet  Fever. 
Longest   37        Shortest   23        Average   30^ 

Fumigations. 

Houses                                      56      Rooms    89 

Antitoxin. 

Cases  of  diphtheria  reported   29 

Cases  in  which  antitoxin  was  used   23 

Cases  in  which  antitoxin  was  not  used   6 

Deaths  after  use  of  antitoxin   I 

Bureau  of  Plumbing,  Drainage  and  Ventilation. 
In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  one 
hundred  eighty-eight  inspections  made  of  which  one  hundred  nineteen 
were  of  old  buildings  and  sixty-nine  of  ne  wbuildings.  There  were  fifty- 
seven  iron  drains  laid,  twenty-three  connections  with  street  sewers,  twenty- 
six  tile  drains,  eight  urinals,  twenty-seven  cesspools,  forty-nine  sinks, 
fifty-six  wash  basins,  thirty-nine  bath  tubs,  thirty-three  wash  trays,  three 
trap  hoppers  in  yard,  eighty-seven  tank  closets,  two  slop  hoppers.  There 
were  one  hundred  thirty-eight  permits  issued  of  which  one  hundred  were 
for  plumbing  and  thirty-eight  for  building  purposes.  There  were  twenty- 
six  plans  submitted  of  which  twelve  were  of  old  buildings  and  thirteen 
for  new  buildings.  There  were  five  houses  tested  on  complaint,  one  with 
blue,  red  and  four  with  peppermint  test.  There  were  twelve  water 
tests.  Twenty-six  houses  examined  on  complaint  and  forty-three  re- 
inspections.  Seventeen  complaints  were  found  valid  and  nine  without 
cause.  1 


668 


SOCIETY  PROCEEDINGS 


Society  Proceedings 

Medical  Society  of  the  County  of  Albany. 


Memorial  Meeting — Harriet  A.  Woodzvard. 

A  special  meeting  of  the  Medical  Society  of  the  County  of  Albany 
was  held  in  the  library  of  the  Albany  Medical  College,  Monday,  July 
30,  1906,  at  5  o'clock  in  the  afternoon. 

The  President  stated  that  the  meeting  had  been  called  in  order  to 
take  action  on  the  death  of  Dr.  Harriet  A.  Woodward,  a  member  of  the 
Society. 

The  President  said :  "  Dr.  Harriet  A.  Woodward  graduated  in  medi- 
cine from  Syracuse  University  in  1875,  and  coming  to  Albany,  joined 
the  Medical  Society  of  the  County  of  Albany  in  1876,  since  which  time 
she  has  been  a  member  in  good  standing. 

"  She  faithfully  performed  all  the  duties  of  her  profession  and  took 
upon  herself  cheerfully  all  the  obligations  devolving  upon  her  in  the  field 
which  she  selected  for  the  practice  of  medicine.  It  is  in  order  to  show  a 
just  appreciation  of  her  faithful,  conscientious  work  that  this  meeting  has 
been  called.  The  chair  has  appointed  the  following  committee  to  draw  up 
resolutions  as  a  memorial  of  Dr.  Harriet  A.  Woodward." 

The  President  named  the  following  committee:  Drs.  Curtis,  Vander 
Veer,  Ward,  Steenberg  and  Craig. 

Dr.  Curtis  in  behalf  of  the  committee  read  the  following  memorial: 

Memorial  of  Dr.  Harriet  A.  Woodward 

The  death  of  Dr.  Harriet  A.  Woodward  of  Albany  removes  from 
our  list  of  members  one  who  has  been  of  our  membership  for  thirty 
years,  and  who,  in  a  quiet  and  unobtrusive  but  always  loyal  and  ethical 
way,  has  lived  and  labored  among  us.  Often  the  quiet  and  earnest  life 
leaves  a  larger  impress  than  one  that  forces  more  attention.  Dr.  Wood- 
ward has  been  an  earnest  disciple  of  medicine,  she  has  been  devoted  to 
the  best  professional  interests  and  has  done  her  work  in  a  way  that 
has  commanded  the  respect  of  all  of  us  who  have  come  in  contact  with 
her.  We  have  always  found  her  self-respecting,  interested  in  the  duties 
of  her  life,  pursuing  her  calling  with  the  consciousness  of  what  was 
implied  by  and  went  with  the  title  of  physician. 

Most  of  the  members  of  the  committee  appointed  to  give  expression 
to  the  sentiments  of  the  Society  on  this  occasion  became  members  about 
the  time,  or  shortly  before,  Dr.  Woodward  applied  for  membership.  That 
was  in  1876.  The  year  before  Dr.  Mary  Du  Bois  had  been  proposed  for 
membership  and  elected,  and  for  many  years  these  two  were  the  only 
women  physicians  in  the  Society.  Albany  has  had  but  few  women  mem- 
bers of  the  profession,  the  reason  for  which  it  is  difficult  to  see,  for 


SOCIETY  PROCEEDINGS 


669 


they  have  all  been  most  worthy  of  their  place  among  our  number.  We 
can  recall  that  at  the  time  of  these  earliest  applications  for  membership 
there  was  some  discussion  of  the  propriety  of  their  admission.  The 
question  was,  of  course,  only  raised  by  certain  ones  who  had  never  come  in 
contact  with  women  in  medicine.  They  were  most  earnestly  welcomed 
by  most  of  our  members  and  were  always  accorded  their  rightful  place 
among  us.  But  thirty  years  ago  outside  the  large  cities  there  were  few 
women  physicians.  Indeed,  one  of  the  conspicuous  features  of  the  last 
quarter  of  the  19th  century  increasing  in  the  20th,  has  been  the  press- 
ing forward  of  women  to  a  place  in  the  world's  work.  Women  have 
always  cared  for  the  sick  and  this  tenderest  ministry  of  the  sick  room 
has  been  almost  exclusively  theirs ;  and  there  is  no  reason  why,  with 
amplest  propriety,  it  should  not  rightfully  be  theirs  to  take  the  responsible 
place  of  the  physician  as  well  as  the  subordinate  one  of  nurse,  in  much 
that  goes  to  make  medical  practice. 

Both  of  these  two  pioneer  women  in  Albany  medicine  worked  here 
in  this  city  side  by  side  with  us,  and  both  of  them  several  years  ago, 
retired  from  the  active  pursuit  of  their  professional  work.  They  have 
been  entitled  to,  and  have  always  received,  the  respect  and  regard  of 
all  members  of  our  allied  association. 

Dr.  Woodward  was  of  retiring  nature  and  modest  in  her  claims  for 
attention  and  position.  She  was  for  years  a  very  constant  attendant  on 
our  meetings  and  it  was  always  a  pleasure  to  meet  her  and  to  receive 
her  greeting.  She  did  not  have  a  strong  physique  and  her  work  must 
have  been  hampered  to  a  degree  by  lack  of  it.  But  as  we  have  met 
her  in  her  work,  she  has  shown  good  professional  attainment,  and  good, 
careful  judgment  and  discrimination.  She  had  too,  as  most  women 
physicians  do,  a  loyal  love  for  her  professional  work,  consciousness  of 
its  obligation  and  devotion  to  the  subjects  of  her  care,  even  to  a  more 
sensitive  degree  than  men  are  accustomed  to  show.  It  would  be  well  if 
medical  men  had  a  certain  degree  of  womanliness  in  their  work. 

She  was  a  native  of  Schuyler  county,  in  this  State,  having  been  born 
and  spent  her  early  life  in  Hector  in  that  county.  She  had  her  medical 
training  at  the  Medical  Department  of  Syracuse  University  and  graduated 
in  1875.  She  joined  this  Society  from  Greenbush.  now  Rensselaer,  but 
soon  came  over  to  Albany,  where  until  recent  time  she  spent  her  life. 
About  four  years  ago  she  moved  to  Round  Lake  and  there  ended  her 
life,  July  25,  1906. 

We  have  missed  her  cheerful  presence  from  our  meetings  in  these 
later  years  and  shall  cherish  her  memory  with  unmarred  satisfaction. 
Your  committee  requests  that  a  minute  of  this  be  made  on  the  Society 
records- 

B.  U.  Steene-erg, 
F.  C.  Curtis, 
A.  Vander  Veer, 
S.  B.  Ward, 
J.  D.  Craig, 

Committee. 


670 


SOCIETY  PROCEEDINGS 


Dr.  J.  N.  Vander  Veer  moved  that  the  resolutions  be  adopted,  that 
they  be  spread  upon  the  minutes  of  the  Society  and  published  in  the 
Annals,  and  that  a  copy  be  sent  to  the  members  of  Dr.  Woodward's 
family.    The  motion  was  carried. 

Upon  motion  of  Dr.  Curtis  the  Society  adjourned. 

Arthur  T.  Laird,  Secretary. 

George  Gustav  Lempe,  President. 


Memorial  Meeting — James  E.  Smith. 

A  special  meeting  of  the  Medical  Society  of  the  County  of  Albany  was 
held  at  the  Albany  Medical  College,  Monday  afternoon,  August  20th  at 
5  130  o'clock. 

The  President  stated  that  the  meeting  had  been  called  in  order  to  take 
action  on  the  death  of  Dr.  James  E.  Smith,  a  member  of  the  Society.  Dr. 
Smith,  he  said,  had  graduated  from  the  Albany  Medical  College  in  1889 
and  had  joined  the  Society  in  1890.  He  was  a  kind  and  generous  friend,  a 
physician  and  a  patriot.  In  order  to  express  in  a  fitting  way  the  senti- 
ments of  the  Society  with  regard  to  his  untimely  death,  the  President 
had  appointed  Drs.  GifTen  (chairman),  Beilby,  Holding,  Macdonald  and 
E.  A.  Vander  Veer  a  committee  to  draw  up  suitable  resolutions. 

The  following  resolutions  were  then  read : 

"It  is  with  feelings  of  profound  regret  that  we,  the  members  of  the 
Medical  Society  of  the  County  of  Albany,  record  the  death  of  our  esteemed 
fellow  worker  James  E.  Smith,  M.  D.,  for  a  number  of  years  a  practising 
physician  in  this  city. 

"Dr.  James  E.  Smith  was  a  graduate  of  the  Albany  Medical  College  of 
the  class  of  1889,  and  has  been  a  member  of  the  Medical  Society  of  the 
County  of  Albany  in  good  standing  since  October  14th,  1890. 

"  Resolved,  That  inasmuch  as  in  the  wise  dispensation  of  Providence, 
our  late  colleague,  Dr.  James  E.  Smith,  has  passed  to  his  eternal  rest,  that 
we,  the  members  of  the  Medical  Society  of  the  County  of  Albany,  herewith 
express  our  sorrow  at  his  early  death; 

"  Resolved,  1  hat  we,  the  members  of  the  Medical  Society  of  the  County 
of  Albany,  convey  to  the  parents  of  the  late  James  E.  Smith,  our  heartfelt 
sympathy  and  commend  them  to  the  1  Father  of  Mercies  and  the  God  of  all 
comfort,'  in  this  time  of  sorrow  and  bereavement. 

"John  Giffen,  Chairman, 
"Geo.  E.  Beilby, 
"Arthur  F.  Holding, 
"W.  G.  Macdonald, 
"E.  A.  Vander  Veer." 

Dr.  E.  A.  Vander  Veer  moved  that  the  report  of  the  committee  be 
accepted,  and  that  a  copy  of  the  resolutions  be  sent  to  the  parents  of  Dr. 
Smith  and  that  a  copy  be  sent  to  the  Annals  for  publication. 

Motion  was  carried. 

On  motion  of  Dr.  D.  H.  Cook,  the  meeting  was  adjourned. 

A.  T.  Laird,  Secretary. 

George  Gustav  Lempe,  President. 


MEDICAL  NEWS 


671 


/De&tcal  Tlews 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick. — Statistics  for  July, 
1906.  Number  of  new  cases,  119;  classified  as  follows:  Dispensary  patients 
receiving  home  care,  3;  district  cases  reported  by  health  physicians,  10; 
charity  cases  reported  by  other  physicians,  46;  patients  of  limited  means, 
60;.  old  cases  still  under  treatment,  41;  total  number  of  patients  under 
nursing  care  during  the  month,  160.  Classification  of  diseases  (new 
cases):  Medical,  29;  surgical,  5;  gynaecological,  3.  Obstetrical  work  of 
the  Guild,  40  mothers  and  39  infants  under  professional  care ;  dental,  1 ; 
skin,  1 ;  transferred  to  hospitals,  2 ;  deaths,  7. 

Special  Obstetrical  Department. — Number  of  obstetricians  in  charge  of 
cases,  2;  attending  obstetricians,  2;  medical  students  in  attendance,  4; 
Guild  nurses,  5;  number  of  visits  by  attending  obstetricians,  8;  by  the 
medical  students,  40;  by  the  Guild  nurses,  55.  Total  number  of  visits 
for  this  department,  103. 

Visits  of  Guild  nurses  (all  departments)  :  Number  of  visits  with  nursing 
treatment,  1,227;  for  professional  supervision  of  convalescents,  162;  total 
number  of  visits,  1,3(89.  Four  graduate  nurses  and  4  assistant  nurses 
were  on  duty.  Cases  were  reported  to  the  guild  by  3  of  the  health 
physicians  and  by  28  other  physicians  and  by  1  dentist. 

Inspector  of  Nurse  Training  Schools. — The  State  Civil  Service  Com- 
mission will  receive  applications  until  September  4,  1906,  for  the  position 
of  Woman  Inspector  of  Nurse  Training  Schools  in  the  State  Department 
of  Education.  The  salary  is  from  $1800  to  $2100.  Candidates  must  be 
citizens  of  the  United  States,  legal  residents  of  New  York  State,  registered 
nurses  and  graduates  of  a  registered  nurse  training  school  with  at  least 
five  years  experience  since  graduation  in  supervision,  administration  or 
instruction  in  a  nurse  training  school. 

Application  forms  and  particulars  of  the  competition  may  be  obtained 
by  addressing  the  Commissioner  at  Albany. 

Charles  S.  Fowler,  Chief  Examiner. 

The  Quarterly  Journal  of  Inebriety. — The  Summer  number  of  the 
Quarterly  Journal  of  Inebriety  is  a  particularly  notable  issue  of  this 
always  interesting  and  valuable  publication.  It  has  been  greatly  enlarged, 
and  its  typographical  appearance  is  exceptionally  attractive.  Among  the 
leading  articles  in  this  number  are :  "  The  Relation  of  Alcohol  to  Tuber- 
culosis "  by  J.  W.  Grosvenor,  M.  D.,  "  Physiological  Action  of  Tea  as  a 
Beverage  "  by  Sir.  Lander  Brunton,  M.  D.,  "  Morbid  Predisposing  Causes 
in  Dipsomania "  by  W.  L.  Howard,  M.  D.,  "  Reflexes  from  the  Eye  in 
Narcosomania "  by  T.  H.  Evans,  M.  D.,  "  The  Alcohol  Cult "  by  John 
Madden,  M.  D.,  "  Comparison  of  the  Effects  of  Alcohol  and  Opium  "  by 
W.  H.  Park,  M.  D.,  and  two  articles  by  the  editor,  Dr.  T.  D.  Crothers, 
on  "  Unrecognized  Toxic  Insanities "  and  "  Farmfield  Reformatory  for 
Inebriate  Women."   Many  pages  of  sound  editorials,  entertaining  abstracts. 


672 


MEDICAL  NEWS 


book  reviews  and  comments  complete  an  issue  that  will  prove  of  interest 
and  value  to  every  physician. 

Personal.— Dr.  Louis  Le  Brun  (A.  M.  C,  1891),  after  a  prolonged 
period  of  post-graduate  study  abroad,  in  which  he  perfected  himself  for 
the  treatment  of  diseases  of  the  ear,  nose  and  throat,  has  opened  an  office 
for  the  practice  of  his  specialty  at  238  Lark  street,  Albany,  N.  Y. 

—Dr.  Elmer  E.  Martin  (A.  M.  C,  1892)  has  removed  from  Stottville, 
N.  Y.,  to  Millville,  California. 

The  Boston  Medical  and  Surgical  Journal  of  August  16,  1906,  contains 
the  following  complimentary  reference  to  work  done  by  Dr.  If.  S.  Gregory, 
a  graduate  of  the  Albany  Medical  College  in  the  class  of  1898: 

Psychiatry  in  Germany.  With  a  view  to  securing  for  the  new  Bellevue 
Hospital  the  benefit  to  be  derived  from  special  studies  in  hospital  con- 
struction and  management  at  the  best  institutions  in  England  and  on  the 
continent,  Dr.  M.  S.  Gregory,  resident  alienist  and  chief  of  the  psycho- 
pathic department,  was  sent  abroad  last  April  by  the  trustees  of  Bellevue 
and  Allied  Hospitals.  He  has  just  returned  from  the  trip  after  visiting 
London,  Paris,  Berlin,  Munich,  Berne,  Lucerne  and  other  cities  and  will 
embody  the  results  of  his  investigations  in  a  formal  report  to  the  board  of 
trustees.  In  speaking  of  the  status  of  psychiatry  in  Germany  he  states 
that  he  was  much  impressed  with  the  feeling  regarding  insanity  there. 
Mental  diseases,  instead  of  exciting  the  abhorrence  in  the  public  mind 
which  is  met  with  in  this  and  many  other  countries,  are  looked  upon  in  the 
same  light  as  cases  of  disease  of  other  parts  of  the  body.  The  result  is  that 
a  large  percentage  of  patients  who  might  otherwise  be  regarded  as  in- 
curable, and  be  shut  up  in  an  institution  for  a  lifetime,  receive  treatment 
in  the  early  stages  of  their  maladies,  and  are  restored  to  a  normal  con- 
condition  and  returned  to  their  families  within  a  few  months.  No 
taint  of  having  been  legally  adjudged  insane  is  on  them,  and  they  have 
nothing  to  live  down  in  the  communities  in  which  they  reside.  The  study 
and  treatment  of  these  cases  is  conducted  in  the  most  scientific  manner, 
and  in  the  preliminary  dealing  with  mental  diseases,  Dr.  Gregory  thinks 
the  German  hospitals  lead  the  world.  He  found  the  procedure  in  criminal 
cases,  with  alleged  insanity,  also  most  admirable. 

"  For  instance,"  said  he,  "a  man  commits  a  murder  in  Germany  and 
sets  up  a  plea  of  insanity.  They  have  no  foolish  system  such  as  we  have. 
They  do  not  call,  say,  fifteen  physicians  for  the  defense  and  fifteen  phy- 
sicians for  the  state,  and  perhaps  as  many  laymen  and  tell  them  to  find 
out  whether  the  murderer  is  sane  or  insane.  Instead,  the  judge  orders  the 
prisoner  committed  to  a  general  hospital  in  the  district,  and  it  becomes  the 
duty  of  the  state  alienist  to  that  institution  to  keep  the  prisoner  under 
observation.  He  takes  his  own  time  for  his  study  of  the  case,  and  upon 
his  report  the  accused  is  tried  or  not  tried.  This  official  gets  no  fee 
He  has  no  prejudices  concerning  the  prisoner,  one  way  or  the  other.  If  he 
declares  the  man  sane,  and  his  verdict  is  successfully  challenged,  the  work 
of  that  alienist  for  the  government  ends,  then  and  there.  No  politician 
can  save  him." 


IN  MEMORIAM 


673 


Dr.  Gregory  found  nothing  better  abroad  than  the  New  York  State 
Hospitals  as  regards  buildings,  management  and  the  treatment  of  in- 
sanity. As  to  the  treatment  of  patients  in  general  hospitals,  he  expresses 
the  opinion  that  nowhere  in  Europe  do  such  patients  have  so  many  com- 
forts and  privileges  as  in  Bellevue  and  other  similar  institutions  here. 

— Dr.  Joseph  Day  Olin  (A.  M.  C,  1904)  after  two  years  of  post- 
graduate work  in  Albany,  is  about  to  open  an  office  in  Watertown,  N.  Y. 

— Dr.  Harold  E.  Hoyt  (A.  M.  C,  1904),  who  has  been  in  Porto  Rico 
during  the  last  year,  has  gone  to  the  far  West,  and  will  probably  settle 
in  Portland,  Oregon. 

— Dr.  J.  P.  Faber  (A.  M.  C,  1905),  who  was  associated  with  Dr.  Hoyt 
in  his  work  in  Porto  Rico,  has  opened  an  office  in  Scotia,  N.  Y. 

— Dr.  John  D.  Crane  (A.  M.  C,  1905)  is  at  Hawley,  Pa. 


Death. — George  H.  Spafford,  M.  D.,  a  member  of  the  class  of  1859 
of  the  Albany  Medical  College,  assistant  surgeon  of  the  Sixteenth  Vermont 
Volunteer  Infantry  during  the  Civil  War,  a  member  of  the  Pension 
Examining  Board  and  school  director,  died  at  his  home  in  Cavendish,  Vt, 
June  18,  1906,  after  an  illness  of  six  months. 


Hn  flDemoriam 

Harrison  Edwin  Webster,  LL.D. 

Union  University  Quarterly,  August,  igo6. 

Harrison  Edwin  Webster,  LL.D.,  President  of  Union  College  from 
1888  to  1894,  died  at  the  family  residence  in  Rochester  on  Saturday 
morning,  June  16,  at  the  age  of  sixty-four  years  and  nine  months.  Dr. 
Webster  had  not  been  in  good  health  for  many  years  and  seme  three 
years  ago  he  was  twice  stricken  with  paralysis.  His  mortal  illness  set 
in  about  four  weeks  prior  to  his  death.  He  is  survived  by  his  wife,  by 
one  daughter,  Mrs.  Annie  Noel  Webster  of  New  York  City,  and  by 
three  sons,  Edwin  J.,  Ralph  P.  and  Thomas  Webster,  all  of  Rochester. 
The  funeral  service  was  observed  at  the  residence  in  Rochester  on 
Monday  morning,  June  18,  and  in  the  afternoon  Dr.  Webster  was  buried 
in  the  College  plot  in  Vale  Cemetery,  Schenectady. 

Harrison  E.  Webster  was  born  in  Angelica,  Cattaraugus  county,  Sep- 
tember 9,  1841.  At  the  age  of  seven  he  removed  to  Clayville  where  he 
received  his  common  school  education.  Eager  to  go  farther  he  pre- 
pared for  college,  largely  through  his  own  efforts,  and  entered  the 
sophomore  class  of  Union  College  in  1859.  Withdrawing  from  college 
on  the  outbreak  of  the  Civil  War,  he  enlisted  with  the  117th  New  York 
Infantry  and  served  as  a  private  soldier  until  the  close  of  the  war. 


674 


IN  MEIfORIAlf 


Having  acquired  the  means  of  completing  his  college  course  by  teaching 
school,  he  returned  to  Union  and  was  graduated  with  the  highest  rank 
in  1868. 

Dr.  Webster  was  appointed  tutor  in  Natural  History  and  Physical 
Geography  at  Union  in  1869  and  in  1873  was  made  professor  of  Natural 
History.  In  this  chair  he  continued  until  1883.  During  the  years  of 
his  service  as  a  professor  at  Union,  Dr.  Webster  gained  national  and, 
through  his  publications  on  Annelida  Chaetopoda,  even  international 
repute  as  a  scientist.  In  the  pursuit  of  his  investigations  he  organized 
several  expeditions  to  the  Bermudas,  associating  students  of  the  college 
with  him.  In  the  course  of  these  expeditions  he  collected  many  valuable 
specimens  of  marine  life;  these  he  gave  to  the  college.  However, 
that  which  most  distinguished  Dr.  Webster  as  a  professor  was  his 
genius  for  friendship  which  enabled  him  to  get  very  close  to  his 
students  and  to  impart  the  best  gifts  of  an  intensely  human  heart  and 
of  a  very  active,  keen  and  versatile  mind;  through  the  medium  of 
friendship  he  gave  inspiration. 

In  1883  Dr.  Webster  resigned  his  professorship  at  Union  and  accepted 
the  professorship  of  Geology  and  Natural  History  at  the  University  of 
Rochester.  There  he  remained  until  1888,  when  he  became  president  of 
Union  College.  The  College  was  then  almost  in  a  condition  of  suspended 
animation.  Dr.  Webster  revived  it  and  strengthened  it  and,  in  par- 
ticular, greatly  increased  the  attendance.  However,  after  an  administra- 
tion of  six  years,  he  resigned  his  office  on  account  of  ill  health  and 
retired  from  active  life.    Since  that  time  he  has  resided  in  Rochester. 

Dr.  Webster  was  a  member  of  the  Zeta  Psi  and  the  Phi  Beta  Kappa 
fraternities  and  an  active  and  honorary  member  of  many  scientific 
societies.  The  degree  of  M.  D.  was  conferred  upon  him  by  the  Albany 
Medical  college  in  1881  and  that  of  LL.D.  by  the  University  of  Rochester 
in  1888. 

At  the  funeral  service  in  Rochester,  Professor  Walter  Rauschenbusch 
of  the  Rochester  Theological  Seminary  paid  this  fine  tribute  to  Dr. 
Webster's  memory: 

"  We  have  been  brought  together  by  our  common  love  and  reverence 
for  a  life  which  has  probably  meant  more  to  many  of  us  than  we  our- 
selves shall  ever  know.  I  should  like  to  express  very  simply  what  is  in 
all  our  hearts  to-day,  and  what  will  be  in  the  thoughts  of  a  great  number 
of  others  when  the  word  reaches  them  that  Dr.  Webster  is  dead. 

"For  his  family  a  very  loving  heart  has  ceased  to  beat.  Nothing 
can  ever  replace  for  his  children  what  they  have  now  lost.  Men  of  great 
social  gifts  often  live  for  the  outside  world,  turning  a  radiant  hemisphere 
to  strangers,  and  a  morose  and  silent  face  to  their  own  people.  Men  of 
intense  intellectual  nature  are  often  so  abstracted  by  their  studies  that 
their  own  children  get  only  the  dregs  of  their  interest  and  vitality. 
Dr.  Webster  was  a  man  of  great  social  brilliancy  and  attractiveness, 
and  a  man  of  continued  intellectual  application,  but  nothing  ever  eclipsed 
his  children.  He  was  most  tenderly  interested  in  their  welfare,  sym- 
pathetic, tolerant,  hopeful  and  glad.  In  an  interval  of  consciousness 
before  his  death  he  said  to  me :  'I  don't  know  anything  now  but  children, 


Albany  Medical  Annals, 
September,  iqo6. 


IN  ME  MORI  AM 


67S 


children,  children,'  and  he  repeated  the  word  'children'  over  and  over.  It 
was  the  palsied  hand  of  his  mind  feeling  its  way  along  the  most  familiar 
strings  on  the  harp  of  his  life.  His  first  grandchild,  named  after  him, 
was  a  great  and  sweet  comfort  to  him.  For  his  wife  he  expressed  an 
affection  so  tender  that  I  must  not  quote  his  words.  His  last  words 
were  a  blessing  on  her  faithfulness.  Because  he  loved  his  family  so 
passionately,  any  sorrow  coming  to  him  by  the  death  or  affliction  of 
his  dearest  ones  hurt  him  profoundly.  Some  things  he  rarely  or  never 
mentioned.  With  all  the  careless  ease  of  his  talk  he  had  a  deep  reticence. 
But  much  of  the  cloud  that  darkened  his  later  years  had  risen  out  of 
the  depths  of  his  griefs. 

"  To  his  friends  he  gave  unstinted  devotion  and  fidelity.  He  was  an 
exceedingly  companionable  man,  ready  to  meet  any  man,  swift  to  find 
the  plane  of  ideas  and  interests  on  which  the  man  lived,  and  most 
adaptable  in  meeting  him  on  his  own  level.  If  he  found  any  measure 
of  intellectual  candor  or  of  the  love  of  truth  and  justice,  he  adopted 
the  man  into  the  great  family  of  his  friends  and  never  forgot  him  again. 
It  was  a  comfort  to  him  to  think  of  simple-minded  men  whom  he  had 
met  only  once  or  twice  in  his  life.  In  his  range  of  selections  he  was 
very  catholic.  He  did  not  follow  the  conventional  lines  of  society,  nor 
even  professional  and  intellectual  lines.  He  picked  out  people  for  their 
human  qualities.  What  he  hated  was  obliquity.  I  remember  the  calm 
tones  with  which  he  pronounced  the  verdict  on  a  certain  minister :  1 1 
think  he  is  the  most  disingenuous  man  I  ever  met.' 

"  By  the  same  process  he  won  the  hearts  of  the  men  he  liked.  There 
was  an  immediate  feeling  that  here  was  a  man, — genuine  human  nature 
and  of  a  very  high  order.  He  said  to  me  once :  '  I'm  no  good  myself, 
but  I've  had  the  salt  of  the  earth  for  my  friends.'  Not  all  of  his  friends, 
however,  rose  above  the  conventional  standards  of  judging  as  nobly  as 
he  did  himself.  Not  all  of  them  were  as  faithful  to  him  as  he  was  to 
them,  and  to  some  of  us  the  keenest  pang  in  the  news  of  his  death  will 
be  the  thought  that  we  neglected  him  when  he  needed  us  most. 

"  Dr.  Webster  was  a  man  of  very  unusual  intellect.  An  eminent 
physician  in  Albany  who  was  one  of  his  pupils,  says  of  him :  '  He  was 
the  most  intellectual  man  I  have  ever  known.'  His  intellectual  interests 
ranged  all  around  the  horizon.  If  there  was  anything  to  which  his  mind 
had  remained  unrespective  and  torpid,  I  don't  know  what  it  was.  At 
one  time  or  another  he  had  taught  nearly  everything  in  the  old  college 
curriculum.  Yet  he  carried  his  learning  so  lightly  that  he  was  never 
ponderous.  He  never  bored  you.  He  could  play  with  every  fact  he 
knew.  His  body  never  carried  much  size  of  muscle,  but  when  he  used 
to  work  in  dredging  for  marine  specimens,  he  could  outpull  the  pro- 
fessional boatman;  his  muscular  fibre  was  flexible  and  supple.  His 
intellectual  fibre  had  the  same  quality.  He  was  a  wrestler  and  loved 
nothing  so  well  as  to  strip  and  grapple  with  a  heavy-weight.  His  best 
work  was  done  in  conversation.  In  public  speaking  and  in  writing  he 
lacked  the  stimulus  of  opposition.  I  do  not  think  I  have  ever  met  a 
keener  talker.  He  instantly  understood  the  drift  of  your  mind,  saw 
the  end  of  your  argument  before  you  saw  the  middle,  and  helped  you 


676 


IN    M  E  MORI  AM 


to  get  it  stated.  Socrates  the  Athenian  is  a  concrete  figure  to  me,  for 
I  put  Webster  the  American  in  his  place  and  then  he  is  very  compre- 
hensible.   Only  Webster  would  have  been  less  prolix  than  Socrates. 

"One  chief  cause  for  his  mental  suppleness  was  the  utter  lack  of 
dogmatic  ballast  in  his  mind.  He  had  strong  opinions,  opinions  which 
he  never  actually  changed.  But  he  always  held  them  open  for  discussion. 
When  he  began  his  teaching  in  the  University  of  Rochester,  I  remember 
that  he  invited  discussion  in  the  class-room  and  said :  '  Everything  is 
open  for  discussion  in  this  class-room  except  the  multiplication-table 
and  the  Lord  Jesus  Christ.'  In  other  words,  he  refused  to  call  in 
question  the  self-evident  truths  of  the  natural  world  and  the  self-evident 
laws  of  the  moral  world,  but  all  other  things  were  there  to  be  examined. 
Another  cause  for  his  continued  flexibility  was  his  humility.  He  was 
utterly  fearless  in  his  mental  processes,  and  to  many  doubtless  he  seemed 
irreverent  and  reckless,  but  still  he  was  a  humble  thinker.  His  agnosti- 
cism was  largely  due  to  his  distrust  of  human  ability.  '  I've  only  got  a 
two-penny  intellect  anyway/  he  would  say,  and  he  did  not  feel  that 
1  God  had  called  him  into  all  his  counsels  when  he  created  the  world.' 

"  His  early  professional  work  was  in  zoology,  and  he  did  brilliant 
and  original  work  in  it.  But  describing  specimens  or  even  discovering 
new  species  was  not  the  end  of  mental  existence  with  him.  He  was 
always  reaching  out  lor  the  larger  truths  to  which  natural  science 
might  lead.  One  of  his  pupils  at  Union  College,  who  afterward  became 
his  successor  in  the  chair  of  Natural  History,  Professor  James  H. 
Stoller,  says :  '  His  great  merit  was  his  power  to  arouse  the  interest  of 
his  students  not  only  in  the  subject-matter  of  natural  science,  but  also 
in  its  philosophical  interpretations — its  values  for  human  thought  and 
human  life.'  At  that  time  the  era  of  natural  science  had  just  begun 
in  our  country.  The  Darwinian  theory  was  stimulating  inquiry  and 
opening  new  views  of  all  life  and  of  the  whole  universe  and  its  Maker. 
That  was  the  real  cause  of  attraction  for  him.  In  studying  marine 
zoology  he  was  on  the  firing-line  in  the  great  philosophic  battle  of  those 
decades.  Later  his  interests  were  more  given  to  the  larger  questions. 
As  he  once  quaintly  said  to  me :  '  I'm  glad  I  studied  bugs,  but  I'm  glad 
I  don't  have  to  study  them  any  more.'  In  later  years  the  sociological 
questions  forged  to  the  front  in  his  mind  as  in  the  thought  of  the  whole 
world,  and  again  he  was  on  the  firing-line.  I  remember  with  what  pro- 
found interest  he  told  me  in  1885  of  the  hold  the  land  theories  of  Henry 
George  were  getting  on  the  trades-unions. 

"  With  such  a  mental  make-up  he  could  not  help  being  a  brilhant 
teacher.  He  was  entirely  simple  and  clear  in  his  statements.  He  could 
light  up  the  plainest  subject  with  the  largest  generalizations.  He  was 
witty  and  quick  in  repartee  in  the  class.  He  was  wholly  unconventional 
in  his  talk  and  bearing,  perfectly  free  and  easy  with  the  men,  and  yet 
with  so  firm  a  grip  on  their  behavior  that  no  class  ventured  on  a  second 
folly  after  it  had  seen  one  man  come  to  grief.  It  is  no  wonder  that 
his  students  fell  resistlessly  under  his  spell,  and  the  best  men  most. 
They  quoted  his  epigrams  and  they  drank  in  his  philosophy  of  life. 
But  he  in  turn  gave  himself  to  the  men.    His  work  did  not  end  with 


IN   ME  MORI  AM 


677 


the  class-room.  He  found  ways  ot  attaching  the  promising  men  to 
himself,  induced  them  to  visit  him,  and  sat  up  to  the  small  hours  of  the 
night  to  talk  over  their  difficulties  with  them.  The  present  Dean  of 
Union  College,  Professor  B.  H.  Ripton,  says :  '  Never  have  I  known  a 
man  who  gave  himself  so  unselfishly  to  young  men  and  who  received 
in  turn  so  large  a  measure  of  devotion  and  influenced  so  deeply  their  life 
and  thought.'  In  his  way  he  was  a  real  pastor  of  a  new  type,  a  shepherd 
of  souls  to  a  class  of  men  not  reached  by  many  pastors,  the  intellectual 
young  man  who  is  in  doubt.  To  others  he  might  seem  an  iconoclast; 
to  such  men  he  was  a  builder  of  faith.  He  gave  them  assurance  in 
turning  their  back  on  obsolete  traditions,  but  so  far  as  he  exerted  spiritual 
authority,  it  was  for  faith  in  God  and  the  moral  law.  One  of  his  pupils, 
Professor  Arthur  S.  Wright,  of  the  Case  School  of  Applied  Science 
in  Cleveland,  says  very  truly :  1  His  influence  was  especially  marked 
with  the  wayward  and  he  saved  many  a  fellow  from  evil  ways.  I  know 
men  to-day,  sound  in  mind  and  heart,  whom  he  restrained  and  helped 
to  start  right  in  life.  For  long  years  he  gave  his  time,  his  money, 
his  energies — and  I  fear  his  health — to  the  work  of  strengthening  and 
guiding  young  men.  Religion,  which  to  him  was  simply  living  the 
Divine  life,  was,  I  am  convinced,  the  motive  and  mainspring  of  his 
work  and  life.  Scores  of  ministers  of  the  Gospel  would,  I  am  sure, 
gladly  bear  witness  to  his  influence  over  them  in  the  things  of  the  spirit' 
His  influence  was  for  and  not  against  religion.  Dr.  C.  M.  Culver  of 
Albany  says :  1  No  other  man,  except  my  own  father,  has  so  beneficially 
affected  my  life.  He  had  me  join  the  church  after  I  had  been  for 
years,  at  least  seemingly,  quite  on  the  other  side.'  I  remember  how  he 
suggested  that  any  man  in  doubt  about  religion,  shouid  read  the  Gospel 
of  John  and  mark  anything  that  he  could  not  assent  to,  knowing  well  that 
there  would  be  very  little.  I  do  not  say  that  he  never  upset  and 
injured  young  men.  The  open  air  of  soul-liberty  is  raw  to  those  who 
have  always  lived  in-doors.  But  if  any  man  has  tried  to  help  human 
souls  in  trouble  and  has  never  unintentionally  hurt  any  of  them,  his 
experience  has  been  singularly  fortunate. 

"  Dr.  Webster  was  always  a  truth-seeker.  He  had  the  altitude  of  mind 
expressed  by  Lessing  in  his  famous  epigram.  In  boyhood  he  became 
an  infidel  because  he  sought  the  truth.  He  had  read  geology  and  collided 
with  the  traditional  religious  teaching  about  the  origin  of  the  world  in 
six  days.  With  that  doctrine  went  the  whole  authority  of  the  church  as 
he  then  understood  it.  As  a  callow  youth  he  was  the  leader  in  a  kind 
of  free-thinker's  club.  He  was  wrong,  but  it  was  because  he  was  on 
the  road  to  the  truth.  The  church  now  stands  where  he  then  stood 
about  the  first  chapter  of  Genesis.  Later  on  he  re-examined  all  his 
objections  to  Christianity  and  worked  his  way  back  to  religious  faith 
by  giving  simple  adhesion  to  everything  which  convinced  him  as  true, 
and  above  all  to  Jesus  Christ.  'Jesus  Christ  is  my  God;  I  haven't  got 
any  other  God,'  he  used  to  say.  The  Christ-life  in  humanity  was  all 
he  cared  for,  all  he  hoped  in,  and  his  deepest  dejection  came  when  he 
felt  how  little  hold  it  had  taken  on  humanity  as  yet.  Most  men  would 
have  classed  him  as  a  rationalist  and  agnostic  in  religion,  and  he  was 


678 


IN   MEM  OKI  AM 


both.  But  I  think  in  his  real  religious  life  he  was  a  humble  believer 
in  spiritual  truth,  a  follower  of  Jesus  Chrtet,  and  a  spiritual  mystic. 
He  has  told  me  of  experiences  in  which  he  had  realized  Christ's  spiritual 
presence  as  tangible  as  if  Christ  were  in  the  room  with  him;  and 
others  in  which  he  had  obeyed  a  higher  inner  voice  and  found  it  justified. 
If  he  has  sinned,  he  suffered  for  it.  But  if  we  knew  all,  if  we  under- 
stood how  his  sins  grew  directly  out  of  the  finest  virtues,  we  should 
feel  that  perhaps  with  God  who  knows  all,  it  will  be  easier  to  pardon 
his  faults  than  the  respectable  virtues  of  some  of  the  rest  of  us. 

"  He  was  glad  to  die.  In  the  last  conversation  I  had  with  him,  he 
was  anxious  to  know  if  I  believed  he  was  going  to  die.  When  I  told 
him,  yes,  I  knew  he  could  live  only  a  short  time  longer,  he  shouted 
for  joy  to  have  his  hope  confirmed;  he  struck  his  breast  and  cried  aloud: 
'  Good,  good,  good,'  I  prayed  with  him,  and  then  he  continued  the 
prayer  in  extreme  feebleness  of  body  and  mind.  I  wrote  down  the  words 
when  I  got  home :— '  I  want  to  pray  God  to  bless  my  children  and  be 
to  them  all  he  has  been  to  me.  He  has  always  taken  care  of  me  ever 
since  I  was  a  child.  And  when  my  life  was  shattered,  he  took  my 
life  and  changed  me  and  made  me  a  Christian.  There  was  a  time  when 
I  hated  God  and  hated  his  word,  and  it  was  all  offensive  to  me.  But 
then  the  time  came  when  it  was  all  good.  I  want  God  to  take  me  home 
soon.    I  am  tired  and  want  to  go." 

James  E.  Smith,  M.  D. 

Dr.  James  Ezra  Smith  died  on  the  morning  of  August  15,  1906,  at  the 
Albany  Hospital  following  a  stroke  of  paralysis  and  a  fracture  of  the 
skull  sustained  by  a  consequent  fall.  Dr.  Smith  was  stricken  at  his  home, 
315  Washington  avenue,  was  immediately  taken  to  the  Albany  Hospital 
but  never  regained  consciousness. 

Dr.  Smith  was  the  oldest  son  of  Dr.  Charles  H.  and  Lucy  Blair  Smith, 
and  was  born  in  Albany,  October  5,  1867.  He  was  educated  at  the 
Albany  Academy,  and  at  Union  College.  He  then  studied  with  Dr. 
Vander  Veer  and  graduated  from  the  Albany  Medical  College  with  the 
class  of  1889.  He  did  post-graduate  work  at  the  New  York  Polyclinic 
and  New  York  Post-Graduate  School  and  Hospital.  He  was  the  vale- 
dictorian of  his  class  when  graduated  from  the  Albany  Medical  College. 
He  was  a  member  of  the  Medical  Society  of  the  County  of  Albany  and 
was  county  physician  for  four  years,  from  1890  to  1893.  He  was  a 
member  of  the  Albany  Club. 

Dr.  Smith  was  particularly  interested  in  military  affairs.  His  military 
career  commenced  at  the  Albany  Academy.  On  July  9,  1885,  he  enlisted 
as  a  private  in  Company  A,  Tenth  Battalion;  on  June  9,  1889  he  was 
elected  a  sergeant;  on  November  15,  1893,  he  was  made  inspector  of 
small  arms  practice  with  rank  of  first  lieutenant.  At  the  outbreak  of  the 
Spanish  war  he  became  second  lieutenant  of  Company  D,  First  New 
York  Volunteer  Infantry,  in  which  he  served  in  the  Hawaiian  islands. 
On  May  18,  1904,  he  was  made  assistant  surgeon  of  the  Tenth  Battalion 
and  on  May  1,  1905,  when  the  Tenth  Regiment  was  organized,  he  was 
rendered  supernumerary. 


CURRENT  MEDICAL  LITERATURE 


679 


Lieutenant  Smith  was  among  the  first  who  assisted  in  the  organization 
of  Captain  Frank  Rockwell  Palmer  Camp,  Spanish-American  War 
Veterans.  He  was  an  earnest  worker  in  the  interests  of  the  Spanish 
war  veterans,  and  two  years  before  his  death  was  elected  commander  of 
Palmer  Camp.  A  week  before  his  death  he  was  elected  senior  vice- 
commander  of  the  State  Department  of  the  Veterans,  and  had  he  lived 
he  would  undoubtedly  have  succeeded  to  be  State  commander.  He  was 
a  member  of  the  Albany  Association  of  National  Guard  Officers. 


Current  /fccMcal  Xttcraturc 

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ANNOUNCEMENT  OF  NEW  BOOKS 

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fall  the  following  works : 

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Webster's  Text-Book  of  Gynecology. 

Hill's  Histology  and  Organography. 

McConnell's  Pathology. 

Morrow's  Immediate  Care  of  the  Injured. 

Stevenson's  Photoscopy  (Retinoscopy  and  Skiascopy). 

Preiswerk  and  Warren's  Atlas  of  Dentistry. 

Goepp's  State  Board  Questions  and  Answers. 

Lusk's  Elements  of  Nutrition. 


The  Practical  Medicine  Series.  Comprising  ten  volumes  on  the  year's 
progress  in  medicine  and  surgery,  under  the  general  editorial  charge 
of  Gustavus  P.  Head,  M.  D.  Vol.  Ill,  The  Eye,  Ear,  Nose  and 
Throat,  edited  by  Casey  A.  Wood,  C.  M.,  M.  D.,  D.  C.  L., 
Professor  of  Clinical  Ophthalmology,  Medical  University  of  Illinois ; 
Albert  H.  Andrews,  M.  D.,  Professor  of  Otology,  Chicago  Post- 
Graduate  Medical  School;  Gustavus  P.  Head,  M.  D.,  Professor  of 
Larvnology  and  Rhinology,  Chicago  Post-Graduate  Medical  School. 
Series  1906.  The  Yearbook  Publishers,  40  Dearborne  street, 
Chicago.    Cloth.  Octavo. 

The  third  volume  of  this  series  fully  sustains  the  reputation  achieved 
by  the  two  that  have  preceded  it.  While  it  is  impossible  to  completely 
cover  the  year's  work  done  in  these  three  important  medical  specialties, 
within  the  space  allotted  to  them  in  this  book  of  369  pages,  the  editors 
in  charge  have  given  us  a  compact  and  well  written  resume  of  the  progress 
made  along  these  lines. 


68o 


CURRENT   MEDICAL  LITERATURE 


An  equal  number  of  pages  have  been  devoted  to  each  specialty,  and 
while  the  rare  and  unusual  have  not  been  neglected  by  the  editors  in 
arranging  their  abstracts,  still  the  more  practical  side,  that  which  will 
appeal  to  the  general  practitioner  as  well  as  the  specialist,  have  been 
emphasized  and  more  fully  discussed,  and  the  value  of  this  work  as  a 
book  of  reference  enhanced. 

Considerable  attention  has  been  devoted  to  papers  on  ocular  symptoms 
in  general  diseases  and  this  is  true  in  regard  to  those  parts  of  the  work 
which  treat  of  the  ear,  and  of  the  nose  and  throat. 

Also,  because  of  their  eminently  practical  value,  many  therapeutic  agents 
have  been  described  and  their  employment  discussed  at  some  length.  A 
comprehensive  and  well  arranged  index  and  a  list  of  all  the  authors  cited 
bring  the  volume  to  a  close. 

c.  H.  M. 


A  Text-Book  on  the  Practice  of  Gynecology.  For  practitioners  and 
students.  By  W.  Easterly  Ashton,  M.  D.,  LL.D.  Octavo 
volume  of  1079  pages,  with  1046  illustrations.  Second  edition. 
Philadelphia  and  London :  W.  B.  Saunders  and  Company,  1906. 

A  review  of  the  first  edition  may  be  found  in  the  August  Annals  for 
1005.  The  author  states  that  "  In  making  this  review  of  my  Practice 
of  Gynecology  within  so  short  a  time,  the  changes  are  necessarily  few  in 
number  and  chiefly  limited  to  correcting  a  few  typographical  errors  and 
altering  several  of  the  illustrations." 

J.  a.  s. 


Eczema.    By  Samuel  H.  Brown,  M.  D.    P.  Blakiston's  Sons  &  Company, 

Philadelphia,  1906. 

The  author  in  this  small  volume  of  100  pages  discusses  eczema  and 
eczema  seborrhoicum  after  the  manner  of  a  clinical  lecture.  It  is  not 
intended  to  be  an  original  piece  of  work,  nor  does  it  contain  anything 
new.  The  facts,  however,  are  stated  clearly  and  concisely  and  everything 
theoretical  is  omitted.  The  author  is  purposely  dogmatic  lest  the  state- 
ments lose  weight  by  being  qualified. 

The  therapeutic  measures  recommended  are  valuable  in  that  they  are 
arranged  to  suit  every  variety  of  the  disease.  Proprietary  preparations 
such  as  cuticura  and  eczymol  are  condemned  because  the  conditions  in 
the  skin  are  constantly  changing  and  demand  frequent  alterations  in 
the  strength  of  the  medicaments  used.  The  role  of  diathesis  in  the  etiology 
of  eczema  is  of  little  importance. 


Vol.  xxvii 


OCTOBER,  1906 


No.  10 


ALBANY 
MEDICAL  ANNALS 


©riainal  Communications 

NIL  DESPERANDUM  AS  AN  ARTICLE  OF  THE  RE- 
FRACTIONIST'S  MATERIA  MEDICA. 

By  GEORGE  M.  GOULD,  M.  D., 

Philadelphia. 

Between  two  and  three  years  ago  Professor  Blank,  34  years  old, 
of  one  of  our  large  eastern  universities,  came  to  me  and  gave 
a  sad  history  of  ocular  and  other  symptoms.  His  troubles  began 
at  least  fourteen  years  ago,  since  which  time  he  had  worn  spec- 
tacles constantly.  Ten  years  ago  he  had  a  "nervous  breakdown" 
when  in  college.  His  earliest  symptoms  were  headache,  "a 
strained  feeling,''  etc.,  in  the  eyes.  There  was  little  or  no  relief, 
and  a  crisis  came  in  January,  1901.  It  was  the  kind  of  "crisis" 
which  occurs  more  often  than  we  know — a  sudden  dilation  of  the 
pupil  of  the  right  eye,  with  paralysis  of  the  accommodation.  Con- 
sultations followed  with  a  number  of  the  most  famous  oculists  of 
Germany,  Von  Hippel,  Schmidt-Rimpler,  Englehardt,  Pantynsky, 
etc.  None,  of  course,  gave  any  relief,  or  influenced  the  condi- 
tion, for  none  dreamed  of  the  cause.  One  gave  pilocarpin,  tem- 
porarily relieving  the  objective  symptoms.  Studies  and  occupa- 
tion were  given  up — a  small  matter  with  a  young,  ambitious 
successful  teacher  and  man  of  learning,  and  soon  "nervous  pros- 
tration" ensued.  He  then  tried  a  period  of  absolute  rest,  and  per- 
fect recovery  seemed  established.  Why  should  ocular  rest  have 
cured  the  cycloplegia?  Because  eyestrain  had  caused  it,  would 
rppear  a  sensible  answer.  Europe  did  not  recognize  such  simple 
clinical  facts  and  such  simpler  logic.  In  one  week  after  "perfect 
recovery,"  with  resumption  of  literary  work,  there  was  absolute 
"breakdown"  again.  The  pilocarpin  was  again  renewed  with 
temporary  ability  to  work  some.    The  habit  of  doctoring  the 


682 


NIL  DESPERANDUM 


symptom,  treating  the  effect  and  ignoring  the  cause— how  old  it 
is,  and  how  stupid!  Gradually  pilocarpin  became  useless,  and 
then  renunciation  of  effort,  and  resignation  both  collegiate  and 
psychic,  followed.  His  last  glasses  were  ordered  by  Dr.  W.  of 
New  York,  who  prescribed: 


R.+S.  3.00+Cyl.  1.75  ax.  450 
L.+S.  4.00+Cyl.  2.00  ax.  1350 

R-+S.  3-75+Cyl.  1-75  ax. 


For  distance 


K.+b.  3-75+Cyl.  1-75  ax.  450  ) 
L.+S.  4.00+Cyl.  2.00  ax.  i35°  }  F°r  readmg- 

This  physician  had  found,  therefore,  a  slight  paresis  of  accom- 
modation in  the  right  eye,  and  none  in  the  left.  But  several 
other  things  were  not  found  which  were  necessary  to  cure. 

Intense  photophobia  now  appeared,  and  became  so  severe  that 
the  patient  had  to  sit  in  the  darkness  every  evening,  as  no  artifi- 
cial light  could  be  endured.  This  symptom,  with  many  varia- 
tions, is  also  common  in  other  patients.  Why  can  the  weak  small 
flames  of  artificial  lights  not  be  borne  when  daylight  and  even 
sunlight  gives  no  trouble?  Because  daylight  is  diffused,  the  sun 
is  never  looked  at,  the  ocular  stimulus  is  reflected.  The  shading 
mechanisms  of  the  eye  are  numerous,  and  of  great  varieties,  but 
the  illumination  of  our  houses  and  public  buildings  is  atrocious. 
The  source  of  light  should  never  be  seen.  But  Nature,  and  all 
the  "theater  headaches,"  "panorama  headaches,"  etc.,  are  not  to 
be  considered ! 

Finally  my  patient  could  not  endure  the  daylight,  could  not  read 
at  all  in  any  light  and  by  any  means.  In  the  last  year  before 
coming  to  me,  even  the  writing  of  a  letter  brought  on  headache, 
first  frontal,  then  extending  to  the  temples  and  occiput ;  in  twenty 
minutes  his  head  would  feel  as  if  it  would  burst  ("rush  of  blood 
to  the  head"  of  antiquity,  ancient  and  modern).  In  the  last 
months  before  coming  to  me  he  has  had  attacks  of  dizziness, 
"grippe,"  etc.  His  digestion  is  perfect.  Repeated  urinalyses 
show  renal  normality.  During  the  severe  attacks  of  photophobia 
he  would  "shake  all  over."  In  former  years  he  had  high  ner- 
vous tension,  and  great  mental  depression,  but  he  is  not  just 
now  despondent,  although  physically  is  "run  down."  He  is  now 
very  "irritable."  The  New  York  physician,  (Praised  be  the 
Lord!)  ordered  the  pilocarpin  discontinued  entirely. 

At  the  first  visit  I  found  the  right  pupil  half  dilated  and 


GEORGE  M.  GOULD 


683 


stabile — the  flag  was  at  half-mast !  The  iris  responded  to  no  test. 
The  media  and  fundus  were  normal.  Under  cycloplegia  the 
errors  of  refraction  were : — 

R.+S.  2.75+Cyi.  2.25  ax.  45°=2o/20 
L.+S.  3.75+Cyl.  2.25  ax.  i35°=2o/40 

Significant  also  was  the  fact  that  although  at  twenty  feet  the 
muscle  balance  showed  3°  B.  O.,  the  abduction  was  io°  and  the 
adduction  only  14.  More  significant  still  was  this :  There  was 
subnornal  accommodation  amounting  to  about  two  diopters.  As 
I  should  for  a  time  order  discontinuance  of  near-work  I  added 
in  a  second  frame  only  one  diopter  to  the  mydriatic  error  in  order 
to  help  him  a  little  in  his  necessary  writing  of  a  few  letters, 
ordering  also  the  full  mydriatic  correction  for  constant  use. 
Prism-gymnastic  exercises  were  instituted  to  increase  the  adduc- 
tion power.  In  the  next  five  months  there  was  considerable  gain 
in  the  ability  to  read,  which  was  now  an  hour  or  two  a  day ;  but 
he  had  failed  to  return  for  advice  as  I  had  urged,  and  I  found 
now  that  the  muscles  had  become  badly  unbalanced ;  some  hyper- 
phoria, and  an  abnormally  high  esophoria  had  appeared.  The 
acuteness  of  vision  had  improved  in  both  eyes,  the  left  register- 
ing 20/30  and  with  both  eyes  20/20+.  I  now  ordered  bifocals, 
adding  two  diopters  to  the  distance  correction  in  the  reading 
segments.  At  first  these  produced  nausea,  and  he  had  to  lie  in 
bed  for  several  days.  This  was  to  me  a  good  sign  instead  of  a 
bad  one.  I  was  steadily  and  doggedly  resisting  the  wish  and 
suggestion  of  tenotomy,  and  thought  several  times  I  might  lose 
my  patient  by  my  conviction  that  it  could  do  only  harm.  The 
nausea  soon  stopped,  the  reading  ability  grew,  and  by  June,  1905, 
the  man  was  reading  three  or  more  hours  a  day  with  no  head- 
ache, etc.  The  hyperphoria  had  practically  disappeared,  and  the 
esophoria  was  rapidly  lessening.  In  October,  1905,  his  prescrip- 
tion for  new  glasses  read  as  follows: — 


From  tl?is  time  the  gain  has  been  more  rapid,  until  now  he  may 
be  called  well,  and  able  to  resume  his  work  again.  He  is  trying 
to  secure  some  college  or  teaching  position.  I  append  extracts 
from  his  last  letters. 


R.+Sph.  3.00-fCyl.  2.00  ax.  500 
L+Sph.  4.00+Cyl.  2.00  ax.  1300 
R+Sph.  5.00  and  cylinder 
L+Sph.  5.50  and  cylinder 


Distance 


Near 


Bifocals. 


684 


NIL  DESPERANDUM 


"  I  am  getting  on  splendidly.  I  am  using  my  eyes  about  six 
hours  a  day  at  close  work  now.  When  they  get  tired  I  stop. 
I  have  had  no  nervous  setback  for  three  months  or  more.  You 
have  no  idea  how  rejoiced  I  am.  I  never  really  began  to  improve 
until  last  November.  I  shall  be  at  work  next  fall,  and  I  have 
only  you  to  thank,  and  you  cannot  know  how  much  I  am  indebted 
to  you.  I  was  so  discouraged,  and  I  fear  you  also  were,  it 
took  so  long  for  the  tide  to  turn." 

"  I  have  practically  to  begin  life  over  again,  but  with  all  the 
drawbacks  and  encumbrances  of  a  late  start.  You  have  made 
it  possible  for  me  to  go  on  with  my  life-work  and  that  is  every- 
thing— it  cannot  be  measured  in  dollars  and  cents.  After  four 
years  of  sickness — etc." 

I  have  for  the  most  part  omitted  some  of  the  more  important 
parts  and  details  of  a  full  report  because  they  might  prove 
wearisome  to  those  who  give  pilocarpin  for  eyestrain  cycloplegia, 
or  who,  with  a  polite  goodbye,  hand  an  ophthalmometer-diagnosis 
and  prescription,  made  in  two  minutes,  for  a  patient  without  a 
history,  without  an  occupation,  and  without  a  future.  That  is 
good  enough  for  "  Science  "  and  for  "  Success,"  but  it  will  not 
cure  the  patient.  And  it  would  be  difficult  to  epitomize  the 
struggle  I  had  for  nearly  two  years  against  temporary  relapses, 
against  despondency,  against  "  neurasthenia,"  against  new 
symptoms,  against  tenotomy,  against  photophobia,  and  against 
temporary  heterophoria  and  even  passing  strabismus,  and  sev- 
eral other  worries.  To  several  prerequisites  of  faith,  and 
articles  of  faith  I  held  fast  and  kept  my  patient  from  despair 
and  from  trying  any  "  experiments  "  : — 

1.  The  man  had  a  history;  his  disease  had  a  history.  The 
existing  disease  and  the  hurt  patient  there  before  the  physician 
are  not  the  only,  often  not  the  chief,  data  in  making  a  diagnosis. 
They  are  what  one  treats,  and  sometimes  they  may  help  in 
diagnosis.  The  careful  eliciting  of  a  long  tedious  history,  neces- 
sary to  the  rational  practice  of  medicine  is  ignored,  even  scorned 
by  many  physicians.  Only  the  biographic  clinic  can  show  the 
causes  of  the  disease,  running  back  through  years  of  morbid 
habit. 

2.  Every  item  of  the  history  cried  out,  Eyestrain !  The  nervous 
breakdown  at  college  and  with  study,  the  recuperation  with 
ocular  rest,  the  ingravescence  of  symptoms,  the  resisting  digestive 


GEORGE  M.  GOULD 


685 


system,  the  cerebral  symptoms,  all  begged  for — simply  a  pair  of 
spectacles  that  would  stop  the  cause  eyestrain. 

3.  "  Scientific  ophthalmology/'  especially  the  European  brand, 
had  resulted  in  the  common  farce-tragedy.  Pilocarpin,  and 
incorrect  glasses  were  as  much  or  as  little  indicated  as  trephining, 
or  as  tenotomy  of  the  Achilles  tendon  or  of  the  inferior  oblique 
of  the  eyes. 

4.  The  patient  was  a  human  being,  having  emotions,  desires 
to  live,  with  ambitions,  and  abilities  (all  except  ocular  ones), 
for  a  career — then  for  two  years  ruined.  His  future  happiness, 
usefulness,  and  perhaps  life,  depended  upon  his  cure,  and  upon 
the  methods  and  characteristics  of  the  man  who  undertook  it. 
There  is  more  in  medicine  than  treating  the  disease,  more  than 
in  treating  the  patient.  The  patient  is  a  person,  a  friend  and 
brother,  with  a  past  and  a  future.  The  classing  and  treating 
sick  human  beings  exclusively  as  "  clinical  material  "  is  an  ac- 
cursed thing  and  the  curse  of  medicine. 

5.  Being  certain  that  this  patient's  disease  was  due  to  eyestrain, 
and  his  heterophoria  due  to  ametropia.  I  resolutely  persisted  in 
refusing  any  treatment  except  by  and  through  the  eyes. 

6.  But  there  was  accurate  refraction-diagnosis,  upon  which  all 
else  depended,  accurate  fitting  and  wearing  of  spectacles ;  and 
his  subnormal  accommodation  was  attended  to.  his  entire 
astigmatism  was  corrected,  and  the  eyes  generally  put  in  such 
a  condition  that  the  accommodation  was  in  physiologic  play, 
with  as  little  strain  as  possible. 

7.  As  usual  the  influence  of  dextrocularity,  etc..  was  clearly 
shown  in  the  exclusion  first,  of  the  left,  amblyopia,  (always  to 
be  watched  as  a  sign,  usually  ignored)  then  in  the  renunciation 
of  the  right  by  cycloplegia. 

8.  The  motto  of  a  good  physician  is  Nil  despcrandum !  In  the 
Xew  Ophthalmology  (scientific  refraction-work)  the  cures  are 
usually,  i.  e.,  in  not  too  chronic  cases,  so  much  the  rule,  so 
auick  and  brilliant,  that  it  seems  almost  absurd.  But  when  other 
bodily  organs  have  been  injured  or  diseased,  when  the  mind 
has  lost  resisting  power,  when  even  the  mere  habit  of  disease 
has  become  too  inveterate,  pluck,  and  self-confidence,  and  "  hang- 
ing to  the  patient."  if  based  upon  skill,  self-scrutiny  and  caution, 
will  finally  reward  one  for  the  long  struggle. 


686 


TUMORS  OF  THE  TRACHEA 


TUMORS  OF  THE  TRACHEA. 

Read  at  the  Annual  Meeting  of  the  American  Laryngological  Association  at 
Niagara  Falls,  A\  Y.,  June  i,  igo6. 

By  CLEMENT  F.  THEISEN,  M.  D., 

Clinical  Professor  in  Diseases  of  the  Nose  and  Throat,  Albany  Medical  College. 

Bruns,  in  his  very  complete  article  on  the  neoplasms  in  the 
air  passages  (trachea),  states  that  the  first  observation  of  a 
tracheal  tumor  was  in  1767,  by  Lieutaud.  The  patient  in  whom 
it  was  observed,  a  boy,  died  of  a  sudden  attack  of  dyspnea,  and  a 
polyp  with  a  long  pedicle,  which  had  been  carried  into  the  glottis 
by  the  air  current  and  had  caused  the  sudden  death,  was  found. 
After  the  introduction  of  the  laryngoscope  the  reports  of  tracheal 
tumors  became  more  frequent. 

Tuerck,  in  1861,  was  the  first  to  observe  a  tumor  in  the  upper 
part  of  the  trachea  in  the  laryngeal  mirror.  After  him  cases 
were  reported  by  M.  Mackenzie,  Schroetter,  and  Stoerk.  This 
rare  occurrence  of  tracheal  tumors  is  in  great  contrast  to  the  fre- 
quency of  laryngeal  tumors,  as  Semon  in  1889  collected  over 
10,000  cases  of  benign  laryngeal  neoplasms  (Bruns).  Accord- 
ing to  these  figures,  tracheal  new  growths  as  compared  to  those 
occurring  in  the  larynx  would  be  less  than  one  per  cent.,  or,  in 
other  words,  the  relation  would  be  approximately  100  laryngeal 
growths  to  one  in  the  trachea. 

Bruns'  personal  observations  are  somewhat  different,  as  he 
observed  300  laryngeal  growths  to  seven  in  the  trachea. 

Moritz  Schmidt,  out  of  42,635  cases  of  diseases  of  the  upper 
air  passages,  observed  2,088  new  growths,  of  which  748  were 
laryngeal  and  only  three  tracheal. 

Bruns  states  that  the  slight  tendency  of  the  trachea  to  the  de- 
velopment of  new  growths  may  be  explained  by  the  fact  that  the 
trachea,  which  is  a  simple  rather  rigid,  smooth  tube,  has  prac- 
tically only  the  passive  function  of  the  passage  of  air,  while  the 
larynx  has  a  complicated  structure,  and  such  a  function  that  its 
parts  are  in  almost  constant  motion.  This  also  explains  perhaps 
the  slight  tendency  of  the  trachea  to  primary  catarrhal  inflam- 
mations, and  the  fact  that  the  majority  of  tracheal  tumors  are 
in  the  upper  part  of  the  trachea  and  the  smallest  number  in  the 
middle,  because  particularly  this  part  of  the  trachea  is  so  well 
protected  from  irritation  of  all  kinds. 


CLEMENT  F.  THEISEN 


687 


In  order  to  study  the  subject,  the  statistics  of  the  different 
writers  had  to  be  consulted.  The  valuable  theses  of  Mueller,3 
Koch,1  Orth,4  Schroetter,5  Lemoine,7  Scheuer,6  and  Bains'  mono- 
graph8 were  of  great  assistance  in  preparing  this  paper.  The 
monograph  of  J.  Solis-Cohen41  in  Ashhurst's  Encyclopedia  was 
also  used.  A  good  many  of  the  original  reports  of  cases  were 
also  consulted. 

Granulation  tumors  resulting  from  tracheotomies  and  the  wear- 
ing of  tracheal  cannulas,  and  the  syphilitic  or  tuberculous  granu- 
lomata,  were  not  considered  genuine  tumors,  and  were  not  in- 
cluded in  this  paper.  The  writer's  paper  is  based  on  a  study  of 
most  of  the  authentic  cases  of  primary  tracheal  tumors  in  the 
literature,  135  cases  in  all.  Other  cases  have  been  reported,  but 
in  some  of  them  there  was  some  doubt  of  the  diagnosis  and  in 
others  the  data  were  insufficient. 

Of  the  135  cases  89  are  benign  and  46  malignant. 

Benign  Neoplasms 

The  benign  new  growths  occurring  in  the  trachea  are  about 
the  same  as  those  observed  in  the  larynx.  The  following  varie- 
ties occur  in  the  trachea :  the  fibroma  (polypus,  fibrous  polypus), 
the  lipoma,  the  papilloma,  the  ecchondroma  and  chondro-osteoma, 
the  adenoma,  the  intratracheal  goitre  or  struma,  and  the  lymph- 
oma. Of  the  malignant  neoplasms  only  the  sarcoma  and  car- 
cinoma have  been  observed  occurring  primarily  in  the  trachea. 

Intratracheal  Struma. — Considering  first  the  benign  growths, 
we  find  that  the  intratracheal  struma  is  one  of  the  rarest  as  well 
as  one  of  the  most  interesting  forms. 

Cases  of  intratracheal  struma  have  been  reported  by  Ziems- 
sen,73  Bruns,74  Heise,75  Roth,77  Paltauf,78  Baurowics,80  Freer,81 
and  Theisen.82 

Three  cases,  those  of  Neumayer71  and  Frankenberger,72  re- 
ported as  cases  of  struma,  have  not  been  included  in  this  list, 
because  the  diagnosis  was  not  proved  in  any  of  the  cases. 

Abstracts  of  the  reported  cases  of  intratracheal  struma  will  not 
be  given,  because  they  were  published  in  the  writer's  original 
paper,  "A  Case  of  Intratracheal  Colloid  Struma :  Operation,"  in 
the  American  Journal  of  the  Medical  Sciences,  June,  1902.82  A 
full  report  of  the  writer's  case  was  published  at  that  time,  with 
the  histological  diagnosis,  which  was  "  colloid  struma  originating 
in  thyroid  tissue  situated  beneath  the  submucosa  of  the  trachea." 


688 


TUMORS  OF  THE  TRACHEA 


It  may  be  of  interest  to  mention  at  this  time  that  the  tumor, 
which  was  removed  by  tracheo-fissure,  November  i6,  1901,  and 
which  extended  downwards  along  the  posterior  wall  of  the 
trachea  from  the  first  ring  for  a  distance  of  five  centimeters,  has 
not  returned.  I  examined  the  patient  a  few  months  ago,  and 
found  the  trachea  clear  with  the  exception  of  a  little  thickening 
where  the  tumor  had  been  attached  to  the  tracheal  wall.  Fig.  1 
shows  the  tumor  as  it  looked  on  laryngoscopy  examination,  and 
Fig.  2  shows  a  drawing  of  a  section,  low  power. 

As  the  etiology  of  this  class  of  benign  intratracheal  growths 
has  been  so  well  studied,  I  will  consider  it  rather  thoroughly. 
Up  to  the  time  of  Paltauf's78  investigation  it  was,  however, 
rather  obscure. 

The  two  theories  as  to  the  origin  of  this  most  interesting  form 
of  tumor  that  have  received  the  most  consideration  are  those  of 
Bruns79  and  Paltauf.70  Bruns  and  Heise,  the  chief  exponents 
of  the  embryonal  theory,  held  that  in  intrauterine  life  a  small 
accessory  thyroid  lobule  from  aberrant  embryonic  rudiments  of 
the  thyroid  gland  ("Angeborene  Verlagerung  von  Schilddrues- 
engewebe")  must  have,  in  such  cases,  been  present  in  the  foetal 
larynx  or  trachea.  This  lobule,  developing  about  the  time  of 
puberty,  resulted  in  the  true  intralaryngeal  or  tracheal  so-called 
"  accessory  thyroid  tumor."  Paltauf  was  able  to  prove  in  his 
case  by  microscopical  examinations  that  this  theory  was  not 
tenable.  In  his  case  there  was  a  connection  between  the  intra- 
tracheal growth  and  the  thyroid  gland  externally.  The  thyroid 
was  so  firmly  attached  to  the  cricoid  cartilage  and  upper  three 
tracheal  rings  that  it  could  not  be  separated  from  them.  The 
space  between  the  cricoid  and  first  tracheal  ring,  and  a  portion 
of  the  external  lateral  lobe  of  the  thyroid,  which  was  firmly  ad- 
herent to  the  cartilage  at  this  point,  were  examined  microscopic- 
ally, and  he  was  able  to  prove  positively  that  the  thyroid  tissue 
had  penetrated  (through  the  interstitial  membranes)  to  the  per- 
ichondrium and  submucosa  on  the  inner  surface  of  the  trachea, 
the  cartilage  itself  remaining  intact.  This  observation  of  Pal- 
tauf's is  the  first  instance  on  record  of  normal  thyroid  gland  tissue 
penetrating  to  the  interior  of  the  trachea,  although  Orth,86  in  his 
"  Pathological  Anatomy."  makes  the  statement  that  "  strumas, 
but  particularly  malignant  neoplasms,  could  penetrate  into  the  air 
passages." 

Paltauf's  conclusions,  that  these  tracheal  tumors  springing 


CLEMENT  F.  THEISEN 


689 


from  thyroid  tissue  do  not  owe  their  origin  to  an  intrauterine 
deposit  of  thyroid  tissue,  are  of  great  interest.  They  should 
therefore  not  be  called  accessory  thyroid  tumors.  They  originate 
in  extra-uterine  life  by  penetration  of  the  gland  tissue  between 
the  cricoid  and  the  thyroid  cartilages,  between  the  cricoid  and 
first  tracheal  ring,  between  the  upper  tracheal  rings,  and  through 
the  interstitial  tracheal  membrane  itself,  from  without.  When 
this  occurs  it  should  be  considered  as  a  direct  extension  of  an 
enlarged  thyroid  gland — a  parenchymatous  struma.  Proof  of 
this  assertion  is  that  the  thyroid  gland  has  really  grown  fast  to 
the  cricoid  cartilage,  interstitial  membranes,  and  upper  tracheal 
rings.  This  abnormal  adhesion  can  be  explained  neither  by 
pressure,  nor  by  an  inflammatory  process,  but  can  only  have 
occurred  during  the  formation  and  development  of  the  thyroid 
gland,  and  only  in  the  way  that  the  fcetal  gland,  in  these  cases, 
must  be  united  with  the  perichondrium  of  the  cartilage  and  the 
interstitial  membranes. 

Gruber's  investigations,83  perhaps,  would  give  additional  sup- 
port to  Paltauf's  theory.  He  found,  after  examinations  of  many 
Russians  and  Bohemians,  that  there  was  often  an  accessory  or 
really  an  extra  lobule  extending  downward  from  the  lowest  pos- 
terior margin  of  the  lateral  lobes  and  lying  very  close  to  the 
trachea.  These  extra  lobules  may  also  lie  in  the  cricothyroid 
space.  The  only  parallel  cases  that  possibly  give  some  support  to 
Bruns'  theory  are  those  observed  by  Streckeisen.87  He  found 
on  sections  through  the  hyoid  bone  seven  times  the  so-called 
glandulae  intrahyoidea,  that  is,  thyroid  tissue  was  shut  in  the 
bone.  He  believes  that  this  was  shut  in  during  the  ossifica- 
tion period. 

In  my  own  case  it  could  not  be  determined  during  the  opera- 
tion whether  the  left  lateral  thyroid  lobe,  which  was  enlarged, 
was  adherent  to  the  trachea  or  not.  The  isthmus  was  not, 
because  in  ligating  it  the  ligatures  could  be  readily  passed  be- 
tween it  and  the  trachea.  It  is  a  rational  deduction,  however, 
from  the  fact  that  the  intratracheal  growth  was  really  part  of 
the  tracheal  wall,  and,  springing  as  it  did  from  the  posterior 
and  left  lateral  wall,  that  in  this  case,  too,  the  intratracheal 
tumor  was  really  an  offshoot  from  the  left  lateral  thyroid 
lobe. 

An  analysis  of  the  ten  cases  of  this  class  of  tumors  brings  out 
a  number  of  interesting  points :    (a)  The  location  of  the  tumors 


690 


TUMORS  OF.  THE  TRACHEA 


in  all  the  cases,  with  the  exception  of  Bruns'  last  case,  was  char- 
acteristic. They  were  all  situated  in  the  lower  part  of  the  larynx 
and  upper  part  of  the  trachea  and  attached  to  the  lateral  and 
posterior  walls.  Bruns'  last  case  was  the  only  exception  to  this 
rule,  the  growth  being  attached  to  the  anterior  wall,  (b)  This 
point  decides  another  interesting  fact  before  mentioned  that  these 
tumors  for  this  reason,  should  not  be  called  accessory  thyroid 
tumors,  because  they  are  really  offshoots,  from  the  thyroid,  as 
proved  in  the  majority  of  the  cases  by  the  adhesion  of  the  thyroid 
to  the  tracheal  wall,  and  in  Paltauf's  case,  microscopically,  by 
the  infiltration  of  the  interstitial  membranes  with  the  follicles  of 
the  thyroid  gland,  (c)  They  were  all  observed  early  in  life, 
from  the  fifteenth  to  the  thirty-third  year,  with  the  exception  of 
Roth's  case77  (the  fortieth  year),  (d)  A  goitre  of  moderate  size 
was  present  in  all  except  in  one  of  Heise's  and  in  Freer's  case,  (e) 
They  occurred  in  both  sexes — three  in  males,  and  seven  (includ- 
ing the  author's)  in  girls  and  young  adult  women. 

Papillomata. — The  trachael  papilloma  is  one  of  the  commonest 
benign  tracheal  growths,  and  usually  occurs  together  with  multi- 
ple laryngeal  pappillomata.  The  majority  of  the  cases  of  tracheal 
papilloma  occur  in  children. 

Six  of  the  recorded  cases  of  tracheal  papilloma  were  undoubt- 
edly congenital,  because  the  children  were  hoarse  and  there  was 
dyspnea  from  birth. 

Bruns  has  found  the  same  to  be  true  of  laryngeal  papilloma  in 
children,  about  one  fourth  of  the  cases  being  congenital.  (Bruns, 
P.  Die  Laryngotomie  z.  Entfernung  intra-laryngaler  Neubildun- 
gen,  Berlin,  1878,  S.  179). 

Cases  of  tracheal  papilloma  have  been  reported  by  Davis  Col- 
ley,11  Maissonneuve,10  Bruns,9  Schroetter,12  Mackenzie,  M.,1* 
Labus,15  Mackenzie,  M.,14  Butlin,16  Labus,17  J.  Solis-Cohen,18 
Schaller,™  Teschendorf,20  Chiari,21  Siegert,22  Weil.23  Stoerk,24 
Mackenzie,  M.,26  Stoerk,25  and  Krishaber.27 

A  study  of  the  reported  cases  shows  that  in  a  little  less  than 
one-third  of  the  number  the  papillomata  were  confined  to  the 
trachea  and  in  the  majority  of  the  cases  are  attached  to  the  ante- 
rior wall,  although  they  also  occur  in  the  posterior  and  lateral 
walls.  Siegert22  has  reported  a  papilloma  as  large  as  a  pigeon 
egg,  close  to  the  bifurcation,  and  Stoerk25  has  also  reported  a  case 
in  which  the  growth  was  close  to  the  bifurcation. 

Chiari21  diagnosed  a  case  with  the  laryngeal  mirror  in  which 


t 


CLEMENT  F.  THEISEN  691 

the  growth  was  attached  to  the  posterior  wall  at  about  the  tenth 
ring.  Maissonneuve,10  in  1856,  at  autopsy,  found  in  the  trachea 
of  a  boy  aged  ten  years  numerous  reddish-white  vegetations, 
which  extended  upwards  to  the  vocal  cords.  They  had  started 
about  two  years  before  death,  with  catarrhal  symptoms  of  the  air 
passages. 

Stoerk24  observed  another  case  in  a  man,  aged  22  years,  in 
which  multiple  papillomata  were  present  in  the  trachea  at  the 
level  of  the  third  ring,  with  numerous  laryngeal  papillomata. 

Labus45  48  has  reported  three  cases  removed  per  vias  naturales. 
In  the  first  case  there  were  papillomata  of  the  left  vocal  cord, 
and  others  in  the  trachea  (fifth  to  eighth  rings).  Removed  with 
forceps,  but  recurred  every  four  or  five  months.  Final  cure 
was  obtained. 

Second  case:  Small  growth  at  level  of  third  tracheal  ring  in 
boy,  13  years  old.  Removed  with  forceps.  No  recurrence  after 
five  years.  Although  the  diagnosis  of  fibrosarcoma  was  made 
in  this  case  microscopically,  it  was  probably  not  malignant,  from 
the  fact  that  there  was  no  recurrence  after  an  endotracheal 
removal. 

Third  case:  Tracheal  papilloma,  man  aged  63  years,  at  the 
level  of  the  fifth  ring.  Removed  with  forceps  in  different  sit- 
tings. 

Mackenzie,  J.  N.  ("Transactions  American  Laryngoiogical  As- 
sociation," 1898),  described  tuberculous  tumors  in  the  trachea, 
which  at  times  takes  the  form  of  papillomata. 

Bruns9  has  reported  two  cases  of  tracheal  papilloma  in  children 
aged  respectively  seven  and  ten  years,  occurring  in  conjunction 
with  multiple  laryngeal  papillomata.  In  the  case  of  a  child  of  5 
years  dying  of  a  suffocative  attack  (Teschendorf20)  a  mass  of 
papillomata  extending  from  the  epiglottis  to  the  bronchus  was 
found,  and  in  another  case,  that  of  a  child  who  had  also  died  during 
an  attack  of  suffocation,  the  trachea  at  autopsy  was  found  to 
contain  numerous  papillomatous  excrescences  extending  almost 
to  the  bifurcation.  Reported  by  Schaller.19  Sudden  deaths  of 
this  kind  have  occurred  mainly  in  children ;  the  only  adult  case  of 
which  I  could  find  any  record  was  the  one  reported  by  Macken- 
zie, M.26  Sudden  death  was  produced  in  this  case  by  a  papilloma 
as  large  as  a  bean. 

Lipomata. — Only  one  case  of  genuine  lipoma  has  been  reported, 


692 


TUMORS  OF  THE  TRACHEA 


by  Rokitansky,36  Fig.  3.  At  the  autopsy  of  a  man,  aged  85  years, 
a  lipoma  as  large  as  a  hazelnut  was  found  in  the  left  bronchus. 

In  another  case,  that  of  Chiari,35  a  primary  bronchial  tumor 
turned  out  to  be  a  mixed  lipoma  and  adenoma.  The  case  was 
that  of  a  woman  aged  68  years,  who  died  of  emphyzema.  It  was 
made  up  mainly  of  fatty  tissue. 

Lymphomata. — I  could  only  find  record  of  two  cases  of  lymph- 
oma of  the  trachea.  They  were  reported  by  Clark37  and 
Vogler.38 

In  Clark's  case,  that  of  a  woman  aged  75  years,  a  tracheotomy 
which  resulted  in  the  death  of  the  patient  had  been  performed  for 
urgent  dyspnea.    The  growth  was  found  at  autopsy. 

In  Vogler's  case,  that  of  a  girl  aged  19  years,  a  round  tumor  as 
large  as  a  cherry,  attached  to  the  lateral  tracheal  wall,  could  be 


Fig.  3- 


seen  with  the  laryngeal  mirror.  It  was  removed  by  tracheo- 
fissure. 

Adenomata. — Seven  cases  have  been  reported:  by  Radestock,29 
Chiari,31  Mayer,30  Scheuer,28  Kolisko,32  Paltauf33  and  Rosen- 
heim.34 

They  are  round  tumors,  originating  as  hypertrophies  of  the 
mucous  glands.  They  are  as  a  rule  only  slightly  movable,  and 
have  their  seat  in  the  posterior  wall  of  the  trachea. 

In  Rosenheim's  case,  that  of  a  young  woman  aged  23  years,  a 
small,  red,  not  movable  tumor  was  seen  in  the  upper  part  of  the 
trachea.  It  was  removed  by  tracheotomy  and  was  found  attached 
to  the  cricoid  and  upper  tracheal  rings.  Diagnosis,  colloid  fibro- 
adenoma. 


CLEMENT  F.    Hi  EI  SEN 


693 


Scheuer  reported  thq  case  of  a  woman  aged  56  years,  in  whose 
trachea  a  round  tumor  about  the  size  of  a  cherry  was  found  on 
laryngoscopic  examination.  It  was  attached  to  the  posterior  wall, 
by  a  thick  pedicle,  at  the  level  of  eighth  ring.  Removed  by 
tracheotomy.  Kolisko  and  Chiari  have  reported  cases  of  aden- 
oma of  the  bronchi.  Chiari's  case  occurred  in  a  man  73  years 
of  age,  who  had  died  of  tuberculosis. 

Fibromata  (fibrous  polypi). — Cases  of  this  kind  have  been  re- 
ported by  Rokitansky,51  Stallard,54,  Eppinger,55  Tuerck,52  Mais- 
sonneuve,53  Mackenzie,  M.,56  Fifield,57  Mackenzie,  M.,58  Crutch- 
ley-Mackenzie,59  Ingals,  E.  F.,60  Avellis,64  Braun,63  Masini,62 
Lewin,61  Makenzie-Johnston,65  Oazmann,66  Bidwell,67  Jurasz,68 
Bockenheimer,69  Fournie.70 

Rokitansky  in  185 1  reported  the  first  pedunculated  fibroma, 
situated  at  the  bifurcation  of  the  trachea.  He  did  not  describe  it 
accurately. 

I  will  give  brief  abstracts  of  only  the  most  interesting  cases. 

Tuerck  reported  the  case  of  a  fibroma  of  the  trachea  found  at 
autopsy.  The  patient,  a  man  aged  37  years,  had  died  of  tuber- 
culosis. It  was  situated  in  the  upper  part  of  the  trachea,  and 
was  attached  to  the  posterior  wall.  Stallard  found  in  the  trachea 
of  a  man  aged  40  years,  who  had  died  during  an  attack  of  suffo- 
cation, a  polyp  as  large  as  a  tonsil.  It  had  been  attached  to  the 
anterior  wall  of  the  trachea,  high  up. 

In  Eppinger's  case,  a  man  aged  23  years,  who  had  died  sud- 
denly, a  round  tumor  as  large  as  a  hazelnut  was  found  on  the 
posterior  wall  of  the  trachea  4.5  centimeters  above  the  bifurca- 
tion.   The  diagnosis  was  made  microscopically. 

Mackenzie  has  reported  four  cases  of  tracheal  fibroma,  all  the 
cases  he  observed. 

In  the  first  case,  a  man  aged  41  years,  the  growth  was 
attached  to  the  anterior  wall  of  the  trachea  at  the  second  ring. 
In  the  second  case,  a  woman  aged  22  years,  the  tumor  was 
attached  to  the  posterior  wall  at  the  third  ring.  In  an  attempt 
to  destroy  this  with  the  cautery  both  vocal  cords  were  injured. 

In  the  third  case,  a  man  aged  37  years,  and  in  the  fourth  case, 
a  man  aged  45  years,  the  polypi  were  attached  to  the  anterior 
wall,  in  the  one  at  the  second  ring  and  in  the  other  about  the 
fourth  ring. 

In  two  of  Mackenzie's  cases  the  polypi  were  destroyed  with 
the  cautery.    In  the  fourth  case  the  patient  refused  operation  and 


694  TUMORS  OF  THE  TRACHEA 

died  suddenly  a  few  months  after  returning  home,  piobably  of 
asphyxia. 

Ingals  has  reported  a  case  of  tracheal  polyp  in  a  man  aged  60 
years. 

In  a  case  reported  by  Lewin,  in  which  a  fibroid  polyp  was 
attached  to  the  posterior  wall  of  the  trachea,  a  tracheotomy  was 
performed,  and  the  patient  wore  the  cannula  twenty-four  years. 
He  refused  any  other  operative  procedure. 

Mackenzie-Johnston  and  Oazmann  have  also  reported  cases  of 
tracheal  polypi.  In  Mackenzie-Johnston's  case,  the  growth  was 
removed  by  tracheotomy,  and  in  Oazmann's  case  it  was  removed 
endotracheally. 

Altogether  I  could  find  records  of  twenty-four  cases  of  tracheal 
fibroma,  although  there  are  undoubtedly  more.  Of  this  number 
fifteen  were  pedunculated  and  nine  were  attached  by  a  broad  base. 
They  were  situated  about  equally  in  the  upper  and  lower  parts  of 
the  trachea,  and  attached  to  the  anterior  and  posterior  walls  in 
about  the  same  number  of  cases. 

In  the  majority  of  the  cases  they  occurred  in  middle  life,  only 
three  cases  having  been  observed  in  children  between  the  fifth  and 
fourteenth  years.  In  eight  of  the  reported  cases  sudden  death 
from  suffocation  occurred. 

Ecchondromata  and  Chondro-osteomata. — The  solitary  carti- 
laginous tumor  of  the  trachea  is  almost  unknown.  Only  one  case 
could  be  found,  that  of  Berg  (Virchow,  Jahresber,  11  S.  206. 
1890).  He  observed  a  tumor  as  large  as  a  nut  at  the  fifth 
tracheal  ring.  It  was  removed  by  tracheofissure,  and  was  found 
to  be  made  up  of  cartilage. 

Other  ecchondromata  and  osteomata  have  been  reported  by 
Solis-Cohen,41  Virchow,40  Ganghofer,38  Chiari,42  Heymann,43 
Steudener,44  Hammer,45  Wilks,46  Chiari,  O.,47  Schroetter,48 
Mischaikoff,49  and  Klebs.50 

Very  little  is  known  in  regard  to  the  genesis  of  this  interesting 
class  of  new  growths. 

H.  Chiari,42  in  1878,  described  the  formation  of  osteomata  in 
the  trachea  of  a  man  aged  25  years,  who  had  died  of  tuberculosis. 

The  first  case  of  this  kind  was  probably  described  by  Wilks,48 
in  1856.  In  this  case,  that  of  a  woman  aged  38  years,  there  was 
a  formation  of  bone  in  the  mucous  membrane  of  the  trachea. 
His  patient  died  of  pulmonary  tuberculosis,  and  at  the  autopsy 
the  whole  inner  surface  of  the  trachea  was  found  covered  with 


CLEMENT  F.  THEISEN 


695 


small  movable  bony  plates,  which  were  attached  to  the  anterior 
wall.    No  connection  could  be  discovered  with  the  tracheal  rings. 

Heymann43  has  reported  a  similar  case  in  a  woman  aged  61 
years.  In  his  case  a  tracheotomy  was  performed  and  later  a 
thyrotomy  resulting  in  the  death  of  the  patient. 

Five  other  cases  have  been  reported  by  Hammer.45 

J.  Solis-Cohen41  found  in  the  trachea  of  a  tuberculous  patient, 
after  death,  a  considerable  number  of  minute  closely  aggregated 
ecchondromata  beneath  the  mucous  membrane. 

As  will  be  seen  from  a  consideration  of  these  cases,  such  bony 
and  cartilaginous  formations  in  the  trachea  are  practically  always 
multiple.  They  have  all  occurred  in  adults  between  the  twenty- 
fifth  and  sixtieth  years. 

The  causes  of  death  in  cases  in  which  this  condition  was  found 
were  seven  times  tuberculosis,  four  times  pneumonia,  and,  in 
one  case  each,  laryngeal  perichondritis,  meningitis,  brain  tumor, 
and  carcinoma  of  the  uterus.  Tuberculosis  would  appear  to  play 
rather  an  important  role  etiologically,  although  in  wThat  way  has 
not  been  determined. 

MischaikofFs  investigations49  have  perhaps  helped  to  clear  up 
the  origin  of  these  tracheal  chondro-osteomata.  He  claims  that 
they  do  not  develop  from  the  ordinary  connective  tissue  of  the 
mucous  membrane,  but  from  strands  of  connective  tissue  spring- 
ing from  the  perichondrium.  This  is  brought  about,  he  states,  by 
an  anomaly  in  the  development  of  the  tracheal  cartilage. 

MALIGNANT  NEOPLASMS. 

Carcinomata. — Primary  carcinoma  of  the  trachea  occurs  most 
frequently  as  a  medullary  carcinoma  and  exceptionally  as  a  cyl- 
indroma (Koschier). 

Langhans  has  shown  in  a  number  of  cases  that  these  neoplasms 
originate  in  the  mucous  glands  of  the  trachea. 

Bruns104  has  reported  a  case  that  shows  a  probable  malignant 
change  in  an  intratracheal  struma.  As  this  is  the  only  case  of 
which  I  could  find  any  record,  in  which  an  extensive  resection  of 
the  trachea  was  performed.  I  will  report  it  rather  fully. 

The  patient  was  a  man  aged  thirty-one  years,  who  had  suffered 
from  slowly  increasing  dyspnea  for  many  years.  On  laryngoscopy 
examination  the  trachea  was  seen  to  be  filled  with  rounded,  nodu- 
lar masses  attached  to  the  posterior  wall.  Bruns  resected  the 
trachea,  including  eleven  rings  and  extirpated  the  growth.  The 
4 


696 


TUMORS  OF  THE  TRACHEA 


patient  lived  for  six  years.  The  histological  examination  showed 
it  to  be  an  adenocarcinoma,  probably  an  intratracheal  malignant 
struma. 

Tracheal  cancer  appears  to  favor  the  male  sex ;  out  of  the  cases 
collected  by  the  writer,  men  were  afflicted  about  twice  as  fre- 
quently as  women. 

The  youngest  patient  was  twenty-eight  years  old,  the  average 
age,  however,  being  from  the  fiftieth  to  the  sixtieth  year.  Many 
more  cases  occur  between  these  years  than  between  the  thirtieth 
and  fiftieth. 

Tracheal  cancer  assumes  a  number  of  different  forms.  Lang- 
hans,90  who  in  1871  was  the  first  to  describe  a  primary  cancer  of 
the  trachea,  also  first  described  the  infiltrative  form  of  tracheal 
carcinoma.  His  patient,  a  man  aged  forty  years,  had  suffered  for 
years  with  symptoms  pointing  to  a  stenosis  of  the  right  bronchus. 
The  true  condition  was  not,  however,  determined  during  life.  At 
the  autopsy  the  lungs  were  found  normal,  the  bronchial  glands 
enlarged  and  melanotic.  A  swelling  was  found  in  the  lower  part 
of  the  trachea,  extending  upwards  for  about  four  centimeters 
from  the  bifurcation.  There  were  also  nodules  at  the  bifurca- 
tion, extending  into  the  right  bronchus  for  a  distance  of  two  and 
one-half  centimeters.  The  bronchus  itself  was  narrowed  by  a 
number  of  warty  like  elevations  attached  to  its  walls. 

M.  Mackenzie91  has  reported  one  case  also  discovered  at 
autopsy.  In  the  trachea  of  this  patient,  a  woman  aged  fifty-seven 
years,  an  ulcerated  growth  occupying  the  middle  third  of  the 
trachea  was  found.  On  microscopical  examination,  the  growth 
was  found  to  be  an  epithelial  cancer. 

In  Schroetter's  case.92  a  man  aged  fifty-eight  years,  a  trache- 
otomy was  performed.  At  autopsy  a  nodular  mass  was  found 
in  the  trachea,  extending  from  the  first  to  the  ninth  rings. 
A  microscopical  diagnosis  of  carcinoma  fibrosum  was  made. 

Oestreich100  observed  in  V.  Leyden's  clinic  a  primary  car- 
cinoma in  the  trachea  of  a  woman  aged  twenty-eight  years,  the 
youngest  patient  on  record. 

Another  case  of  carcinoma  at  the  tracheal  bifurcation  was  re- 
ported by  Ehlich,101  in  a  man  aged  sixty-five  years. 

Koschier102  has  reported  two  cases  (cylindroma),  both  attached 
to  the  anterior  wall,  and  another  case,103  a  woman  aged  forty 
years,  in  whose  case  a  carcinoma  was  removed  per  vias  natur- 
ales  with  a  specially  constructed  sharp  spoon  of  Stoerk. 


CLEMENT  F.  THEISEN 


697 


Other  authentic  cases  have  been  reported  by  Hoffman,106  Dela- 
field,8e  Gibb,93  Klebs,95  Reiche,98  Fischer,09  Boschi,105  Koerner,109 
Pick,111  Hinterstoisser112  Schmidt,113  Pogresbinsky110  and  Sa- 
bourin.109 

The  writer  would  add  still  another  case  of  his  own  to  this  list. 
The  patient,  a  man  of  fifty-eight  years  of  age,  presented  himself 
for  the  relief  of  urgent  dyspnea.  With  the  laryngeal  mirror  a  mass 
could  be  seen  filling  the  upper  part  of  the  trachea  and  extending 
to  the  subglottic  portion  of  the  larynx.  A  tracheotomy  was  per- 
formed with  cocaine.  No  other  operation  could  be  performed, 
because  there  was  already  involvement  of  the  glands  of  the  neck. 
The  patient  lived  about  four  weeks  after  the  operation.  A  micro- 
scopical diagnosis  of  carcinoma  was  made. 

In  Boschi's  case,  a  man  aged  sixty  years,  a  tumor  extending 
from  the  bifurcation  five  centimeters  upwards  was  found.  It  ex- 
tended through  the  trachea  and  was  attached  anteriorly  to  the 
posterior  wall  of  the  ascending  aorta  as  well  as  to  the  arch. 

In  all  I  could  find  records  of  twenty-seven  cases,  making  with 
my  own  case  twenty-eight  cases. 

The  favorite  seats  for  primary  tracheal  cancer  are  the  upper 
parts  of  the  trachea  and  the  lower  parts  close  to  the  bifurcation. 
The  middle  third  is  rarely  involved. 

In  the  majority  of  the  cases  the  posterior  wall  is  involved, 
while  the  anterior  wall  is  not  so  frequently  implicated. 

The  writer  .has  only  considered  cases  of  primary  tracheal  car- 
cinoma. No  mention  will  be  made  of  cancer  secondary  to  laryn- 
geal or  esophageal  cancer. 

Carcinoma  of  the  thyroid  gland  also  frequently  infiltrates  the 
tracheal  wall. 

Sarcomata. — Only  primary  sarcomata  will  be  considered.  In 
three  cases,  however,  those  of  Jurasz,131  Pieniazek,12S  and 
Wright136  the  larynx  was  also  involved,  but  as  this  involvement 
was  just  at  the  dividing  point,  the  origin  of  the  tumor  was  prob- 
ably in  the  trachea. 

Although  primary  tracheal  sarcoma  is  rarer  than  carcinoma, 
we  have  been  able  to  collect  eighteen  cases  from  the  literature. 

They  have  been  reported  by  Schroetter,115  116  O.  Chiari,118 
Levi, 119  Prota,120  Heyninx,121  Killian,122  Gleitsmann,123  Schroet- 
ter,124 Labus,125  Johnston-Cottrill,126  Bamberger-Billroth,127 
Schech,129  Pieniazek,128  Wright,130  Jurasz,131  and  Mayer-Hueni.132 

In  seven  cases  endotracheal  operations  were  performed. 


698 


TUMORS  OF  THE  TRACHEA 


Of  these  one  of  Schroetter's  cases110  lived  twenty  years,  with 
many  recurrences.  Gleitsmann's  case,  which  I  will  describe  more 
fully  later  on,  lived  nearly  two  years,  with  a  recurrence  in  about 
fifteen  months. 

In  Heyninx's  case,  121  in  which  a  myxosarcoma  was  removed 
from  the  trachea  of  a  woman  aged  forty-one  years,  with  the  hot 
loop.    I  could  find  no  record  of  the  final  result. 

In  three  cases  no  recurrence  could  be  detected  after  a  short 
period.    Cases  of  Labus,12r>  Johnston-Cottrill,128  and  Schech.139 

Of  the  cases  operated  on  by  tracheofissure,  the  final  result  is 
only  known  in  a  few.  In  Mayer-Hueni's132  and  Wright's130  cases 
no  recurrence  took  place  for  a  considerable  period.  In  Jurasz's131 
case  a  slowly  growing  recurrence  was  noticed  after  two  years. 

Prota120  has  reported  two  cases,  both  in  women  between 
forty  and  fifty,  in  whom  the  growth  was  situated  high  up  in 
the  trachea. 

Gleitsmann123  has  reported  one  of  the  few  cases  of  tracheal 
sarcoma  operated  upon  endotracheally. 

The  tumor  in  his  case,  that  of  a  man  aged  fifty-two  years,  was 
situated  in  the  upper  part  of  the  trachea  and  nearly  filled  its  lumen. 
It  was  as  large  as  a  small  walnut.  The  tumor  was  removed  endo- 
tracheally with  the  Schech  cannula,  iridoplatinum  wire,  devised 
by  Dr.  Gleitsmann  in  1894,  being  used.  The  growth  was  brought 
through  the  glottis  without  difficulty. 

There  was  no  recurrence  for  about  fifteen  months.  The  further 
history  of  the  case,  which  Dr.  Gleitsmann  kindly  sent  me,  is  as 
follows:  In  March,  1903  (the  first  operation  was  performed  in 
December,  1901),  a  small  tumor  reappeared  below  the  anterior 
commissure  and  was  removed  with  the  snare  as  before.  During 
the  following  months  (April,  1903),  the  ventricular  band  became 
infiltrated,  pain,  fever,  and  aphonia  developed,  and  at  the  last 
examination.  May  9,  1903,  the  left  half  of  the  larynx  did  not 
move  freely,  and  in  the  trachea  small  nodules  could  be  seen  below 
the  anterior  commissure  and  below  the  left  vocal  cord.  A  radical 
operation  which  was  recommended  was  declined,  and  the  patient 
was  not  seen  again  by  Dr.  Gleitsmann.  He  died  some  time  in 
1903. 

This  case  teaches  a  valuable  lesson.  It  proves  the  fact  that 
endotracheal  operations  for  malignant  neoplasms  offer  very  little 
chance  of  success.  I  have  not  been  able  to  find  records  of  any 
cases  in  which  a  patient  remained  permanently  cured  after  an 
endotracheal  operation.    In  the  three  cases  before  mentioned 


CLEMENT  F.  THEISEN 


699 


those  of  Labus,  Schech,  and  Johnston-Cottrill,  the  statement  was 
made  that  a  cure  was  obtained  after  a  "short  period." 

Both  sexes  seem  to  be  equally  afflicted  with  tracheal  sarcoma, 
and  young  people  rather  more  frequently  than  persons  more  ad- 
vanced in  years 

As  a  rule  tracheal  sarcomata  are  attached  to  the  tracheal  wall 
by  a  broad  base  and  have  a  smooth  surface.  Occasionally  they 
are  pedunculated.  They  often  reach  a  considerable  size  and 
almost  completely  fill  the  tracheal  lumen. 

For  the  sake  of  completeness  I  will  give  brief  abstracts  of  two 
other  tracheal  tumors,  reported  by  Johanni134  and  Henrici.135 

The  tumor  in  Johanni's  case  filled  the  lower  part  of  the  larynx 
and  upper  part  of  the  trachea  in  a  woman  aged  sixty-six  years, 
and  finally  caused  her  death.  An  exact  histological  examination  is 
given.    It  was  called  an  amyloid  tumor. 

In  Henrici's  case  a  tumor  was  present  in  the  trachea  of  a  man 
aged  sixty-one  years,  who  had  suffered  from  "asthma"  for  fifteen 
or  twenty  years.  It  was  situated  on  the  posterior  wall  at  the  level 
of  the  third  ring.  A  tracheofissure  was  made,  and  the  tumor, 
which  was  two  and  one-half  centimeters  long  and  covered  with  a 
smooth  intact  mucous  membrane,  removed.  Patient  died  suddenly 
two  months  after  the  operation. 

The  classification  of  the  tumor  could  not  be  determined  by  the 
microscopical  examination. 

A  review  of  the  recorded  cases  of  intratracheal  tumors  brings 
out  some  interesting  points. 

Of  the  benign  growths  papillomata  occur  most  frequently,  and 
of  the  malignant  carcinomata  are  most  frequently  observed. 

The  following  table  shows  the  order  of  frequency  with  the 
number  of  each  variety  of  tumor  collected  by  the  writer.  This 
number  could  undoubtedly  be  added  to  materially,  but  it  com- 
prises most  of  the  authentic  cases  on  record  to  date: 

Benign. — Papillomata,  25  cases;  fibromata  (fibrous  polypi), 
24  cases;  ecchondromata  and  chondro-osteomata,  17  cases;  intra- 
tracheal strumas,  10  cases  ;  adenomata,  7  cases  ;  lipomata,  3  cases ; 
lymphomata,  2  cases ;  amyloid  tumor,  1  case. 

Malignant. — Carcinomata,  28  cases ;  sarcomata,  18  cases,  mak- 
ing in  all  135  cases,  eighty-nine  of  which  are  benign  and  forty-six 
malignant. 

A  study  of  the  cases  shows  also  that  tracheal  tumors  are  situ- 
ated in  the  majority  of  the  cases  in  the  upper  part  of  the  trachea 


700 


TUMORS  OF  THE  TRACHEA 


and  less  frequently  in  the  lower  part.  They  most  rarely  occur  in 
the  middle  of  the  trachea.  They  are  attached  most  frequently  to 
the  posterior  wall,  which  is  rich  in  mucous  glands.  This  is  par- 
ticularly true  of  the  carcinomata,  which  appear  to  take  their 
origin  from  these  mucous  glands. 

Some  other  interesting  facts  are  brought  out  by  a  consid- 
eration of  the  reported  cases  of  tracheal  tumors. 

In  the  first  place  their  great  rarity.  The  135  cases  collected  by 
the  writer  represent  nearly  all  the  authentic  cases  recorded  dur- 
ing the  past  seventy-five  years.  The  majority  of  the  cases  have 
been  reported,  of  course,  since  the  first  one  was  observed  with 
the  laryngoscope  in  1861. 

The  rarity  of  tracheal  tumors  becomes  much  more  striking 
when  the  eighty-nine  benign  and  forty-six  malignant  tracheal 
tumors  are  compared  to  the  10,747  benign  and  1,550  malignant 
laryngeal  tumors  which  Semon  collected  between  1862  and  1888. 

The  malignant  tumors  of  the  larynx  represent  only  about  eleven 
per  cent,  of  the  total  number,  while  in  the  trachea,  according  to 
the  cases  collected  by  the  writer,  they  represent  about  fifty  per 
cent,  of  the  total  number.  These  figures  are  significant,  because 
they  show  that  a  strong  suspicion  of  malignancy  must  always 
attach  to  a  tracheal  tumor. 

Etiology. — Very  little  is  known  in  regard  to  the  etiology  of 
most  tracheal  tumors,  and  writers  as  a  rule  barely  mention  it. 
In  considering  the  etiology  of  tracheal  new  growths  etiological 
factors  such  as  congenital  displacement  of  tissue,  predisposition, 
and  a  general  specific  diathesis  of  the  system  are  of  importance. 

The  fact  that  the  trachea  is  not  more  often  the  seat  of  new 
growths  may  be  explained  by  its  protected  position  and  its  some- 
what passive  functions.  It  is  not  easily  subjected  to  mechanical 
or  chemical  irritation. 

Granulation  tumors  originating  after  tracheotomies  were  not 
considered  in  the  writer's  paper,  because  they  are  not  true  new 
growths.  A  chronic  inflammation  of  the  tracheal  mucous  mem- 
brane probably  plays  an  important  role  in  the  development  of 
neoplasms.  An  inflammatory  process,  in  conjunction  with  pul- 
monary tuberculosis,  seems  to  have  an  important  etiological  bear- 
ing on  the  development  of  cartilaginous  and  bony  formations. 
There  is  no  apparent  reason  for  this,  however. 

The  etiology  of  intratracheal  struma,  which  has  been  well 
worked  out,  has  already  been  considered  in  this  paper. 


CLEMENT  F.  THEISEN 


701 


Symptoms. — As  the  main  symptoms  of  all  tracheal  new  growths 
are  those  produced  by  the  resulting  stenosis,  and  as  we  are  to 
have  an  exhaustive  paper  on  this  subject  I  will  not  mention 
symptoms  directly  caused  by  stenosis  at  all. 

There  are  a  few  symptoms,  however,  which  can  be  attributed  to 
the  tumors  themselves.  Tumors  in  the  trachea  may  be  present 
for  years  without  causing  any  special  symptoms,  and  it  is  sur- 
prising that  even  large  ones  sometimes  cause  so  little  disturbance. 

A  case  has  been  reported  by  Siegert22  in  which  a  papilloma 
as  large  as  a  pigeon  egg  was  situated  at  the  tracheal  bifurcation 
and  did  not  cause  any  particular  difficulty  in  breathing.  This 
patient,  a  man  54  years  old,  died  of  general  septicemia  following 
an  infection  of  a  wound,  and  the  tumor  in  the  trachea  was  found 
at  autopsy. 

In  one  of  Schroetter's  cases115  the  patient  lived  many  years 
with  a  sarcoma  that  almost  completely  filled  the  tracheal  lumen. 

In  some  cases  attacks  of  suffocation  only  come  on  periodically. 
This  was  so  in  the  case  reported  by  Fifield,57  in  which  a  fibroid 
polyp  as  large  as  a  berry,  covering  the  opening  of  the  left 
bronchus,  was  found  at  autopsy. 

The  character  of  the  dyspnea  varies  according  to  whether  the 
growth  is  pedunculated  and  freely  movable  or  not.  A  movable 
growth  acts  like  a  valve,  so  that  at  times  there  will  be  an  inspir- 
atory dyspnea  and  at  other  times  an  expiratory  dsypnea. 

Gerhardt  claims  that  a  bending  forward  of  the  head  is  a  symp- 
tom that  is  always  present  in  tracheal  obstruction,  while  in 
laryngeal  stenosis  the  head  is  bent  backwards. 

The  voice  as  a  rule  is  not  affected,  except  when  growths  with 
long  pedicles  are  situated  high  up  in  the  trachea  and  are  carried 
to  the  glottis  by  the  air  current.  In  such  cases  some  hoarseness 
may  be  present  without  much  dyspnea.  Masini62  and  Jurasz68 
both  observed  cases  of  this  kind. 

The  voice  may  be  also  affected  by  an  involvement  of  the 
recurrent  laryngeal  in  cases  of  tracheal  carcinoma.  Such  obser- 
vations have  been  made  by  Hinterstoisser112  and  Oestreich.107 

Secondary  symptoms  are  also  produced  particularly  by  slowly 
growing  tumors.  Occasionally  diffuse  bronchiectasis,  empyema, 
and  atelectasis  are  produced  in  certain  portions  of  the  lungs. 
Catarrhal  bronchitis,  lobar  and  lobular  pneumonia,  are  also  some- 
times complications. 

Koerner109  has  reported  a  case  in  which  a  carcinoma  in  the 


702 


TUMORS  OF  THE  TRACHEA 


lower- part  of  the  trachea  encroached  upon  the  right  bronchus, 
and  produced  an  obstructive  atelectasis  of  the  whole  right  lung. 

Diagnosis — When  the  characteristic  symptoms  are  present 
it  is  usually  quite  easy  to  make  a  diagnosis  of  some  tracheal 
obstruction,  although  without  direct  inspection  it  would  be  hard 
to  determine  whether  the  obstruction  is  caused  by  a  tumor,  a 
stricture,  or  a  foreign  body.  The  diagnosis  of  a  tracheal 
stenosis,  the  common  symptom  of  intratracheal  growths,  is  of 
course  simple.  It  must  be  determined,  however,  whether  the 
cause  is  in  the  trachea  itself  or  from  external  pressure. 

An  examination  of  the  upper  part  of  the  trachea,  except  in 
young  children,  can  usually  be  made  with  the  ordinary  laryngeal 
mirror,  after  cocainization  ;  in  some  cases  without  it. 

Laryngoscopy  can,  however,  be  quite  easily  practised  even  in 
young  children  if  they  are  given  a  little  chloroform  or  somno- 
forme.  A  forehead  lamp,  or  a  self-illuminating  mirror,  is  most 
convenient. 

For  laryngoscopy  under  an  anesthetic  a  loop  of  silkworm  gut 
may  be  passed  through  the  tongue,  as  recommended  by  Jackson 
(Laryngoscope,  April,  1905),  and  will  not  cause  as  much  sore- 
ness as  a  tongue  forceps.  The  Kirstein  spatula  is  also  of  service 
for  diagnosing  tumors  in  the  upper  part  of  the  trachea,  and  in 
children  can  be  used  just  as  well  under  general  anesthesia.  A 
good  inspection  of  the  trachea  in  adults  may  often  be  obtained, 
if  the  patient  is  examined  while  standing,  according  to  Killian's 
method.  In  six  of  the  seven  cases  of  tracheal  tumors  operated 
upon  by  Bruns,  he  was  able  to  make  the  diagnosis  with  the 
ordinary  mirror.  After  cocainization  much  can  be  learned  in 
regard  to  the  nature  of  the  growth  with  an  extra  long  laryngeal 
probe.  Instead  of  employing  Kirstein's  autoscope  a  Grant  epi- 
glottis lifter  may  be  applied  with  the  patient  in  Rosen's  position 
and  the  upper  part  of  the  trachea  inspected  in  this  way. 

An  X-ray  examination  will  at  times  show  the  presence  of 
tumors  that  cannot  be  easily  inspected  and  is  a  great  aid  in  the 
diagnosis.  For  tumors  below  the  middle  of  the  trachea  Killian's 
tracheoscopy  or  bronchoscopy  would  be  of  service  if  the  tumor 
cannot  be  inspected  in  any  other  way. 

As  the  methods  of  performing  tracheoscopy,  as  well  as  the 
improvements  of  Ingals,  Jackson,  and  others  in  instruments  and 
methods  of  lighting  the  deeper  parts  of  the  trachea  and  bronchi, 


CLEMENT  F.  THEISEN 


are  so  well  known,  I  will  not  mention  them  here.  Then  we  are  to 
have  a  paper  on  tracheoscopy. 

As  an  operation  would  have  to  be  performed  in  any  event,  it 
is  best  to  perform  tracheotomy  when  symptoms  become  urgent, 
and  make  the  diagnosis  and  perform  the  operation  for  the  removal 
of  the  growth,  at  the  same  time,  rather  than  to  subject  the  patient 
to  a  preliminary  bronchoscopy  or  tracheoscopy.  After  trache- 
otomy an  excellent  inspection  of  the  lower  part  of  the  trachea  may 
be  obtained  through  the  ordinary  Kelly  cystoscope,  after  passing 
it  down  through  the  tracheal  wound.  An  ordinary  head  mirror 
can  be  used  in  throwing  light  through  the  cystoscope.  Small 
benign  tumors  could  be  removed  through  the  cysioscope  with 
forceps,  particularly  if  a  large  cystoscope  can  be  used. 

The  fibroma  or  fibrous  polyp  is  usually  pedunculated,  and 
Schroetter114  has  reported  a  case  of  a  distinctly  pedunculated 
sarcoma  which  was  freely  movable. 

In  Proebsting's  case132  an  apparent  polyp  with  a  long  pedicle, 
which  had  been  coughed  out  was  found  to  be  carcinomatous. 
The  intratracheal  struma  has  been  fully  considered. 

It  is  often  difficult  to  make  a  differential  diagnosis  between 
carcinoma  and  sarcoma. 

It  was  found  in  a  study  of  the  cases  that  carcinoma  occurs 
more  frequently,  particularly  in  men  of  advanced  years.  When 
metastases,  which  are  rare  in  primary  tracheal  carcinoma,  occur 
in  the  lymphatic  glands  of  the  neck  or  in  the  larynx,  esophagus, 
or  bronchi,  there  is  no  doubt  about  the  diagnosis. 

Sarcoma  usually  occurs  as  a  growth  with  a  broad  base  and 
smooth  surface.'  It  grows  slowly,  sometimes  becoming  very  ex- 
tensive, however,  and  shows  little  tendency  to  ulceration. 

Carcinoma  shows  a  greater  tendency  to  ulceration,  and  is 
usually  more  irregular  in  outline. 

The  tracheal  papilloma  can,  as  a  rule,  be  recognized  by  its 
appearance,  particularly  when  it  occurs  in  children,  and  is  also 
present  at  the  same  time  in  the  larynx. 

Schroetter113  has  described  a  tracheal  carcinoma  occurring  in 
the  form  of  papillomatous  excrescences.  Wright129  has  also 
described  sarcoma  simulating  papilloma. 

Prognosis. — The  prognosis  of  tracheal  neoplasms,  unless  some 
operative  measures  are  promptly  carried  out,  may  be  said  to  be 
almost  absolutely  unfavorable,  because  without  operation  the 
stenosis  caused  by  the  tumor  becomes  greater  all  the  time,  and  the 


704 


TUMORS  OF  THE  TRACHEA 


patient  may  suddenly  die  of  asphyxia  even  before  tracheotomy 
can  be  performed.  The  higher  up  in  the  trachea  the  tumor  is 
situated,  the  more  favorable  the  prognosis,  because  it  can  not  only 
be  more  easily  reached  during  operations,  but,  if  tracheotomy 
becomes  necessary,  the  cannula  can  be  introduced  below  the 
tumor. 

When  tumors  are  present  low  down  in  the  trachea  near  the 
bifurcation,  a  tracheotomy,  without  at  the  same  time  a  removal 
of  the  growth,  may  not  do  much  good,  because  it  would  be  diffi- 
cult to  get  the  end  of  the  cannula  below  the  growth.  The 
fibromata,  particularly  the  pedunculated  polypi,  according  to  all 
authorities,  give  the  most  favorable  prognosis,  because  they 
usually  occur  singly  and  do  not  show  a  tendency  to  recur  when 
removed. 

Lemoine7  states  that  in  twenty-six  cases  of  benign  tracheal 
growths  collected  by  him  cures  were  obtained  by  operations  in 
ten  out  of  fourteen  patients.  Of  twelve  not  operated  upon  ten 
died. 

The  prognosis  of  the  intratracheal  strumas  is  also  favorable, 
as  their  growth  is  very  slow  and  they  apparently  do  not  readily 
recur  after  removal.  In  the  writer's  case  before  mentioned,  re- 
moved by  tracheofissure,  there  has  been  no  recurrence  since  the 
operation  was  performed  in  1901. 

The  papillomata  are  not  so  favorable,  because  they  are  usually 
multiple,  often  recurring  simultaneously  in  the  larynx  and  trachea, 
and  show  a  decided  tendency  to  recur  after  removal. 

Among  the  cases  we  collected  the  endotracheal  removal  was 
performed  in  eight,  in  all  of  which  the  growths  were  situated  in 
the  upper  part  of  the  trachea.  There  were  recurrences  in  a 
number  of  these  cases. 

In  four  cases,  all  children,  a  laryngo-tracheofissare  was  per- 
formed in  order  to  remove  at  the  same  time  the  laryngeal  and 
tracheal  growths.  A  number  of  these  cases  subsequently  died  of 
recurrences.  The  carcinomata  offer  the  most  unfavorable  prog- 
nosis of  all.  Statistics  show  that  patients  afflicted  with  tracheal 
carcinoma  live  as  a  rule  only  a  few  months,  although  they  may 
live  several  years.  Death  usually  results  through  slow  suffoca- 
tion, pneumonia,  or  metastases  to  neighboring  organs. 

On  the  other  hand,  observations  are  on  record  to  show  that  at 
times  the  disease  remains  localized  for  a  very  long  period. 
Tracheotomy  does  not  seem  to  prolong  life  much  in  these  cases, 


CLEMENT  F.  THEISEN 


705 


but  if  the  cannula  can  be  applied  below  the  growth  it  certainly 
makes  the  patient's  death  easier.  Schroetter114  has  reported  a 
case  in  which  it  was  not  possible  to  get  in  the  cannula  at  all. 

From  the  fact  that  some  cases  of  tracheal  carcinoma  develop 
so  slowly  and  show  no  tendency  to  metastases,  it  does  not  seem 
too  much  to  hope  for  that  in  the  near  future  a  radical  operation 
such  as  a  resection  of  the  trachea  will  be  performed  more  fre- 
quently and  just  as  brilliant  results  obtained  as  in  early  laryn- 
gectomy for  laryngeal  cancer.  I  have  been  able  to  find  only  one 
case  in  the  literature  in  which  a  resection  of  the  trachea  for  car- 
cinoma was  performed.  This  case  was  reported  by  Bruns.103 
His  patient  lived  six  years  after  the  operation.  Koschier101  has 
reported  a  case  in  which  a  carcinoma  (cylindroma)  was  removed 
by  tracheotomy,  and  six  months  after  no  trace  of  a  recurrence 
could  be  detected.  In  tracheal  sarcoma  the  prognosis  does  not 
appear  to  be  extremely  unfavorable.  Data  are  lacking  in  regard 
to  recurrences  of  tracheal  sarcoma  after  removal.  In  fact 
practically  nothing  is  known  about  it.  In  Gleitsmann's  case  of 
the  endotracheal  removal  of  a  sarcoma  there  was  no  recurrence 
for  about  fifteen  months,  but  soon  after  that  the  tumor  did  recur. 

The  growth  of  sarcoma  in  the  trachea  is  very  slow,  the  disease 
often  extending  over  a  period  of  years.  Nor  does  the  growth 
show  any  tendency  to  ulceration  or  extension  to  the  surrounding 
structures. 

Of  the  seven  endotracheal  operations  on  record  for  tracheal 
sarcoma,  three  cases  were  reported  cured,  although  there  is  no 
record  to  show  that  they  remained  cured.  These  three  cases 
were  called  cured  because  there  was  no  recurrence  in  four  or  five 
months.  In  one  case  there  was  a  recurrence,  but  the  patient  lived 
many  years,  and  one  case  rapidly  terminated  fatally.  Another 
patient  (Gleitsmann's)  lived  nearly  two  years  after  the  operation. 

The  growths  in  five  cases  were  removed  by  tracheotomy,  and 
in  two  there  had  been  no  recurrence  after  three  months  and  one 
year.  In  one  case  there  was  a  recurrence  after  two  years.  In 
twd  cases  tracheotomy  was  followed  by  a  fatal  issue. 

Treatment. — The  treatment  of  the  large  majority  of  the  cases 
of  tracheal  tumors  may  be  summed  up  in  the  one  word — opera- 
tive. Palliative  measures  may  be  used  when  the  growths  are  so 
small  that  they  do  not  interfere  to  any  extent  with  breathing,  but 
it  must  be  remembered  that  a  good  many  of  the  tracheal  new 


7o6 


TUMORS  OF  THE  TRACHEA 


growths  have  a  fairly  rapid  growth,  so  that  it  is  safer  to  remove 
even  small  growths  as  soon  as  the  diagnosis  is  made. 

Tracheotomy  performed  for  the  purpose  of  relieving  breathing 
comes  under  the  head  of  palliative  measures,  and  is  successful  if 
the  cannula  can  be  inserted  below  the  growth. 

As  statistics  show  that  in  over  one-half  of  all  cases  tracheal 
neoplasms  are  situated  in  the  upper  third  of  the  trachea,  a  low 
tracheotomy  would  relieve  the  patient's  breathing  in  a  majority  of 
the  cases.  In  cases  in  which  the  tumor  is  situated  very  low  down 
in  the  trachea,  a  piece  of  a  rubber  stomach  tube  may  be  used 
in  case  of  emergency,  if  a  long  tracheal  cannula  will  not  reach 
below  the  growth.  In  such  cases,  if  the  patient's  condition  per- 
mits it,  it  would  be  wise  to  attempt  the  removal  of  the  growth 
as  soon  as  free  respiration  is  established.  Other  conditions  some- 
times make  tracheotomy  difficult  and  even  impossible. 

The  patient  died  in  one  of  Schroetter's  cases114  while  he  was 
attempting  to  perform  tracheotomy.  The  lumen  of  the  trachea 
was  so  filled  with  the  growth  (carcinoma)  that  the  cannula  could 
not  be  inserted. 

In  inoperable  cases  a  tracheotomy  will  have  to  be  performed 
in  any  event,  and  in  operable  cases  it  not  only  prepares  the  way 
for  a  thorough  inspection  of  the  trachea,  either  with  the  finger  or 
through  a  tube,  but  it  is  at  times  a  necessary  preliminary  step 
to  an  endotracheal  operation. 

Endotracheal  Operations. — Operations  through  the  mouth 
should  only  be  performed  for  small  pedunculated  benign  growths, 
situated  high  up  in  the  trachea.  Endotracheal  operations  for 
malignant  growths  do  not  offer  a  much  better  chance  of  success 
than  endolaryngeal  operations  for  laryngeal  cancer.  They  should 
not  be  attempted.  Statistics  in  regard  to  the  recurrence  of 
tracheal  sarcoma  after  endotracheal  removal  are  sadly  deficient. 

The  results  of  the  seven  endotracheal  operations  for  sarcoma, 
as  well  as  of  those  removed  by  tracheofissure,  have  already  been 
given.  The  most  favorable  tumors  for  removal  through  the 
mouth  are  the  papillomata,  and  about  a  dozen  such  operations 
have  been  performed — a  majority  of  all  endotracheal  operations. 

The  technique  is  the  same,  except  that  longer  instruments  have 
to  be  used,  as  for  laryngeal  operations. 

Children  can  be  operated  upon  under  general  anesthesia  with 
the  aid  of  the  Kirstein  spatula. 

The  removal  of  tracheal  tumor  by  tracheotomy,  or  better, 


CLEMENT  F.  THEISEN 


707 


tracheofissure,  is  the  operation  of  choice  for  the  majority  of  the 
cases.  Benign  neoplasms  of  all  kinds  can  be  readily  and  radically 
removed  in  this  way,  and  there  is  much  less  chance  for  recur- 
rence than  when  they  are  incompletely  removed  through  the 
mouth.  This  is  particularly  true  of  the  five  cases  of  intratracheal 
struma  (four  of  Bruns  and  the  writer's  case),  in  which  there 
have  been  no  recurrences  after  radical  operations  (tracheofissure). 
There  are  about  twenty  such  operations  for  different  tracheal 
growths  on  record. 

Mayer-Hueni132  removed  in  this  way  a  sarcoma  situated  just 
above  the  bifurcation. 

In  performing  these  operations  the  anterior  wall  of  the  trachea 
should  be;  split  for  a  considerable  distance,  so  as  to  give  the  oper- 
ator plenty  of  room.  Either  a  tampon-cannula  can  be  used,  or  the 
operation  can  be  performed  in  some  cases  of  benign  growth  with- 
out it.  with  the  patient  in  the  Trendelenberg  position. 

Resection  of  the  trachea  has  only  been  performed  in  one  case, 
that  of  Bruns104  before  alluded  to. 

He  removed,  a  carcinoma  of  the  posterior  tracheal  wall,  includ- 
ing the  posterior  wall  and  ten  of  the  rings,  keeping  the  patient 
alive  for  six  years. 

After  tracheotomy  small  tumors  low  down  in  the  trachea  may 
at  times  be  removed  through  a  cystoscope  under  direct  inspection. 

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7  io 


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Deutsche  med.  Wochenschr.,  S.  1024,  1887. 

Virchow's  Archiv.,  Bd.  38,  S.  212,  1867. 

Laryngol.  Mittheil.,  S.  86,  1870. 

Jahresber.  d.  Klin.  f.  iMryngoskopie,  1873,  S.  103. 

Deutsche  med.  Wochenschr.,  S.  210.  1802. 

Monatschr.  f.  Ohrenheilk.,  No.  12,  1882. 

Primaeres  Carcinom  d.  Trachea.  Deutsche  med.  Woch- 
enschr., No.  9,  1895. 

Monatschr  f.  Ohrenheilk,  No.  3,  1896. 

Wiener  klin.  Wochenschr.,  No.  24,  1896. 

Ein  Beitrag  z.  Kenntniss  d.  Trachealtumoren.  Wiener 
med.  Wochenschr.,  No.  35,  1898. 

Resection  der  Trachea  bei  primaeren  Trachealkrebs. 
Beitr.  z   klin.  Chirurgie,  xxi,  1898,  S.  284. 

Scieta  Medicochirurgica  di  Bologna,  Dec.  22,  1899. 

Ein  Fall  von  isolirten  primaeren  Carcinom  d.  Trachea. 
Monatschr.  f.  Ohrenheilk.,  No.  8,  1905. 

Zeitschr.  f.  klin.  Med.,  Bd.  .28. 

Annal.  des  Mai.  de  I'Oreille,  etc.,  p.  11,  1879. 

Muench.  med.  Wochenschr.,  No.  11,  1888. 

Rev.  mens,  de  laryngol..  No.  12,  1894. 

Wien.  klin.  Wochenschr.,  No.  4,  1891. 

Ibid.,  No.  19,  1889. 

Op.  tit.,  S.  641. 

Vorlesungen  u.  d.  Krankh.  d.  Luftroehre, S.  178. 
.  Sarcomata. 

Jahresber.  d.  Klinik  f.  Laryngeskopie ,  S.  80,  187 1. 

Laryngol.  M ittheilungen ,  S.  102,  1875. 

Das  Sarcom  d.  Kehlkopfes  u.  d.  Luftroehre.  Monatschr. 

f.  Ohrenheik.,  Nos.  8,  9,  10,  11,  1895. 
Wiener  klin.  Wochenschr.,  No.  52,  1896. 
Tnmeur  sarcomateuse  de  la  trachee.    Societe  anato- 

mique  de  Paris,  April,  1897. 
Sarcoma     primario   della   trachea    Archiv.    Hal.  dt 

Laringologia,  April,  1899. 
Ber.  d.  Bel.  oto-rhin.  laryngol  Cesellsch.,  June  17  and  18, 

1905. 

Ein  Trachealsarcom.    Archiv.  f.  Laryngol.  u.  Rhinol, 

Bd.  xii,  iii,  S.  423,  1902. 
Subglottic    sarcoma    removed    endo'aryngeally,  etc. 

Trans.  Amer.  Laryngol.  Assn.,  1902. 
Wiener  med.  Jahrb.,  1868. 
Gaz.  d.  Osp"d.,  No.  22,  1880. 
Edinburgh  Med.  Journal,  June,  1886. 
Centralbl.  f.  Larynqologie,  Bd.  iv.  S.  456. 
Arch.  f.  Laryngol.,  Bd.  iv,  S.  226. 
Krankheiten  d.  Kehlkopfes  u.  d.  Luftroehre,  1897. 
Journal  of  the  Amer.  Med.  Assn.,  Sept.  26,  1891. 
Krankheiten  der  oberen  Luftwege,  1892. 
Correspondenzbl.  f.  Schweizer-aerzte,  1881. 
Versamml.  Sueddeutsche  Laryngol.,  1896  (carcinoma). 

Amyloid  Tumor. 
Fraenkel's  Archiv.  f.  Laryngol.,  etc.,  Bd.  14,  H.  2 
S.  33i- 
Unclassified. 

Ein  Beitrag  zur  Kenntniss  der  Trachealtumoren. 
Archiv.  f.  Laryngol.  u.  Rhinol.,  Bd.  xvii,  H.  11,  S. 
283,  1905. 


ADDRESS 


711 


ADDRESS  TO  GRADUATES  OF  THE  SAMARITAN  HOS- 
PITAL TRAINING  SCHOOL  FOR  NURSES. 

Delivered  at  the  Graduating  Exercises  held  in  the  Thurman  Building, 
Troy,  N.  Y.,  January  30,  1906. 

,    By  G.  ALDER  BLUMER,  M.  D., 

Medical  Superintendent  of  the  Butler  Hospital,  Providence,  R.  I. 

Addressing  a  men's  club  in  Providence  the  other  day,  a  dis- 
tinguished rector  related  that,  soon  after  leaving  the  theological 
seminary  with  his  license  to  preach,  he  was  suddenly  called  upon 
to  take  duty  for  a  brother  clergyman  in  circumstances  that  seemed 
to  make  it  desirable  to  curtail  the  service.  So,  approaching  the 
leading  layman  of  the  church  with  a  certain  tiptoe  timorousness, 
he  queried,  "  Don't  you  think  we  might  shorten  the  service  a 
little  ?"  "  By  no  means,"  was  the  emphatic  response,  "  but  you 
may  cut  out  the  sermon." 

This  instructive  incident  from  real  life  recalls  the  experience 
of  the  preacher  who,  upon  starting  out  one  Sunday  morning  to 
enlighten  a  strange  congregation,  found  to  his  dismay  that  his 
sermon  had  been  partly  destroyed  by  a  playful  young  dog.  It 
was  too  late  to  make  additions  or  repairs,  so  trusting  to  luck, 
as  even  clergymen  sometimes -do,  the  preacher  went  bravely  ahead 
with  his  mutilated  manuscript.  A^  the*  close  of  his  discourse  he 
fished  for  an  estimate  of  his  performance  by  interviewing  the 
shrewd  sexton.  "Was  the  sermon  too  short  ?"  he  asked  anxiously. 
"Oh  dear,  no!"  was  the  reply  that  brought  immediate  though 
not  lasting  comfort.  "Ah,  I'm  glad  to  hear  that,  for  the  fact  is 
my  manuscript  was  more  than  half  destroyed  by  one  of  my 
puppies  this  morning."  "  I  say,"  asked  the  sexton  eagerly,  "  do 
you  suppose  you  could  manage  to  give  a  pup  out  of  that  same 
litter  to  our  parson  ?  " 

Tribute  to  Dr.  Ferguson. 

These  two  anecdotes  have  an  obvious  bearing  upon  the  cir- 
cumstances in  which  I  find  myself  this  evening.  Pray  let  me 
wrench  the  moral  into  an  apology,  and  let  yours  be  a  lenient 
judgment.  And  if  further  excuse  be  needed  I  might  add,  what 
most  of  you  know  so  well,  that  my  old  friend,  Dr.  Ferguson, 
is  not  the  man  to  take  no  for  an  answer.    When,  therefore,  he 

m 

5 


-12 


ADDRESS 


summoned  me  to  participation  in  these  exercises  a  second  time, 
waiving  aside  as  futile  my  modest  and  repeated  disclaimer  of 
fitness  as  a  preacher,  and  begging  me  to  help  him  out,  it  was 
stipulated  that  my  willingness  to  respond  was  conditioned  upon 
your  acceptance  of  such  contribution,  however  meagre  and  inade- 
quate to  the  occasion,  as  it  might  be  within  me  to  make.  My 
attitude  towards  Dr.  Ferguson  is,  always  has  been,  and,  so  long 
as  life  endures,  I  trust  ever  will  be,  that  of  a  Scotchman  whose 
services  were  invoked  on  behalf  of  a  brother  in  distress.  The 
two  were  returning  home  under  conditions  of  conviviality  that 
made  the  ditch  the  natural  and  inevitable  goal  of  both  leader  and 
led.  "Can  ye  no  help  me  oot,  Tammas?"  came  the  piteous  cry 
from  the  depths.  "  No,  Sandy,  a  carina  help  ye  oot,  but  a'll  lie 
doon  wi'  ye." 

So  here  I  am,  eager  enough  to  help  if  help  of  any  sort  there 
be  in  the  message  that  I  bring.  A  discerning  American  speaker 
once  declared  the  essential  ingredients  of  an  after-dinner  speech 
to  be  an  anecdote,  a  quotation  and  a  platitude.  The  same  con- 
stituents may,  and  usually  do,  enter  into  utterances  of  a  more 
serious  sort.  You  have  had  anecdotes,  and  more  may  follow, 
and  Heaven  knows  that  it  is  easy  enough  to  be  platitudinous  on 
all  occasions.  Now  then  for  the  quotation  which  I  have  selected 
by  way  of  removing  the  impression  warranted,  perhaps,  by  what 
has  already  been  said,  that  I  intend  to  be  wholly  flippant  on 
serious  ground. 

It  is  from  John  Ruskin: 

"  Remember,  then,  that  I,  at  least,  have  warned  you,  that  the 
happiness  of  your  life,  and  its  power,  and  its  part  or  rank  in 
earth  or  in  heaven,  depend  on  the  way  you  pass  your  days  now. 
They  are  not  to  be  sad  days;  far' from  that,  the  first  duty  of 
young  people  is  to  be  delighted  and  delightful ;  but  they  are  to 
be  in  the  deepest  sense  solemn  days.  There  is  no  solemnity  so 
deep,  to  a  rightly  thinking  creature,  as  that  of  dawn.  But  not 
only  in  that  beautiful  sense,  but  in  all  their  character  and  method, 
they  are  to  be  solemn  days.  Take  your  Latin  dictionary  and 
look  out  '  sollennis,'  and  fix  the  sense  of  the  word  well  in  your 
mind,  and  remember  that  every  day  of  your  early  life  is  ordain- 
ing irrevocably,  for  good  or  evil,  the  custom  and  practice  of 
your  soul;  ordaining  either  sacred  customs  of  dear  and  lovely 
recurrence,  or  trenching  deeper  and  deeper  the  furrows  for  seed 
of  sorrow.   Now,  therefore,  see  that  no  day  passes  in  which  you 


G.  ALDER  BLUMER 


713 


do  not  make  yourself  a  somewhat  better  creature ;  and  in  order 
to  do  that,  find  out,  first,  what  you  are  now." 

A  Sacred  Calling. 

Fain  would  I  go  on  with  this  quotation,  for  I  am  painfully 
conscious  of  boldness  and  unwisdom  in  thus  perpetrating  a  vio- 
lent descent  from  John  Ruskin  to  the  present  speaker.  And 
yet  I  may  at  least  help  you  to  find  out  what  you  are.  For 
three  years  you  have  been  laboring  hard  to  gain  a  practical 
knowledge  of  a  sacred  calling.  It  is  more  than  likely  that  during 
the  impressionable  period  of  your  girlhood  you  were  carried  away 
by  the  glamour  of  nursing  as  a  career,  that  you  retained  some 
of  your  illusions  when  you  became  a  probationer,  and  it  is  certain 
that  you  very  soon  experienced  a  rude  awakening.  The  trained 
nurse  has  been  idealized  of  late  years  more  perhaps  than  any 
other  working  woman.  Her  gentle,  ministering  ways  are  en- 
shrined in  stories  of  which  she  is  the  heroine;  her  professional 
successes  are  heralded  from  house  to  house,  from  battle  field  to 
battle  field.  We  see  her  on  our  streets  and  in  our  houses  in 
trim  uniform,  a  vision  of  female  loveliness.  It  is  almost  the 
exception  to  be  within  earshot  of  a  group  of  quidnuncs  of  your 
own  sex  without  overhearing  the  words  "  trained  nurse "  in 
casual  utterance.  Indeed,  nowadays  it  more  frequently  happens 
that  the  distinguished  patient  under  discussion  has  two  trained 
nurses  at  her  disposal,  or — shall  I  not  rather  say — is  at  the  dis- 
posal of  two  trained  nurses.  There  is  no  factor  in  our  whole 
social  fabric  more  persistently  pervasive  than  the  trained  nurse. 
Small  wonder,  then,  that  young  women,  especially  those  with 
a  touch  of  romance  in  their  mental  makeup,  should  be  attracted 
without  due  thought  of  the  morrow  to  an  arduous  calling  that 
is  already  overcrowded.  Very  few  of  you,  I  imagine,  knew  any- 
thing of  the  seamy  side  of  your  work  before  you  began  your 
probationary  period.  The  sentimental  and  the  frivolous  and  the 
generally  unfit  have  been  weeded  out  and  here  you  are,  fit  sur- 
vivors/ready to  throw  down  the  gage  of  battle  against  disease, — 
ready,  in  short,  to  speak  in  plain  prose,  to  earn  an  honest  living 
in  a  chosen  field  of  labor.  I  say,  then,  that  it  is  a  solemn  occa- 
sion. And,  first,  permit  me  to  congratulate  you  upon  your  gradu- 
ation and  to  bid  you  the  cheer  that  is  your  meed  and  your  need. 
I  do  not  wish  to  say  a  single  word  to  you  that  shall  jar  or  dis- 
courage, but  if,  as  the  result  of  a  large  personal  contact  with 


714  ADDRESS 

nurses,  I  can  say  aught  that  may  be  helpful,  I  shall  feel  thankful 
for  the  privilege  of  this  brief  address. 

Referring  to  the  mooted  question  whether  nursing  is  a  pro- 
fession, on  the  occasion  of  the  opening  of  this  Nurses'  Home,  Dr. 
Ferguson  used  these  words  five  years  ago,  "  I  refer  to  scientific 
nursing.  I  do  not  call  it  the  profession  of  nursing,  and  I  doubt 
the  desirability  of  such  a  title,  though  the  attainments  of  our 
nurses  almost  justify  the  use  of  the  term."  Were  the  author  of 
this  sentiment  to  speak  to-day,  I  fancy  he  would  admit  that  that 
doubt  had  been  removed,  wholly  or  in  part,  for  much  has  been 
accomplished,  even  in  so  brief  an  intervening  period,  to  elevate 
the  standard  of  nursing  in  this  country.  A  better  preliminary 
education  is  exacted  from  the  candidate,  the  curriculum  has  been 
extended,  and  these  requirements,  together  with  state  registration, 
are  making  it  more  and  more  difficult  to  enter  the  fold.  Some- 
one, speaking  of  the  trained  vigilance  of  the  modern  nurse,  sup- 
plementing and  perfecting  the  watchful  care  of  the  doctor,  has 
said,  "  The  hands  of  the  nurse  are  the  physician's  hands  length- 
ened out  to  minister  to  the  sick."  In  a  lecture  to  the  graduating 
class  of  the  Johns  Kopkins  Hospital  Training  School,  which  it 
was  my  privilege  to  hear  two  or  three  years  ago,  Dr.  E.  T. 
Devine  demurred  to  that  simile  and  saw  the  figure  of  the  nurse 
looming  somewhat  larger  in  the  foreground  than  the  words  I 
have  quoted  indicate.  He  insisted  that  her  hands  were  not  an 
extension  of  the  physician's,  but  rather  an  independent  pair  of 
her  own,  doing  certain  things  that  the  physician,  unless  he  have 
gifts  and  training  of  a  nurse  in  addition,  could  not  do  at  all,  or, 
at  any  rate,  could  not  do  so  well  as  the  nurse  does  them,  since 
she  is  engaged  in  the  practice  of  an  art  which  supplements  that 
of  a  physician  and  which  often  involves  a  considerable  degree 
of  self-reliance.  And  he  raised  the  question,  full  of  all  sorts  of 
subtlety  and  sophistry,  whether  the  nurse  is  primarily  the  doc- 
tor's nurse  or  the  patient's  nurse.  That  question  need  not  be 
discussed  here.  It  is  for  the  individual  nurse  to  determine,  by 
her  own  outlook  into  the  ideal,  and  by  her  own  methods  of 
practice,  whether  she  shall  be  regarded,  and  regard  herself,  as 
plying  a  trade  or  practicing  a  profession.  The  important  fact 
to  remember  is  that  increased  advantages  bring  greater  indebted- 
ness, and  that  opportunity  spells  responsibility.  Says  Lord 
Bacon,  "  I  hold  every  man  a  debtor  to  his  profession ;  from  the 
which  as  men  of  course  do  seek  to  receive  countenance  and 


G.  ALDER  BLUMER 


715 


profit,  so  ought  they  of  duty  to  endeavor  themselves  by  way  of 
amends  to  be  a  help  and  ornament  thereunto." 

As  a  Profession. 

You  will  perceive  that  I  am  willing  to  look  upon  your  calling 
as  a  profession,  and  disposed  not  to  insist  too  strongly,  in  view 
of  your  higher  training,  upon  the  entire  subserviency  of  the 
nurse,  in  all  things,  either  to  the  physician  or  the  patient.  But 
please  fix  in  your  minds,  now  and  for  all  time,  the  thought  once 
so  wisely  expressed  by  Professor  Jowett,  "We  are  none  of  us 
infallible,  not  even  our  youngest."  Remember,  too,  that  the  word 
trained  as  applied  to  one  of  your  calling  has  a  far  wider  signifi- 
cance than  appears  on  the  surface.  It  implies,  however  violent 
the  assumption  may  be  in  some  cases,  not  only  medical  and  phys- 
ical knowledge,  but  a  great  variety  of  other  things,  and  anent 
some  of  these  implied  qualities  I  may  be  permitted  a  few  words. 
Your  diplomas  may  be  taken  as  a  sufficient  warrant  of  your 
technical  knowledge,  but  in  applying  that  knowledge  you  will 
have  much  to  learn  every  day  in  the  great  school  of  experience. 
First  in  the  list  of  incidental  requirements  I  would  mention  the 
qualities  of  tact  and  silence  and  bracket  them  as  one  God-given 
gift.  Most  women,  it  is  true,  are  blessed  with  more  of  the  former 
than  men.  It  is  equally  true  that  they  are  credited  with  less  of 
the  priceless  faculty  of  silence.  Women  have  by  nature  a  nicer 
perception  of  the  fit,  a  greater  respect  for  susceptibilities,  a  larger 
adroitness  in  saying  exactly  what  given  circumstances  require,  a 
pleasanter  an<l  a  more  cultivated  aptitude  in  ingratiating  them- 
selves by  subtle  and  devious  approach,  especially  where  men  are 
concerned,  insomuch  that  we  can  all  frankly  echo  the  Tenny- 
sonian  sentiment: 

"And  loved  them  more,  that  they  were  thine 
The  graceful  tact,  the  Christian  art." 

A  woman  without  tact  is  a  creature  very  much  to  be  pitied,  and 
a  trained  nurse  without  that  quality  is  unfit  for  her  calling.  There 
is  no  doubt  that  absence  of  tact  is  more  often  responsible  than 
incompetency  for  the  ill  favor  with  which  the  trained  nurse  is 
regarded  in  some  families  who  have  been  made  to  surfer  in 
consequence  of  that  defect.  Some  of  us  have  had  experience 
with  the  officious  person — now  happily  rare — whose  entrance  into 
a  household  is  the  signal  for  instantaneous  disturbance  of  its 


7 16 


ADDRESS 


smooth  machinery.  Usually  a  young  woman  with  an  overweening 
sense  of  her  own  importance,  her  most  conspicuous  aptitude  is 
that  of  getting  everybody  by  the  ears  from  the  mistress  of  the 
house  down  to  the  maid  in  the  scullery.  She  is  controlled  by 
the  delusion,  the  genesis  of  which  is  a  foregone  conclusion  in 
natures  where  self  is  allowed  unbridled  sway,  that  she  is  entitled 
m  the  household  to  just  as  much  attention  as  the  patient  herself. 
Such  nurses  are  rare  nowadays,  for  considerations  of  policy  have 
taught  them  differently  even  though  by  nature  there  existed  that 
otherwise  unwarranted  expansion  of  self-feeling  among  them 
when  they  began  tentatively  to  feel  their  way  towards  popular 
approval.  One  cannot  insist  too  strongly,  then,  that  natural  tact 
should  be  regarded  as  a  sine  qua  non  to  eligibility  in  a  candidate 
for  training.  At  the  same  time  it  is  not  to  be  gainsaid  that  as 
delicateness  of  physical  touch  can  be  cultivated — and  tact  means 
touch — till  one  acquires  what  surgeons  call  tactus  eruditus,  so 
too  is  tact  in  the  sense  in  which  it  is  here  used  also  susceptible 
of  cultivation  in  those  who  are  by  nature  not  wholly  bereft  of 
it.  If  you  are  interested,  as  you  ought  to  be,  in  popularizing 
your  calling  everywhere,  see  to  it  then  that  your  efforts  in  this 
direction  never  fail,  for  just  as  you  succeed  in  pleasing  those 
who  employ  you,  in  that  same  measure  will  you  create  a  demand 
for  your  services  elsewhere,  and  gradually  extend  that  demand 
to  a  social  class  that  heretofore  has  not  enjoyed  your  ministra- 
tions, largely  because  it  has  feared  the  trained  nurse  and  shrunk 
from  her  as  from  an  awesome  person  whose  services  are  for 
others  in  a  higher  social  scale,  not  for  itself. 

Value  of  Silence. 

Of  the  value  of  silence  it  is  more  difficult  to  speak.  Here 
one  stands  upon  dangerous  and  debatable  ground.  The  Abbot 
of  a  Nitrian  monastery  once  gave  one  of  his  monks,  so  the  story 
goes,  as  a  rule  of  life  the  first  verse  of  the  Psalm  beginning  "  I 
•  said  I  will  take  heed  to  my  ways  that  I  offend  not  with  my 
tongue."  "When  you  can  keep  that  rule,"  said  he,  probably  with 
a  knowing  wink,  "  come  and  I  will  give  you  another."  Tradition 
has  it  that  the  worthy  monk  never  returned.  Now  if  even  a 
monk  found  it  impossible  to  observe  the  rule,  how  much  more 
difficult  would  the  task  be  for  a  nun,  and  where,  pray,  beset  as 
she  is  with  so  many  temptations  to  tell  what  she  knows  and 
more  too,  where  would  a  poor  nurse  stand  in  the  scale  of  dis- 


G.  ALDER  BLUMER 


717 


cretion  ?  The  tendency  to  gossip — and  it  is  by  no  means  confined 
to  women,  however  much  men  may  flatter  themselves  on  the 
score  of  immunity — has  come  down  to  us  mortals  as  one  of  the 
most  insidious  and  most  agreeable  weaknesses  of  our  human 
nature.  In  vain  have  philosophers  and  poets  inveighed  against 
it  from  time  immemorial.    Was  it  not  Horace  who  said: 

"  For  faithful  silence,  too,  there's  sure  reward ; 
Never  beneath  my  roof  or  spreading  sails 
Will  I  allow  the  man  who  blabs 
The  secrets  of  a  sacred  trust/' 

And  the  late  Bishop  Huntington,  among  his  best  obiter  dicta,  once 
said  sagely  that  "  personal  conversation  is  always  dangerous 
inversely  as  the  square  of  the  distance."  What  makes  it  all  the 
more  difficult  for  the  nurse  to  steer  a  straight  course  in  this 
matter  of  gossip  is  the  undoubted  fact  that  she  is  encouraged  in 
her  lingual  incontinence  by  her  patient.  This  extenuating  cir- 
cumstance should  always  be  remembered  in  charity  when  we  dis- 
cover that  through  the  medium  of  a  trained  nurse  in  flourishing 
practice  full  particulars  concerning  the  length,  shape,  cubic  and 
actual  contents,  state  of  decomposition,  etc.,  of  an  amputated 
appendix  have  been  indiscreetly  disclosed  to  the  invalid  of  an 
inquiring  turn  of  mind.  There  seems  to  be  on  the  part  of  some 
patients  during  the  convalescent  stage  of  their  illness  a  morbid 
desire  to  be  informed  concerning  the  ailments  of  others,  and 
particularly  does  the  desire  manifest  itself  with  reference  to  sur- 
gical cases  involving  what  one  may  perhaps  call  the  more  esoteric 
anatomy.  It  is  unquestionably  true,  moreover,  that  the  loosened 
tongue  of  the  nurse  often  gives  animation  to  a  sick  room,  thus 
robbing  it  of  much  of  its  dullness.  Still  the  nurse  must  always 
be  on  her  guard  and  recognize  that,  equally  with  the  physician, 
she  is  bound  by  the  Hippocratic  oath  to  which  she  has  subscribed. 
Cultivate,  then,  that  excellent  quality  that  is  the  birthright  of 
men  born  north  of  the  river  Tweed,  to  wit,  caution.  Personally 
I  have  found  the  anecdote  of  a  brave  little  Scotch  laddie  most 
instructive  as  a  lesson.  His  father  had  been  arrested  for  some 
misdemeanor  consequent  upon  taking  a  "  wee  drappie "  more 
than  was  o-ood  for  him,  and  the  presiding  magistrate  was  trying, 
with  insidious  art,  to  inveigle  the  leal  lad  into  testifying  against 
the  erring  author  of  his  being.  "Where  did  it  happen,  my  boy?" 
he  asked  most  suavely.    "  Ye  ken  Inverness  street."    "  Yes,  I 


7 1  8  ADDRESS 

know  it."  "Weel,  when  ye  gang  alang  Inverness  street,  ye  come 
to  the  Square."  "  Yes,  that's  good,  go  on."  "And  ye  cross  the 
Square'  and  come  to  Dalkeith  street,  and  then  ye  turn  to  your 
right  along  Wallace  street  till  ye  come  to  a  wee  shop  where  they 
sell  baps."  "  Yes,  yes,  I  remember  the  confectioner's."  "And 
then  ye  turn  to  your  left  till  ye  come  to  a  pump."  "  Yes,  my 
lad,  I  know  the  pump  well."  "A'm  glad  to  hear  ye  say  so,  for 
if  you  ken  it  weel  ye  maun  gang  and  pump  it,  for  ye'll  no 
pump  me." 

But  surely  you  will  understand  what  I  mean  when  I  prescribe 
silence,  and  I  shall  have  been  much  misunderstood  if  I  have  not 
made  it  equally  clear  that  silvery  speech  has  its  potent  uses  in 
the  sick  room,  especially  during  the  long  days  of  convalescence. 
We  are  indebted  to  Robert  Louis  Stevenson  for  the  word  "  talk- 
able  "  which  he  uses  "  to  denote  a  certain  distinction  among  the 
possible  subjects  of  human  speech."  Dr.  Van  Dyke  regards  this 
distinction  as  an  illusion,  since  all  subjects,  "  the  foolish  things 
of  the  world  and  the  weak  things  of  the  world,  and  base  things 
of  the  world,  yea,  and  things  that  are  not,"  may  provide  matter 
for  good  talk  if  only  the  right  people  are  engaged  in  the  enter- 
prise. "  No,"  says  he,  "  the  quality  of  talkability  does  not  mark 
a  distinction  among  things ;  it  denotes  a  difference  among  people." 
Talkability  is,  in  short,  a  virtue,  and  talkativeness  a  vice.  "A 
talkative  person  is  like  an  English  sparrow, — a  bird  that  cannot 
sing,  and  will  sing,  and  ought  to  be  persuaded  not  to  try  to  sing. 
But  a  talkable  person  has  the  gift  that  belongs  to  the  wood  thrush 
and  the  veery  and  the  wren,  the  oriole  and  the  white-throat  and 
the  rose-breasted  grosbeak,  the  mockingbird  and  the  robin  (some- 
times) ;  and  the  brown  thrush;  yes,  the  brown  thrush  has  it  to 
perfection  if  you  can  catch  him  alone, — the  gift  of  being  interest- 
ing, charming,  delighting  in  the  most  off-hand  and  various  modes 
of  utterance." 

Service  Among  the  Poor. 

Among  nurses  who  work  as  well  with  the  heart  as  the  hand, 
a  large  part  of  the  charm  of  their  calling  comes  from  the  oppor- 
tunity for  service  among  the  poor.  Those  of  you  who  are  to 
dedicate  yourselves  to  district  nursing,  if  such  there  be  in  this 
class,  are  to  be  envied  above  all  others.  Indeed,  district  nursing 
is  a  branch  of  the  work  that  all  might  follow  with  great  advan- 
tage, if  only  for  a  season.    The  experience  broadens  alike  the 


G.  ALDER  BLUMER 


719 


sympathies  and  the  training  of  the  nurse,  and  fosters  a  resource- 
fulness that  stands  her  well  in  stead  when  she  is  brought  face  to 
face  at  the  bedside  with  emergencies  that  seldom  arise  in  the 
family  of  comfortable  circumstances,  still  less  in  the  well- 
equipped  hospital  with  its  large  staff,  and  where  supplies  in  mani- 
fold abundance  are  ever  ready  to  the  reaching  hand.  Many  a 
time  the  district  nurse  has  been  able  to  prevent  what  is  called 
breaking  up  the  home,  and,  strangely  enough,  the  struggle  for 
integrity  in  this  regard  is  oftentimes  keenest  where  it  seems  least 
worth  while.  To  lend  a  hand  at  such  a  time  is  a  blessed  privi- 
lege. In  all  English  literature  I  know  of  no  more  pathetic 
passage  than  one  which  may  be  found  in  "  Sesame  and  Lilies," 
and  which  I  will  take  the  liberty  of  reading  since  it  illustrates 
the  highest  possibilities  of  your  mission  not  only  of  healing  but 
of  help  in  its  broadest  sense. 

"An  inquiry  was  held  on  Friday  by  Mr.  Richards,  deputy 
coroner,  at  the  White  Horse  Tavern,  Christ  Church,  Spitalfields, 
respecting  the  death  of  Michael  Collins,  aged  fifty-eight  years. 
Mary  Collins,  a  miserable  looking  woman,  said  that  she  lived 
with  the  deceased  and  his  son  in  a  room  at  2  Cobbs'  Court,  Christ 
Church.  Deceased  was  a  '  translator '  of  boots.  Witness  went 
out  and  bought  old  boots ;  deceased  and  his  son  made  them  into 
good  ones,  and  then  witness  sold  them  for  what  she  could  get  at 
the  shops,  which  was  very  little  indeed.  Deceased  and  his  son 
used  to  work  night  and  day  to  try  and  get  a  little  bread  and 
tea,  and  pay  for  the  room  (2s  a  week),  so  as  to  keep  the  home 
together.  On  Friday  night  deceased  got  up  from  his  bench  and 
began  to  shiver.  He  threw  down  the  boots,  saying,  1  Somebody 
must  finish  them  when  I  am  gone,  for  I  can  do  no  more/  There 
was  no  fire,  and  he  said,  '  I  would  be  better  if  I  was  warm.' 
Witness  therefore  took  two  pairs  of  translated  boots  to  sell  at 
the  shop,  but  she  could  only  get  I4d.  for  the  two  pairs,  for  the 
people  at  the  shop  said,  'We  must  have  our  profit.'  Witness 
got  14  pounds  of  coal  and  a  little  tea  and  bread.  Her  son  sat 
up  the  whole  night  to  make  the  '  translations,'  to  get  money,  but 
deceased  died  on  Saturday  morning.  The  family  never  had 
enough  to  eat.  Coroner :  '  It  seems  to  me  deplorable  that  you 
did  not  go  into  the  workhouse.'  Witness:  'We  wanted  the  com- 
forts of  our  little  home.'  A  juror  asked  what  the  comforts  were, 
for  he  only  saw  a  little  straw  in  the  corner  of  the  room,  the 


720  ADDRESS 

windows  of  which  were  broken.  The  witness  began  to  cry,  and 
said  that  they  had  a  quilt  and  other  little  things."  This  passage 
from  John  Ruskin  is  the  more  timely  by  reason  of  the  recent 
extraordinary  cropping  up,  as  of  a  poisonous  weed  that  will  not 
down,  of  the  doctrine  of  euthanasia.  There  has  been  introduced 
into  the  Legislature  of  Ohio,  within  a  fortnight,  a  bill  to  legalize 
the  murder  of  the  aged,  the  sick  and  the  injured,  and,  horrible 
to  relate,  the  measure  is  being  promoted  by  a  woman.  Surely 
here  we  see,  under  thinnest  disguise,  a  hideous  survival  in  man 
of  that  instinct  of  the  lower  animals  which,  in  the  brutal  struggle 
for  existence,  expels  the  stricken  member  of  the  herd,  leaving  it 
to  perish  when  it  is  not  gored  or  trampled  to  death.  It  sur- 
vives in  the  common  expression,  heard  every  day  with  respect 
to  the  special  hospitals,  in  which  my  own  professional  life  has 
been  spent,  that  such  an  one  has  been  "  put  away,"  the  thought, 
more  or  less  unconscious,  being  not  that  he  has  been  isolated 
for  skilled  and  humane  treatment  looking  to  recovery,  but'  put 
out  of  the  sight  of  men.  Happily  the  trained  nurse  will  always 
be  able  to  strike  a  blow  at  such  dangerous  doctrines  as  euthanasia. 
My  apology  for  this  reference  to-night  is  not  so  much  the  action 
taken  in  another  state,  under  the  auspices  and  arguments  of  a 
woman,  as  the  endorsement  of  the  measure  by  an  eminent  New 
England  professor  whose  views  as  proclaimed  broadcast  in  the 
public  prints  reflect  a  sentiment  against  which  all  hospitals,  all 
physicians  and  all  nurses  must  ever  wage  war.  Let  us  recall 
that  letter  of  Washington  in  which  he  speaks  of  the  pitifulness 
of  most  ambitions  of  men  "  when  compared  with  the  minor  virtue 
of  making  our  neighbor  and  our  fellowmen  as  happy  as  their 
frail  condition  and  perishable  natures  will  permit  them  to  be." 

In  the  hospital  over  which  your  speaker  has  the  honor  to  pre- 
side, we  can  point  with  pride  this  year  to  the  fact  that  one.  of 
our  patients  died  after  a  residence  within  its  walls  of  fifty-three 
years.  Not  ours  to  reason  why  the  unfit  survive,  in  apparent 
reversal  of  the  Darwinian  law,  not  for  us  mortal  men  to  arrogate 
to  ourselves  the  arbitrament  of  life  or  death.  In  view  of  this 
new  doctrine  of  death  to  the  dying,  as  promulgated  from  high 
places,  let  us  respond  rather,  with  freshened  fervor,  when  we  hear 
the  sixth  commandment  read  in  our  churches,  "  Lord,  have  mercy 
upon  us  and  incline  our  hearts  to  keep  this  law." 


G.  ALDER  BLUMER 


721 


Care  of  Health. 

The  American  conscience,  we  may  rest  assured,  will  never 
stand  for  wholesale  unmortality,  and  in  our  day  that  conscience 
has  been  quickened  more  than  ever  before  in  all  matters  per- 
taining to  health,  individual  as  well  as  public.  We  realize  that 
on  the  physical  well-being  of  our  communities  depend  their 
efficiency,  their  social  force,  their  morality  and  their  power  of 
further  evolution.  So,  too,  on  a  nurse's  general  health  must 
depend  her  happiness,  her  endurance  of,  and  capacity  for,  work; 
her  thinking,  her  feeling  and  her  conduct.  This  consideration 
leads  me  to  say  a  word  on  the  relation  of  employer  to  employed 
as  affecting  the  physical  needs  of  nurses.  People  are  apt  to 
forget  that  they  owe  a  trained  nurse  who  enters  their  household 
and  becomes  temporarily  a  member  of  it,  something  more  than 
the  wages  they  pay  her.  They  should  see  to  it  that  in  at  least 
three  other  directions  she  receives  humane  consideration,  namely, 
food,  rest,  and  recreation.  Hers,  as  we  have  seen,  and  as  you 
well  know,  is  an  arduous  calling.  There  is  great  wear  and  tear, 
and  consequently  great  need  for  repair  by  nutritious  food.  The 
conditions  of  the  sick  room  are  often  far  from  such  as  create 
appetite.  It  is  important,  therefore — for  employer  as  well  as 
nurse — that  appetite  be  coaxed  by  good  wholesome  food  of  suf- 
ficient variety,  properly  cooked  and  properly  served.  A  nurse 
cannot  do  good  work  on  an  empty  stomach.  Her  meals  should 
be  served  with  regularity,  and  she  should  be  relieved  a  sufficient 
length  of  time  to  eat  after  the  manner  of  the  average  human 
being.  It  is  a  grave  mistake  to  assume,  as  some  people  ap- 
parently do,  that  while  ordinary  individuals  must  pay  the  penalty 
if  they  indulge  in  the  reprehensible  practice  of  bolting  their  food, 
the  nurse,  by  virtue  of  her  occupation,  is  endowed  with  the  diges- 
tive capacity  of  an  elephant,  is  as  regards  dyspepsia  immune,  and 
may  therefore  make  her  stay  in  the  dining  room  as  brief  as  the 
physical  act  of  continuous  swallowing  without  mastication  will 
permit.  More  widespread,  however,  is  the  delusion  that  the 
nurse  needs  no  rest.  It  is  true  that  when  a  woman  chooses 
nursing  as  a  profession  she  cannot  expect  while  on  active  duty 
to  enjoy  her  full  physiological  quota  of  sleeping  hours.  Her 
sleep  will  necessarily  be  broken.  I  submit,  however,  that  it  very 
often  happens  that  there  is  a  woeful  lack  of  consideration  for 


72  2  ADDRESS 

her  in  cases  where,  by  judicious  management,  without  compromis- 
ing the  interests  of  the  patient,  sufficient  rest  might  be  provided. 
So,  too,  in  the  matter  of  recreation.  To  the  employer  I  would 
say  let  the  trained  nurse  have  her  regular  outing  every  day,  and 
I  would  even  go  further  than  this  and  insist  that,  even  though 
her  preference  be  to  stay  indoors,  she  be  urged  to  go  out  into 
God's  sunshine,  to  the  end  that  her  patient  may  all  the  more 
largely  enjoy  the  sunshine  of  her  ministering  presence  when  she 
returns.  Nurses  who  sow  neglect  of  body  reap  disorder  of 
soul,  and  unless  that  body  be  religiously  cared  for  they  will  never 
be  able  to  demonstrate  what  Stevenson  calls  "  the  great  Theorem 
of  the  Livableness  of  Life."  "A  happy  man  or  woman,"  says 
that  cheerful  writer,  "  is  a  better  thing  to  find  than  a  five-pound 
note.  He  or  she  is  a  radiating  focus  of  good-will ;  and  their 
entrance  into  a  room  is  as  though  another  candle  had  been 
lighted."  And  if  it  is  true  that  the  best  way  to  live  well  is  to 
work  well,  it  is  equally  true  that  the  best  way  to  work  well  is 
to  live  well.  Throw  your  whole  nature  into  the  interests  of  your 
patients  and  you  will  surely  escape,  more  effectually  than  in  any 
other  way,  anxiety,  ennui,  and  the  melancholy  of  introspection. 
Cultivate  optimism  at  all  hazards,  but  avoid,  as  a  poisonous  herb, 
the  fatalism  that  saps  persistent  effort.  And  if  your  patient  be 
pessimistic,  tell  her  the  fable  of  the  two  frogs  and  bear  it  ever 
in  mind  yourselves :  Once  there  were  two  frogs,  one  an  optimist, 
the  other  a  pessimist.  Each  fell  into  a  bowl  of  cream.  The 
pessimistic  frog  floundered  about  for  a  while,  and,  long  before 
his  strength  was  exhausted,  sank  to  the  bottom  in  despair  and 
was  drowned.  Not  so  the  optimist.  "  There  was  a  way  into 
this  trouble,"  said  he,  cheerily,  "  and  there  must  be  a  way  out." 
And  sustained  by  that  brave  spirit,  he  struck  out  with  steady 
and  firm  stroke  till  bye  and  bye  he  earned  the  ultimate  reward 
of  faith  and  fortitude  in  a  safe  and  comfortable  seat  upon  a  pat 
of  butter. 

Casting  Off  Worry. 

I  tell  this  fable  to  impress  upon  your  minds  a  fact  which 
men  of  your  speaker's  special  calling  have  abundant  reason  to 
know.  In  the  pursuit  of  happiness  hardly  anything  in  external 
circumstances  is  so  really  valuable  as  the  power  of  casting  off 


G.  ALDER  BLUMER 


723 


worry,  turning  in  times  of  sorrow  to  healthy  work,  taking  habitu- 
ally the  brighter  view  of  things. 

"Oh,  well,  for  him  whose  will  is  strong, 
He  suffers,  but  he  will  not  suffer  long." 

Strive  then,  I  beseech  you,  with  all  your  might,  to  adopt  this 
mental  attitude,  and  in  the  end  you  will  realize  what  a  dear  old 
lady  meant  when  she  once  said,  "  The  weeks  go  by  so  fast  that 
the  Sundays  clash  against  each  other. " 

Ladies  of  the  Graduating  Class,  already  I  have  exceeded  the 
limits  I  had  set  myself  for  this  address.  Time  and  your  own 
limitations  as  to  patience  bid  me  pause.  The  length  of  a  sermon 
should  always  be  proportioned  to  its  breadth,  measured  by  which 
test,  I  fear  I  have  held  your  attention  too  long.  Let  me  take 
you  into  my  confidence,  however,  as  I  close,  by  telling  you  that 
a  recent  mot  of  Dr.  Van  Dyke  has  comforted  me  greatly  in 
writing  what  has  been  set  down  as  the  thoughts  of  wiser  men 
than  your  speaker,  namely,  "  I  like  a  writer  who  is  original 
enough  to  water  his  garden  with  quotations  without  fear  of  being 
drowned  out." 

And  as  a  farewell  word  to  you  who  go  forth  to  labor,  you 
will  pardon  me  if  for  the  nonce  I  transcend  my  province  some- 
what by  recalling  to  your  minds  the  promise  that  "  the  fervent, 
efficacious  prayer  of  the  righteous  man  availeth  much,"  and  if  I 
ask  you  to  pray  always  in  the  spirit  if  not  in  the  letter  of  that 
worker,  now  gone  to  his  reward,  who  asked  of  his  Master :  "Give 
us  to  go  blithely  on  our  business  all  this  day,  bring  us  to  our 
beds  weary  and  content,  and  grant  us  in  the  end  the  gift  of 
sleep.  *  *  *  Call  us  up  with  morning  faces  and  with  morn- 
ing hearts — eager  to  labor — eager  to  be  happy  if  happiness  shall 
be  our  portion, — and  if  the  day  be  marked  for  sorrow,  strong  to 
endure  it.  Amen." 


724 


EDITORIAL 


EMtortal 

There  are  now,  happily,  signs  of  a  reaction  against 
the  recent  excessively  surgical  tendency,  which  has 
been  too  dominant,  toward  a  large  view  of  the  whole 
life  of  woman.  Specialists  are  beginning  to  realize 
that  they  must  broaden  their  view  from  the  pathology 
of  her  organs,  till  lately  so  often  doomed,  if  she  once 
consulted  them,  to  the  entire  problem  of  regimen,  and 
know  at  least  as  much  about  a  woman  as  about  her 
pelvic  diseases.  Indeed,  not  a  few  experts  are  begin- 
ning to  recognize  that  this  larger  field  is  relatively 
unknown  to  them,  and  that  they  must  begin  the  study 
of  the  new  or  higher  gynecology  with  something  like  a 
Socratic  confession  ignorance.  As  long  as  they 
hold  any  exclusive  theory  which  consigns  to  either 
ovaries,  uterus,  tubes,  or  central  nervous  system,  the 
exclusive  dominance,  or  assume  that  either  the  psyche 
or  soma  is  always  primal  or  causal,  little  progress 
can  be  made.  Each  of  the  modern  views  is  partially 
correct  and  must  always  be  considered  as  a  possible 
aspect  of  each  case. 

AdoUscence.  G.  Stanley  Hall. 

*      *  * 


The  alumni  and  friends  of  the  Albany  Medical 
The  Record  College  may  well  feel  proud  of  its  record  as  shown 
of  the       Dy  t}le  resuits  0f  fae   examinations    for  medical 
Albany  Medi-  ..  ,         ,  ••, 

cal  College  llcenses  held  during  1905  by  the  examining  boards 
of  the  various  states  and  published  in  the  Journal 
of  the  American  Medical  Association  for  August  25,  1906.  Table 
F,  at  page  591,  shows  that  of  the  fifty-one  larger  schools,  having 
fifty  or  more  graduates  examined  in  various  states  and  including 
graduates  not  only  of  1905  but  of  all  years,  only  three  schools 
had  no  candidates  rejected.  These  three  schools  were  the  Albany 
Medical  College,  Cornell  University,  and  Johns  Hopkins  Uni- 
versity. The  Albany  Medical  College  graduates  were  fifty-six  in 
number  and  were  examined  in  seven  different  states.  All  passed, 
while  the  percentage  of  failures  for  the  fourteen  largest  schools 
heading  the  list  and  having  100  or  more  graduates  examined, 
varied  from  2.6  to  53,  and,  for  the  entire  list  of  the  fifty-one 
larger  schools,  averaged  15.1.  This  is  certainly  a  good  showing 
for  the  Albany  Medical  College  and  one  with  which  its  alumni 
may  well  be  gratified. 


EDITORIAL 


725 


It  is  distinctly  creditable  to  the  Albany  Medical  College  under 
this  rigid  test,  to  find  itself  in  the  highest  class.  But  there  is  a 
deeper  significance  in  this  incident  than  is  revealed  by  a  mere 
statement  of  success.  When  the  requirement  of  four  courses  of 
eight  months  each  was  introduced  it  was  feared  the  strain  upon 
the  resources  of  the  student  was  too  great,  and  that  the  period 
of  self-support  was  postponed  to  a  point  in  years  which  might 
imperil  the  plan.  With  the  uncertain  results  of  the  independent 
State  examinations  for  license  to  practice  always  before  him,  as 
the  ultimate  obstacle  to  be  overcome,  he  naturally  looked  for 
instruction  which  gave  the  best  assurance  of  success  in  obtaining 
this  license,  necessary  to  him  as  a  means  of  gaining  a  living, 
and  as  compensation  for  years  of  self-denial  and  of  pecuniary 
outlay.  His  attitude  was  reflected  by  the  institutions  and  the 
courses  of  instruction  were  so  arranged  as  to  store  up  in  his 
mind  the  facts  to  be  made  available  before  the  dreaded  final 
tribunal. 

Some  three  or  four  years  ago  the  faculty  of  the  Albany 
Medical  College  decided  to  ignore  this  unsavory  feature  of 
"  cramming  "  the  student  for  an  examination  and  to  place  him 
in  the  way  of  getting  practical  knowledge.  This  step  was  taken 
not  without  misgiving.  The  didactic  lectures  were  relegated  to 
a  subordinate  place,  the  corps  of  instructors  was  increased,  the 
classes  were  divided  into  small  groups,  and  a  strenuous  personal 
effort  was  made  to  teach  each  individual  student  to  see,  to  hear 
and  to  feel  for  himself  that  he  might  learn  the  revelations  of 
the  great  science  of  medicine  by  actual  contact  with  them,  and 
not  by  hearing  them  described  in  a  more  or  less  flowery  or 
coherent  speech.  When  one  reflects  upon  the  propriety  of  this 
method  of  teaching,  it  appears  incredible  that  any  other  ever 
should  have  been  substituted  for  it.  Every  one  knows  that  fifty 
lectures  on  obstetrics  will  not  do  as  much  for  the  student,  as 
the  conduct,  under  proper  supervision,  of  one  case  of  midwifery. 
He  may  read  a  half  dozen  descriptions  of  the  technique  of  a 
suture  or  of  a  hypodermatic  injection,  and  then  grievously  injure 
his  patient  in  his  first  attempt  to  perform  either  operation.  Well- 
drilled  students  who  can  describe  cyanosis  with  the  facility  of 
a  text-book  have  failed  to  recognize  the  discoloration  even  when 
contrasted  with  a  control  healthy  patient.  And,  when  once  they 
have  seen  it,  they  have  never  failed  in  this  respect  again.  Most 
ridiculous  of  all  is  the  attempt  to  teach  by  lectures  the  specialty 


726 


LITTLE  BIOGRAPHIES 


of  dermatology,  consisting,  as  it  does,  entirely  of  external  cutane- 
ous manifestations!  These  even  the  highly  elaborated  print- 
er's art  of  the  present  day  cannot  successfully  reproduce,  and 
they  can  only  be  apprehended  by  seeing  and  studying  the 
patient.    Such  examples  could  be  multiplied  indefinitely. 

Having  thus  boldly  taken  this  important  step  in  medical  edu- 
cation, the  Albany  Medical  College  may  well  be  pleased  at  the 
attending  success.  But  the  revelation  should  not  be  gratify- 
ing to  the  College  alone.  There  is  indicated  a  corresponding 
acquisition  of  good  sense  on  the  part  of  State  examining  boards, 
that  they  have  so  framed  the  supreme  test  that  the  candidate 
shall  be  proved,  not  to  have  acquired  an  array  of  academic  or 
theoretical  facts  only  but  shall  have  been  found  qualified  to 
exercise  his  knowledge  upon  the  community.  While  we  are 
minded  to  congratulate  the  College  we  should  not  deprive  the 
State  examining  boards  of  their  measure  of  approval. 

After  all,  there  is  nothing  new  in  this  plan  of  instruction. 
Socrates  used  it,  two  thousand  years  ago.  "  He  was  opposed 
to  the  rhetorical  teaching  of  the  sophists,  and  had  neither  interest 
nor  confidence  in  the  physical  speculations  of  his  time."  He 
realized  the  fitness  of  things  by  calling  his  method  "  obstetric," 
because  "  it  was  an  art  of  inducing  his  interlocutors  to  develop 
their  own  ideas  under  a  catechetical  system." 

What  was  good  enough  for  Socrates  should  be  good  enough 
for  us. 


Xtttle  ffitograpbtes 

X.  SPIGELIUS. 

ADRIAN  VANDEN  SPIEGHEL,  anatomist  and  botan- 
ist, was  born  in  Brussels  in  1578.  Vesalius,  the 
founder  of  modern  anatomy,  also  born  in  Brussels, 
antedated  Spigelius  by  a  generation  or  more.  Many 
famous  anatomists  followed  in  the  path  of  Vesalius  and  their 
names  have  come  down  to  us  in  the  common  anatomical  terms. 
Among  them  were  Eustachius,  Fallopius,  Vidius,  Arantius, 
Varolius  and  others.   Spigelius  was  one  of  this  goodly  company. 


LITTLE  BIOGRAPHIES 


727 


The  advance  in  the  study  of  anatomy  was  but  one  of  the  mani- 
festations of  the  wonderful  revival  of  learning  of  the  sixteenth 
century.  This  awakening  of  the  human  mind  showed  itself  in 
the  discovery  of  America  by  Columbus,  then  in  the  founding  of 
the  modern  astronomical  system  by  Copernicus,  in  the  invention 
of  printing  and  of  gunpowder,  and  it  was  natural  that  new  dis- 
coveries should  also  be  made  in  medicine. 

Spigelius's  early  medical  studies  were  pursued  in  Louvain, 
about  fifteen  miles  from  Brussels.  This  was  an  important  manu- 
facturing town  specially  noted  for  its  fine  broadcloth.  This 
eminence  in  handicraft  it  shared  with  other  cities  of  Flanders, 
but  it  was  more  especially  noted  for  its  beautiful  buildings  and  its 
university.  Its  churches  were  famous  for  their  architecture  and 
the  Hotel  de  Ville,  begun  in  1447,  was  then  and  is  now,  one  of  the 
most  beautiful  Gothic  buildings  in  the  world.  The  University 
of  Louvain  was  founded  in  1426,  and  in  the  sixteenth  century 
was  one  of  the  foremost  in  Europe.  At  this  time  it  had  more 
than  six  thousand  students. 

From  Flanders,  Spigelius  followed  the  example  of  Vesalius 
and  went  to  Italy,  where  he  completed  his  medical  studies  at 
Padua.  This  was  a  famous  university  town,  about  twenty  miles 
from  Venice  and  was  the  birthplace  of  the  Latin  historian  Livy. 
The  university  was  founded  in  1222  and  at  one  time  was  attended 
by  fifteen  thousand  students.  Galileo  held  the  chair  of  mathematics 
from  1592  until  1598,  and  soon  after  invented  his  telescope  and 
discovered  the  satellites  of  Jupiter.  There  were  other  famous 
teachers  at  the  university  at  this  time ;  among  them,  in  the  medi- 
cal school,  Fabricius,  under  whom  it  was  the  good  fortune  of 
Spigelius  to  study.  The  surroundings  of  the  young  student  must 
therefore  have  been  very  inspiring.  After  obtaining  his  doctor's 
degree,  Spigelius  returned  to  his  native  land.  Soon  after  he 
went  to  Germany  and  established  himself  in  Moravia,  where  he 
had  been  but  a  short  time  when,  at  the  death  of  Casserio,  he  was 
summoned,  in  1605,  by  his  Alma  Mater,  to  Padua,  to  the  chair 
of  anatomy  and  surgery.  Here  he  was  the  direct  successor  of 
Vesalius.  This  position  he  continued  to  hold  until  his  death  in 
1625,  at  the  age  of  47,  just  at  the  period  of  his  greatest  usefulness 
to  science. 

While  at  Padua  he  began  to  arrange  his  written  works  in  a 
system,  but  was  not  able  to  publish  it  in  his  lifetime.  It  was  not 
until  two  years  afterward  that  his  complete  works  arranged  by 

6 


728 


LITTLE  BIOGRAPHIES 


his  son-in-law  Liberalis  Crema,  appeared.  Certain  of  the  treatises 
included  in  this  collection  had  been  published  before  the  death 
of  Spigelius,  among  them  "The  Introduction  to  Botany  (Isagoge 
in  rem  herbarium),"  and  a  treatise  concerning  the  tapeworm 
(De  lumbrico  late  liber),  and  others. 

Crema's  edition  of  Spigelius's  works  (Opera  quae  extant  omnia) 
was  first  published  in  Venice  in  1627,  and  reprinted  in  Amster- 
dam in  1645.  The  greater  part  of  it  consists  of  a  treatise  on 
anatomy  (De  humain  corporis  fabrica)  more  deserving  of  praise 
on  account  of  the  systematic  arrangement  of  the  subject  than 
for  the  new  facts  that  it  contained.  Indeed,  the  main  purpose  of 
the  author  had  been  to  make  the  study  of  anatomy  more  simple. 
Several  discoveries  are  attributed  to  him,  notably  that  of  the  small 
lobe  of  the  liver,  which  bears  his  name.  Among  his  works  there 
is  a  treatise  much  less  extensive  than  the  one  on  anatomy,  which 
gives  perhaps  a  better  idea  of  the  skill  which  Spigelius  possessed 
in  presenting  the  outlines  of  a  given  subject  with  clearness  and 
precision.  It  is  the  one  that  bears  the  title  "  Introduction  to 
Botany,"  (In  rem  herbarian  isagoge),  originally  published  in 
Padua  in  1606,  in  a  quarto  of  138  pages,  and  dedicated  to  the 
German  youth  who  came  to  study  at  Padua.  It  was  afterward 
printed  at  Leyden  on  the  Elzevir  Press.  In  this  edition,  it  is 
one  of  the  most  beautiful  of  works  on  botany,  and  the  contents 
are  fully  in  harmony  with  its  typographical  excellence  for  it 
gives  a  most  satisfactory  outline  of  the  subject  as  understood  at 
that  time.  There  are  two  main  divisions  of  the  work.  The  first 
is  devoted  to  a  description  of  the  plants  themselves,  and  the 
second  to  their  uses.  In  general,  the  author  follows  Theophrastes 
as  a  guide,  but  adds  certain  particulars  which  shows  that  he  him- 
self was  a  close  observer  of  nature.  He  describes  methods  for 
preserving  plants  by  drying.  In  the  second  volume  he  takes  up 
the  uses  of  plants,  making  a  sharp  distinction  between  plants 
used  for  medicine  and  those  used  for  food.  He  regards  as 
chimerical  the  view  quite  generally  held  at  that  time  that  one 
could  tell  the  internal  properties  of  plants  from  their  external 
appearance.  This  idea  was  known  as  the  "  Doctrine  of  Signa- 
tures." On  the  other  hand,  he  recognized  the  fact  that  experience 
and  even  accidental  circumstances  had  brought  to  light  certain 
valuable  properties  of  plants.  He  did  not  wish  to  neglect  any 
source  of  information  regarding  such  facts.  He  even  placed 
some  reliance  on  the  beliefs  of  the  country  people  as  to  the  virtues 


LITTLE  BIOGRAPHIES 


729 


of  certain  plants  growing  near  their  homes.  For  the  purpose 
of  informing  himself  more  fully  in  regard  to  these  beliefs  he 
traveled  through  many  of  the  Italian  cantons  disguised  as  a 
peasant  to  better  gain  the  confidence  of  the  people.  A  part  of 
the  work  is  devoted  to  the  subject  of  dietetics.  In  conclusion 
he  gives  an  abridged  history  of  the  science  of  botany  and  recom- 
mends to  his  pupils  that  they  arrange  all  they  learn  about  the 
subject  according  to  some  systematic  plan.  One  can  see  from  a 
perusal  of  this  work  that  Spigelius  followed  a  method  of  study 
which  ought  to  have  brought  about  lasting  results,  but  his  influ- 
ence upon  his  successors  does  not  seem  to  have  been  great,  and 
he  is  hardly  mentioned  by  some  of  them.  Linnaeus  classes  him 
among  the  authors  who  are  rather  obscure.  Nevertheless,  he 
has  given  in  honor  of  him  the  name  Spigelia,  to  a  genus  of 
American  plants,  one  species  of  which  furnishes  an  efficient  vermi- 
fuge. This  name  recalls  the  fact  that  Spigelius  once  wrote  a 
treatise  on  the  tenia  (de  Lumbrico  late  liber),  published  in  1618. 
A  fairly  complete  list  of  the  writings  of  Spigelius  is  as  follows : 

Isagoge  in  rem  herbarian.    Padua,  1606. 

De  lumbrico  late  liber.  1618. 

Catastrophe  anatomise  publicae  in  Lycaeo  Patavino  absolutae. 
1624. 

De  semitertiana  libri  quantor.  1624. 
De  formato  foctu  liber.  1626. 
De  humani  corporis  fabrica.  1627. 
Opera  quae  extant  omnia.  1645. 

BIBLIOGRAPHY. 

Hirst-Gurlt.    Biographisckes  Lexicon  der  hervorragenden  Aertze.    Wien  u.  Leipzig, 
1888,  v.  484. 

(Michaud).     Biographie  Universelle,  Paris,  1842-1865,  xl,  54. 

Arthur  Turner  Laird. 


no 


SCIENTIFIC  REVIEW 


Scientific  IRexnew 

Opsonins  and  Aggressins. 

The  role  which  opsonins  play  in  immunity  against  disease  is 
so  interesting  and  the  literature  so  extensive  that  the  subject 
is  worthy  a  short  review,  and  since  the  theory  of  aggressins 
is  at  first  sight  a  directly  opposite  view  it  also  deserves  some 
attention. 

Metschnikoff  has  shown  that  the  white  corpuscles  of  the  blood 
have  the  power  of  ingesting  and  devouring  bacteria  and  believes 
that  through  this  cellular  agency  we  have  immunity  to  disease. 
Buchner  and  his  school  believe  and  have  shown  that  immunity 
in  some  diseases  at  least  is  due  not  to  the  cells  but  to  the  fluids 
of  the  body.  Wright  has  shown  that  in  some  diseases  immunity 
is  due  not  to  the  cells  alone  and  not  to  the  fluids  alone  but  to 
their  combined  action.  To  do  this  he  takes  each  agent  entering 
into  the  act  of  phagocytosis,  viz.,  the  leucocytes,  the  bacteria  and 
the  fluid  in  which  they  move  and  these  he  studies  in  their  various 
combinations,  imitating  of  course  the  natural  condition  as  to 
temperature  and  reaction  of  media.  He  found  that  when  the 
leucocytes  and  bacteria  met  in  an  artificial  normal  saline  media 
no  phagocytic  action  took  place.  Also  if  he  used  as  media  normal 
serum  heated  to  650  C.  no  action  occurred.  And  if  he  used 
serum  a  week  old,  action  was  again  absent;  but  if  he  used  fresh 
unaltered  serum  the  bacteria  were  taken  up  by  the  leucocytes. 
Thus  apparently  some  substance  in  the  fresh  unheated  serum 
acted  as  a  sensitizer  or  appetizer  and  this  has  been  called  by 
Wright,  Opsonin  (I  prepare  food).  Briefly  the  technique  of 
the  experiment  is  as  follows: 

(1)  An  emulsion  of  bacteria  is  made  by  rubbing  up  a  little  of 
a  pure  agar  culture  in  distilled  water  or  normal  saline ; 

(2)  Fresh  serum  prepared  by  drawing  about  six  drops  of 
fresh  blood  into  a  miniature  cigar  shaped  tube  with  capillary 
ends,  sealing  and  centrif uging ; 

(3)  A  quantity  of  corpuscles  free  from  serum  prepared  by 
dropping  ten  drops  of  fresh  blood  into  4  c.  c.  of  a  fluid  to  pre- 
vent clotting  for  which  one  per  cent,  sodium  nitrate  solution  is 
best.    Then  by  the  settling  of  the  corpuscles  to  the  bottom  by 


SCIENTIFIC  REVIEW 


731 


centrifuging  they  are  washed  free  from  serum  and  are  still 
in  an  uninjured  and  active  condition. 

Equal  volumes  of  corpuscles,  serum  and  emulsion  of  bacteria 
are  mixed  and  incubated  for  fifteen  minutes  at  body  temperature 
(37. 50  C.)  using  as  incubation  chamber  a  small  test-tube,  capil- 
lary tube  or  after  the  original  method  of  Leishman  a  slide  and 
cover  glass. 

At  the  end  of  period  spread  contents  on  glass  slides  and  stain 
cocci  by  Leishman's,  Jenner's,  Wright's  or  Hasting's  stain; 
tubercle  by  the  Zeihl-Neilson-methylene  blue  method. 

Under  the  1/12  lens  the  number  of  the  bacteria  in  the  interior 
of  the  corpuscles  are  counted. 

By  similar  technic  with  variations  and  modifications  opsonins 
have  been  shown  to  have  the  following  qualities: 

They  are  present  in  almost  constant  quantity  in  the  normal 
animal,  are  present  at  birth,  are  thermolabile  and  destroyed  above 
65 0  C.  and  gradually  disappear  on  standing  in  about  six  days. 
They  are  specific  and  the  specific  opsonin  may  be  precipitated  by 
an  emulsion  of  that  particular  variety  of  bacteria,  are  absorbed 
by  the  latter,  from  which  they  are  then  inseparable  and  are  not 
affected  by  heat  above  65 0  C. 

The  relative  degree  of  phagocytosis  is  directly  in  proportion 
to  the  quantity  of  opsonin  present. 

In  nature  opsonins  are  bodies  built  on  the  type  of  agglutinins 
and  analogous  to  Ehrlich's  receptor  of  the  second  class.  They 
are  composed  of  two  groups ;  a  haptophore  group  for  union  with 
bacterial  receptors  and  an  opsoniferous  group  which  affects  the 
change  necessary  for  phagocytosis.  Their  action  is  analogous  to 
that  of  solutions  of  certain  poisonous  or  irritating  drugs  which 
prevent  phagocytosis,  not  by  harming  the  leucocytes,  but  by  pre- 
venting the  sensitizing  action  of  the  opsonins. 

Their  proportion  is  greater  in  certain  parts  of  the  circulation 
than  m  others,  being  as  a  round  foci  of  septic  inflammation. 

In  healthy  persons  they  are  present  in  about  the  same  ratio, 
but  in  the  subjects  of  chronic  infection  by  pathogenic  bacteria 
the  specific  opsonin  is  decreased,  but  in  proportion  as  it  increases 
the  infection  decreases.  This  has  been  found  especially  true  in 
cases  of  chronic  infection  by  the  tubercle  bacillus,  staphylococcus, 
pneumococcus,  streptococcus,  gonococcus,  B.  coli  and  B.  dysen- 
teriae,  in  fact  in  all  except  the  B.  diphtheriae  and  B.  Xerosis. 

But  the  point  of  practical  importance  in  therapeutics  is  that  it 


732 


SCIENTIFIC  REVIEW 


has  been  found  possible  to  experimentally  increase  the  specific 
opsonin' to  a  degree  exceeding  the  normal  healthy  ratio,  and  when 
this  can  be  accomplished  the  disease  which  had  formerly  resisted 
all  former  measures  to  alleviate  it  thus  comes  under  control. 
Among  the  diseases  in  which  this  has  been  done  are: 

Tuberculous  ulcers. 

Tuberculous  glands. 

Tuberculosis  of  bones  and  joints. 

Lupus  vulgaris. 

Tuberculosis  of  lungs,  Primary. 
Staphylococcus  infection  producing  furunculosis. 
Carbuncles.    Acne.  Sycosia. 
Pyorrhoea  alveolaris. 

Pneumococcic  infection  causing  chronic  empyema. 
Gonococcic  infection  causing  gleet. 
B.  coli  and  B.  dysenteriae  causing  chronic  diarrhoea. 
The  line  of  procedure  in  treating  a  case  of  chronic  infection 
so  far  incurable  is  briefly  as  follows: 

I.  First  cultures  and  plates  are  made  and  if  possible  the  infect- 
ing organisms  are  isolated. 

II.  A  determination  is  made  of  the  opsonic  index,  i.  e.,  the  ratio 
of  opsonin  in  the  blood  of  the  infected  individual  to  that  in  a 
healthy  person;  or  putting  it  in  other  words,  the  ratio  of  organ- 
isms ingested  by  a  given  number  of  leucocytes  in  a  given  time 
when  the  patient's  serum  is  used,  to  the  number  ingested  under 
exactly  similar  circumstances  when  the  serum  of  a  healthy  indi- 
vidual is  used. 

III.  A  sterilized  vaccine  is  prepared  of  the  organism  from  a 
pure  culture  on  agar.  In  the  case  of  the  staphylococcus  this 
should  contain  about  500,000,000  cocci  per  c.  c.  m.  or  about 
1.0  mg.  of  dried  culture.  In  the  case  of  tuberculosis  the  vaccine 
should  contain  1/2000-1/200  mg.  of  dried  tubercle  powder  per 
c.  c.  m. 

IV.  Following  the  determination  of  the  opsonic  index  a  sub- 
cutaneous injection  of  vaccine  is  made,  the  dose  varying  0.1  mg. 
to  1.0  mg.  in  coccal  infections  and  from  1/1000-1/500  in  tuber- 
culous cases. 

Subsequent  treatment  depends  on  the  result  of  the  initial 
injection. 

The  effect  of  an  inoculation  of  vaccine  in  a  healthy  uninfected 


SCIENTIFIC  REVIEW 


733 


individual  is  an  immediate  rise  in  the  opsonic  content  of  the 
blood. 

The  effect  on  an  unhealthy  infected  person  is  the  opposite.  A 
fall  or  decrease  which  extends  gradually  over  a  number  of  days 
is  the  negative  phase,  to  be  followed  by  a  return  to  its  original 
height  and  a  subsequent  rise  beyond,  the  positive  phase. 

Coincidently  with  the  rise  occurs  an  amelioration  in  the  signs 
and  symptoms  of  the  disease,  which  again  assumes  a  stationary 
but  improved  condition,  and  a  daily  determination  of  the  opsonic 
index  over  a  period  shows  that  it  also  has  reached  a  stationary 
but  higher  level. 

Exceptions  to  this  rule  occur  if  the  (i)  initial  dose  has  been 
too  large;  (2)  if  the  machinery  of  immunization,  i.  e.,  the  power 
of  reaction  is  already  overtaxed;  (3)  if  reinoculation  takes  place 
within  the  negative  phase. 

Reinoculation  of  a  larger  dose  after  the  positive  phase  has 
reached  its  height  is  followed  by  similar  effects  as  before,  the 
amount  of  opsinin  being  gradually  increased  until  it  is  equal  to 
or  greater  than  normal,  i.  e.,  an  opsonic  index  of  to etc., 
and  with  this  the  disease  shows  marked  improvement. 

Reinoculation  is  therefore  contraindicated  until  the  last  has 
produced  its  maximum  effect  as  shown  by  the  opsonic  index  and 
is  entirely  contraindicated  in  those  cases  in  which  the  first  injec- 
tion is  followed  by  a  permanent  negative  phase. 

Wright  diagrammatically  represents  the  two  possible  effects 
thus : 


Normal  100- 

opsonic 

index. 


t=inocuiation.    n=negative  phase.    £=positive  phase. 

Acute  or  progressing  diseases  are  apparently  unsuitable  for 
this  method  of  treatment,  due  doubtless  to  the  fact  that  auto- 
inoculation  is  continually  taking  place  and  that  the  power  of 
reaction  is  already  overtaxed.  In  active  tuberculosis  exercise 
seems  to  produce  the  same  auto-inoculation  effect,  while  perfect 


734 


SCIENTIFIC  REVIEW 


rest  in  bed  permits  the  reaction  to  the  toxins  already  absorbed 
to  take  place  and  prevents  the  auto-inoculation  of  overdoses. 

The  Opsonic  Theory  in  Diagnosis. 

Those  cases  which  on  repeated  examination  show  a  decreased 
opsonic  index  to  any  organism  as  the  tubercle  bacillus  are  prob- 
ably infected  with  that  organism.  When  several  organisms  are 
present  that  toward  which  the  opsonic  index  is  lowest  is  prob- 
ably the  most  important  in  causing  the  disease. 

When  after  an  injection  of  T.  R.  for  diagnosis  the  fever 
reaction  is  negative  a  sudden  fall  of  the  opsonic  index  may  be 
accepted  as  a  positive  indication. 

Value  of  opsonic  work  in  prognosis.  Cases  of  staphylococcic 
infection  showing  a  long  continued  negative  phase  after  injection 
do  not  offer  good  hopes  of  cure.  Cases  of  tuberculosis  showing 
an  even  opsonic  index  near  normal  are  not  subject  to  severe  auto- 
intoxication, and  hence  the  disease  must  be  quiescent  or  circum- 
scribed. 

In  therapy  its  value  has  been  already  mentioned. 

These  observations  have  been  verified  and  confirmed  by  Wright, 
Bullock,  Bruce,  Goadby  and  many  others  in  England.  By  Hek- 
toen  and  Ruediger,  E.  Walker,  Adami,  Klotz,  J.  J.  Mackenzie, 
Simon  and  many  others  in  America. 

Aggressins. 

To  Wright's  theory  of  opsonins  which  appeared  in  1902,  Bail's 
theory  of  aggressins  appearing  in  1905  was  apparently  the  direct 
opposite.  While  one  believed  that  absence  of  phagocytosis  was 
due  to  lack  of  a  special  substance  which  sensitized  the  bacteria 
for  ingestion  by  the  leucocytes,  the  other  believed  that  absence  of 
phagocytosis  was  due  to  preseace  of  a  special  substance  excreted 
by  the  bacteria  and  capable  of  paralyzing  the  leucocytes.  While 
one  theory  seems  the  antagonist  of  the  other,  there  appear  reasons 
why  both  may  be  true.  E.  L.  Walker  has  shown  that  the  tubercle 
bacillus  representing  the  class  of  infectious  organisms  which  do 
not  cause  a  hyperleucocytosis  excretes  a  toxin  which  has  the 
power  to  inhibit  the  action  of  the  leucocyte  in  the  presence  of 
opsonin,  that  the  toxin  and  opsonin  both  act  independently  and 
that  the  ratio  of  influence  of  opsonin  in  favor  of  phagocytosis 
to  toxin  against  it  is  as  +  9  to  —  II.  In  the  other  class  in 
which  the  toxins  absorbed  cause  a  hyperleucocytosis  as  in  diph- 


SCIENTIFIC  REVIEW 


735 


theria,  Walker  found  that  the  toxins  did  not  prevent  or  inhibit 
phagocytosis,  but  aided  it.  According  to  Bail's  division  of 
pathogenic  bacteria  these  two  represent  two  extreme  classes — 
the  true  parasite  which  excretes  aggressive  substances,  which, 
inoculated  in  the  least  quantity  can  grow,  and  by  paralyzing 
the  cellular  powers  of  defense  spreads  itself  through  the  whole 
body,  and  the  true  saphrophyte  which  excretes  no  aggressive 
substances  and  develops  locally. 

The  facultative  or  half  parasite  occupies  a  middle  position, 
since  it  is  able  to  spread  through  the  body  only  if  inoculated  in 
quantities  sufficiently  great  to  produce  enough  aggressin. 

Bail's  argument  in  brief  is  as  follows :  If  into  the  blood  stream 
of  one  animal  are  injected  simultaneously  equal  numbers  of  the 
anthrax  bacillus  and  B.  subtilis,  by  this  means  being  spread 
equally  through  the  various  organs,  and  if  the  anthrax  bacilli  are 
able  rapidly  to  increase  while  the  B.  subtilis  does  not  although 
the  same  powers  of  defense  are  exerted  against  each,  this  must 
be  due  to  only  one  cause,  viz.,  that  the  anthrax  bacilli  are  able 
to  paralyze  the  means  of  defense  opposing  them.  And  to  do 
this  there  must  be  liberated  or  secreted  a  special  substance  hav- 
ing aggressive  qualities  which  he  calls  aggressin. 

Among  the  aggressin  producing  bacteria  which  act  as  true 
parasites  are  the  anthrax  bacillus  in  man,  the  tubercle  bacillus 
in  the  guinea  pig  and  the  diplococcus  and  staphylococcus  m  the 
rabbit. 

For  the  purpose  of  experiment  is  employed  the  peritoneal  exu- 
date of  a  tuberculous  guinea  pig  killed  by  the  intraperitoneal 
injection  of  100  mg.  of  fresh  tubercle  bacilli.  By  this  means  is 
obtained  a  fluid  rich  in  so-called  aggressive  substances.  If  a 
few  cubic  centimetres  of  the  exudate  is  injected  into  a  healthy 
animal  it  does  not  become  sick  or  show  any  effect.  If  a  healthy 
animal  is  inoculated  with  a  considerable  quantity  of  tubercle 
bacilli  at  one  time,  very  slight  change  occurs  at  once  and  the 
period  of  sickness  is  measured  by  days  or  weeks.  But  when 
the  same  doses  which  singly  produced  slight  sickness  are  injected 
together  or  simultaneously,  the  animal  dies  in  a  few  hours.  This 
Bail  calls  the  acute  death.  This  seems  to  bear  out  his  theory 
that  the  exudate  contains  some  substance  which  paralyzes  com- 
pletely the  defensive  powers,  leaving  the  bacilli  to  flourish  un- 
checked. 

The  most  characteristic  postmortem  findings  in  an  animal  after 


736 


SCIENTIFIC  REVIEW 


the  acute  death  are  pleural  and  peritoneal  exudates,  in  which 
lymphocytes  almost  exclusively  exist.  From  whence  does  the 
aggressin  arise?  Is  it  a  product  of  the  bacteria,  i.  e.,  an  excre- 
tion, or  an  endotoxin  the  result  of  the  solution  of  the  body 
substance  of  the  bacteria,  or  is  it  produced  by  the  reaction  of 
the  tissues  to  the  infection.  The  phenomenon  of  Koch  is  taken 
to  indicate  that  it  is  an  endotoxin.  Koch  showed  that  at  a  certain 
period  of  the  guinea  pig's  tuberculous  sickness  a  state  of  over- 
sensitiveness  exists  during  which  the  intraperitoneal  injection  of 
a  small  number  of  fresh  bacilli  again  results  in  an  acute  death. 

This  Bail  attributes  to  the  increased  power  possessed  by  the 
oversensitive  animal  for  producing  a  bacteriolysis  of  the  bacilli, 
thus  setting  free  their  endotoxin  which  acts  as  aggressin.  . 

In  his  later  work  however  Bail  speaks  of  natural  aggressins 
which  are  formed  in  infected  animals  and  cannot  be  identified 
with  such  as  are  formed  from  body  substances  of  bacteria.  These 
cannot  be  demonstrated  chemically  and  represent  only  character- 
istics of  fluids  due  to  products  which  develop  in  the  infected 
body,  and  not  mere  products  resulting  from  the  reaction  of  the 
organism  to  the  infection.  Other  qualities  of  the  aggressin  exu- 
date he  found.  A  small  quantity  is  more  aggressive  than  larger 
quantities,  and  a  small  quantity  of  heated  exudate  is  more  ag- 
gressive than  an  equal  quantity  unheated. 

These  experiments  were  continued  with  the  diplococcus,  staph- 
ylococcus, bacillus  dysenteriae,  anthrax  and  bacillus  typhosus, 
all  of  which  were  shown  to  possess  aggressive  producing  powers. 
Kikuchi  produced  an  aggressin  immunity  to  the  B.  dysenteriae 
by  the  injections  of  its  aggressin. 

This  immunity  protected  the  organism  from  the  bacillus  dysen- 
teriae and  was  not  characterized  by  the  presence  of  increased 
bactericidal  or  agglutinating  substances  in  the  serum.  This  he 
claimed  to  be  a  new  kind  of  immunity. 

Equally  successful  results  were  obtained  by  Hoke  with  the 
diplococcus  and  by  Bail  with  the  typhoid  bacillus. 

At  first  sight  this  would  seem  to  be  immunity  due  to  the  fluid 
substances,  but  Kikuchi  says :  "  The  striking  appearances  observed 
with  the  injections  (intraperitoneal)  employed  consisted  in  the 
rapid  appearance  of  leucocytes  in  the  peritoneal  cavity.  In  pro- 
portion as  the  serum  was  weak  the  entrance  of  the  leucocytes  in 
general  was  delayed.  Strong  phagocytosis  was  only  to  be  ob- 
served in  immunity" 


SCIENTIFIC  REVIEW 


737 


From  this  result  it  docs  not  show  on  the  surface  otherwise 
than  that  the  German  school  headed  by  Bail  working  on  aggres- 
sins  has  achieved  the  same  results  as  the  English  school  headed 
by  Wright  working  on  opsonins,  viz.,  an  opsonic  immunity 
brought  about  by  injection  of  aggressins. 

Von  Perquet  and  Schick  reasoning  from  the  similarity  of  results 
obtained  by  Bail  to  those  obtained  by  themselves  with  serum 
in  serum-sickness,  believe  his  results  to  be  explained,  not  by  a 
new  theoretical  substance  aggressive  in  quality,  bur  simply  to 
the  formation  of  anti-bodies. 

E.  V.  Frederick. 

REFERENCES. 

Uber  die  Immunitdtbei  Infektionskrankheiien  mit  beson- 
derer  Beriicksichtigung  der  Cellulartheorie,  1896;  Imtnu- 
nitdt  1899;  L'Immunite  dans  les  Malades  Infectieuse 's 
1901. 

Uber  die  Bakterientodtende  Wirkung  des  Zellfreien 
Blutserum,  CentraMati  f.  Bakt.,  1889,  Vol.  V,  No.  25; 
ibid,  1889.  Vol.  VI,  No.  i;ibid,  1893,  Vol.  XIII,  No.  20; 
Arch.  Hyg.,  1890,  Vol.  X,  No.  84;  Weitere  Unter- 
suchungen  uber  die  Bakterienfeindlichen  Wirkung  des 
Blutes  und  Blutserums,  Arch.  f.  Hyg.,  1893.  Vol.  XVII , 
p.  112. 

Etudes'  sur  les  Substances  Microbicides  du  Serum  et  des 
Organ  d'  Animaux  a  sang  chaud,  Annates  de  L'Institut 
Pasteur,  1891. 

Ex.  Untersuchungen  uber  die  Veranderung  d'sog.  Mi- 
krobiciden  Kraft  des  Blutes,  Centr.  f.  Bakt.,  1892. 
Vol.  XII. 

Untersuchungen  uber  die  Baktericide  Eigenschaft  des 

Blut  Serums  in  Arbeiten  ad  Geb.  d.  Path.  Anat.  1892. 
An  experimental  investigation  of  the  role  of  the  blood 
fluids  in  connection  with  phagocytosis,  Proc.  Roy.  Soc, 

1903.  Vol.  LXXII,  p.  357;  ibid,  1904;  Vol.  LXXIII. 
p.  28;  ibid,  1902,  Lancet,  July  25,  1903;  ibid,  1904, 
LXXIV;  Lancet,  March  29,  1902;  Lancet,  October  22, 

1904,  pg.  1138;  Lancet,  Dec.  2,  1905;  On  method  of 
counting  Bacteria,  Lancet,  July  4,  1902;  Clinical 
Journal,  Nov.  9,  1904;  Brit.  Med.  Jour.,  Sept.  10,  1904. 

On  the  possibility  of  determining  the  presence  or  absence 
of  tuberculosis  by  examination  of  blood  and  tissue 
fluids,  Proc.  Roy.  Soc,  1905. 
Treatment  of  Tuberculosis  by  Tuberculin,  Lancet,  Dec.  a, 
1905;  On  the  nature  and  action  of  the  opsonic  sub- 
stances with  blood,  Proc.  Roy.  Soc,  February,  1905; 
London  Hosp.  Gaz.,  February,  1905;  Immunity,  Brit. 
Med.  Jour.,  Sept.  10,  1904;  Specificity  of  Opsonins, 
Lancet,  Dec.  2,  1905,  p.  1605. 
Brit.  Med.  Jour.,  1901.  No.  1,  p.  93. 

Studies  in  Phagocytosis,  Jour,  of  Infect.  Diseases,  January 

12,  1905.  pg.  563- 
A  preliminary  note  on  the  treatment  of  alveolar  osteitis 
(Rigsr's  disease)  by  means  of  vaccine,  Brit.  Med.  Jour., 
Sept.  9,  1905. 


1.  Metchnikopf. 

2.  BUCHN'ER. 

3.  DeChristmas. 

4.  szikely  and  lzaka 

5.  Jetter.^ 

«e  t 

9  1 

6.  Wright. 

7.  Wright  and  Reid. 

8.  Bullock. 

9.  Leishman. 
10.  Hektoen  and  Ruediger. 

ri.  Goadby,  K.  W. 


738  PUBLIC  HEALTH 

Tuberculin  in  Tuberculosis  of  Urinary  Passages,  Lancet. 
Dec.  16,  1905. 

A  Study  of  some  Points  in  Relation  to  the  Administration 

of  Tuberculin,  Lancet,  Dec.  9,  1905. 
Observations  on  the  Opsonic  power  of  persons  suffering 

from  Tuberculosis,  Brit.  Med.  Jour.,  July  25,  1905. 
Aggressins,  Weiner  klinische  Woch.,  Vol.  XVIII,  No.  9, 
1905;  Bezeihungen  zwischen  Aggressivitat  und  Leibes- 
substanz  von  Bakterien.  Munch.  Med.  Woch.,  No. 
39-40,  1905,  pg.  1865;  Aggressin  im  Immunitat  gegen 
Typhus  Baziller  und.  Cholera vibrionen,  Wein.  klin. 
Woch.,  No.  17,  1905. 
The  Relative  Influence  of  the  Blood  Fluids  and  Bacterial 
Toxins  on  Phagocytosis,  Jour.  Med.  Res.  1905-6, 
XIV.  p.  i7S. 

Aggressin  Wirkungen  von  Diplococcen  Exudaten,  Wein. 

klin.  Woch.,  Nov.  14,  1905,  p.  348. 
Wein.  klin.  Woch.,  No.  19,  pg.  431. 

Uber  die  Aggressin  Immunitat  gegen  der  Shiga-Kruse- 
schen  dysenteriebazillus,  Wein.  klin.  Woch.,  No.  19, 
1005,  pg.  43°- 


public  toealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 

Department  of  Health — City  of  Albany,  N.  Y. 

Abstract  of  Vital  Statistics,  August,  1906. 
Deaths. 


1902 

1903 

1904 

1905 

1906 

Consumption   

12 

16 

18 

15 

23 

Typhoid  fever  

3 

3 

2 

3 

2 

Scarlet  fever  

0 

0 

0 

0 

0 

Measles   

0 

0 

0 

0 

0 

Whooping-cough   

1 

0 

1 

1 

2 

Diphtheria  and  croup  

2 

1 

1 

2 

1 

Grippe   

0 

0 

0 

0 

0 

Pneumonia   

0 

0 

0 

4 

2 

Broncho-pneumonia   

2 

2 

0 

1 

2 

Bright's  disease  

8 

12 

15 

10 

15 

Apoplexy   

9 

3 

9 

6 

4 

Cancer   

10 

8 

7 

13 

10 

Accidents  and  violence  

6 

7 

7 

20 

9 

16 

18 

30 

24 

32 

Deaths  under  one  year  

17 

36 

25 

24 

27 

Total  deaths  

126 

131 

161 

153 

170 

Death  rate  

14.83 

15.42 

18.94 

18.00 

20.00 

Death  rate  less  non-residents 

14.01 

14.36 

17.53 

16.47 

18.36 

ia.  Pardoe. 

13.  Lawson  and  Stewart. 

14.  Urwick,  R.  H. 

15.  Bail,  Oscar. 

16.  Walker,  E.  L. 

17.  Hoke,  E. 

18.  Von  Pirquet  and  Schick. 

19.  Kikuchi. 


PUBLIC  HEALTH 


739 


Deaths  in  Institutions. 

1902  1903  1904  1905  1906 


Non- 

Non- 

Non- 

Non- 

Non- 

Resi- 

resi- 

Resi- 

resi- 

Resi- 

resi- 

Resi- 

resi- 

Resi- 

resi- 

dent 

dent. 

dent. 

dent. 

dent. 

dent. 

dent. 

dent. 

dent. 

dent. 

II 

7 

5 

4 

7 

6 

12 

9 

10 

15 

Albany  County  Jail . . . 

0 

0 

0 

0 

0 

0 

0 

0 

I 

0 

Albany  Orphan  Asylum 

0 

0 

1 

I 

0 

0 

I 

0 

0 

0 

County  House  

2 

0 

1 

0 

10 

2 

4 

0 

6 

I 

Homeopathic  Hospital. 

2 

0 

2 

2 

1 

0 

2 

1 

2 

I 

Hospital  for  Incurables 

0 

0 

2 

0 

0 

0 

1 

0 

2 

0 

I 

0 

0 

0 

1 

0 

0 

1 

I 

2 

St.  Francis  de  Sayles 

Orphan  Asylum  

0 

0 

2 

0 

0 

1 

0 

0 

0 

0 

St.  Margaret's  Home.. 

0 

0 

2 

I 

0 

0 

4 

2 

0 

0 

St.  Peter's  Hospital... 

6 

0 

3 

I 

7 

3 

6 

0 

4 

0 

Home  for  Aged  Men. . . 

0 

0 

1 

0 

3 

0 

0 

0 

0 

0 

Births  at  term   94 

Still  births  '.   5 

Premature  births   3 

Marriages   70 

Bureau  of  Plumbing,  Drainage  and  Ventilation. 
In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  one 
hundred  sixty-one  inspections  made  during  the  year,  of  which  one  hundred 
eight  were  of  old  buildings  and  fifty-three  of  new  buildings.  There  were 
thirty-five  iron  drains  laid  and  sixteen  connections  with  street  sewers, 
thirty  tile  drains,  six  urinals,  fifty-six  cesspools,  fifty-seven  wash  basins, 
forty-four  sinks,  thirty-nine  bath  tubs,  twenty-four  wash  trays,  two 
butlers'  pantry  sinks,  seven  trap  hoppers  in  yard,  eighty-seven  tank  closets, 
one  slop  hopper,  and  eight  shower  baths.  There  were  one  hundred  eleven 
permits  issued,  of  which  eighty-nine  were  for  plumbing  and  twenty-two 
for  building  purposes.  There  were  twenty-two  plans  submitted,  of  which 
ten  were  of  old  buildings  and  twelve  of  new  buildings.  There  were  six 
houses  tested  on  complaint,  three  with  blue,  red  and  three  with  peppermint. 
There  were  nine  water  tests.  Fourteen  houses  were  examined  on  com- 
plaint and  sixteen  reinspections  were  made.  Eight  complaints  were  found 
valid  and  six  without  cause. 

Bureau  of  Contagious  Disease. 
Cases  Reported. 


1902 

1903 

1004 

1905 

1906 

Typhoid  fever  

9 

11 

21 

12 

23 

5 

3 

1 

3 

7 

Diphtheria  and  croup  

20 

10 

9 

5 

12 

1 

0 

0 

0 

4 

0 

2 

0 

0 

1 

0 

0 

3 

2 

4 

0 

74© 


MEDICAL  NEWS 


Contagious  Disease  in  Relation  to  Public  Schools. 
None  Reported. 

Number  of  days  quarantine  for  diphtheria: 

Longest   52    Shortest   12    Average   23 

Number  of  days  quarantine  for  scarlet  fever: 

Longest   32    Shortest   8    Average   20*4 

Fumigations : 

Houses   24     Rooms   57 

Cases  of  diphtheria  reported   12 

Cases  of  diphtheria  in  which  antitoxin  was  used   II 

Cases  in  which  antitoxin  was  not  used   I 

Deaths  after  use  of  antitoxin   I 


flDe&tcal  Hews 

Edited  by  Arthur  J.  Bedell,  M.  D. 

Albany  Medical  College. — The  Introductory  Lecture  of  the  Seventy- 
sixth  Session  was  delivered  by  Professor  Samuel  B.  Ward,  M.  D.,  Dean 
of  faculty,  in  the  Amphitheatre  of  the  College,  on  Tuesday,  September 
25,  1906,  at  12  m. 

AlbanyGuildfor  the  Care  of  the  Sick.  Statistics  for  August,  1906. 
— Number  of  new  cases,  116;  classified  as  follows:  dispensary  patients  re- 
ceiving home  care,  1;  district  cases  reported  by  the  health  physicians,  10; 
charity  cases  reported  by  other  physicians,  53;  patients  of  limited  means, 
52;  old  cases  still  under  treatment,  66;  total  number  of  patients  under 
nursing  care  during  the  month,  182.  Classification  of  diseases  (new  cases)  : 
medical,  32;  surgical,  8;  obstetrical  work  of  the  Guild,  38  mothers  and 
38  infants  under  professional  care;  transferred  to  hospitals,  3;  deaths,  9. 

Special  Obstetrical  Department. — Number  of  obstetricians  in  charge  of 
cases,  2 ;  attending  obstetricians,  2 ;  medical  students  in  attendance,  1 ; 
Guild  nurses,  2;  cases,  3;  number  of  visits  by  the  medical  students,  28; 
by  the  attending  obstetricians,  6;  by  the  Guild  nurses,  29;  total  number 
of  visits  for  this  department,  63. 

Visits  of  Guild  Nurses  (all  departments)  :  number  of  visits  with  nursing 
treatment,  1,375;  for  professional  supervision  of  convalescents,  138;  total 
number  of  visits,  1,533.  Six  graduate  nurses  and  3  assistant  nurses  were 
on  duty.  Cases  were  reported  to  the  Guild  by  3  of  the  health  physicians 
and  by  31  other  physicians. 

State  Sanitary  Conference. — The  Sixth  Annual  Conference  of  State 
Sanitary*  Officers  will  be  held,  as  has  already  been  announced,  in  the  City 
Hall  of  Syracuse,  N.  Y.,  October  24-26th. 

One  of  the  most  prominent  features  of  the  Conference  will  be  the 
tuberculosis  exhibition  to  be  held  in  connection  with  it.    In  addition 


MEDICAL  NEWS 


741 


there  will  be  four  sessions  devoted  chiefly  to  the  consideration  of  the 
various  aspects  of  the  anti-tuberculosis  movement. 

While  the  subject  of  tuberculosis  will  be  a  prominent  feature  of  the 
Conference,  other  topics  will  be  far  from  neglected. 

The  following  tentative  program  is  now  issued  and,  although  two  of 
the  gentlemen  who  have  been  invited  to  read  papers  have  not  been  able 
as  yet  to  reply  to  the  invitation,  the  others  have  accepted  the  invitations 
extended  to  them,  and  will  be  present,  thus  insuring  a  most  profitable 
and  interesting  Conference  which  no  health  officer  can  afford  to  miss. 

Special  notices  and  invitations  will  shortly  be  sent  to  every  health 
officer  and  to  every  president  of  a  board  of  health,  urging  the  latter  to 
arrange  for  the  attendance  of  their  health  officer  at  the  Conference 
meeting. 

Special  n.ilroad  rates  of  a  fare  and  one-third  have  been  provided  on 
all  lines. 

Provisional  Program. — First  Session,  Wednesday,  2  p.  m.  : 

Addresses  of  Welcome,  Hon.  Alan  C.  Fobes,  Mayor  of  Syracuse;  Hon. 

Giles  H.  Stilwell,  President  Chamber  of  Commerce;  Hon.  James  R.  Day, 

Chancellor  Syracuse  University. 
Opening  Address,  Eugene  H.  Porter,  M.  D.,  State  Commissioner  of 

Health. 

Meat  Inspection,  A.  D.  Melvin,  M.  D.,  Chief  of  the  .Bureau  of  Animal 
Industry,  Washington,  D.  C. 

Adulteration  of  Foods,  Charles  Harrington,  M.  D.,  Secretary  State 
Board  of  Health  of  Massachusetts,  Boston.  Mass. 

Second  Session,  Wednesday,  8  p.  m.  : 

Value  and  Importance  of  Modern  Sanitary  Methods,  Hon.  Sherman 
Moreland,  Leader  of  Assembly,  State  of  New  York. 

The  Scope  and  Value  of  the  Sanatorium  in  the  Anti-tuberculosis 
Movement,  Herbert  M.  King,  M.  D.,  Physician-in-Chief  of  the  Loomis 
Sanatorium,  Liberty,  N.  Y. 

Some  Aspects  of  Sanatorium  Life  (illustrated),  Lawrason  Brown, 
M.  D.,  Resident  Physician,  Adirondack  Cottage  Sanatorium,  Saranac 
Lake,  N.  Y. 

Third  Session,  Thursday,  9:30  a.  if.: 

The  Powers  and  Duties  of  Local  Boards  of  Health  and  Local  Health 
Officers,  Hon.  William  J.  Tully,  Member  of  Senate,  State  of  New  York, 
Corning,  N.  Y. 

The  Principles  of  Water  Purification,  Leonard  M.  Wachter,  Chemist 
and  Bacteriologist.  Albany  Filtration  Plant,  Albany,  N.  Y. 

The  Nature  of  Sewage  and  its  Proper  Disposal,  John  A.  Amyot,  M.  D., 
Director  Laboratory  Provincial  Board  of  Health  of  Toronto,  Toronto, 
Ont 

Fourth  Session,  Thursday,  2  p.  m.  : 

Fleredity,  Portals  of  Entry  of  Infection  and  Immunity  in  Tuberculosis, 
M.  P.  Ravenel,  M.  D.,  Assistant  Director  Henry  Phipps  Institute  for  the 
Study  of  Tuberculosis,  Philadelphia,  Pa. 


742 


MEDICAL  NEWS 


Demonstrations  of  the  Tuberculosis  Exhibition,  Statistical  and  Clinical 
Exhibitions,  demonstrated  by  a  number  of  prominent  physicians. 

Exhibit  of  Tuberculosis  of  Animals,  in  charge  of  Prof.  V.  A.  Moore, 
New  York  State  Veterinary  College,  Ithaca,  N.  Y. 

Pathological  and  Bacteriological  Exhibit  of  Human  Tuberculosis,  in 
charge  of  H.  S.  Steensland,  M.  D.,  Adjunct  Prof,  of  Pathology,  Syracuse 
University.  • 

Fifth  Session,  Thursday,  8. p.  m.  : 

The  Tuberculosis  Dispensary  and  Municipal  Hospitals  for  the  Tuber- 
culous, Herman  M.  Biggs,  M.  D.,  President  National  Association  for  the 
Study  and  Prevention  of  Tuberculosis,  New  York. 

Quackery  and  Tuberculosis,  Samuel  Hopkins  Adams,  Esq.,  New  York 
City. 

Sixth  Session,  Friday,  9:30  a.  m.  : 

Symposium  on  Disinfection,  with  Demonstrations. 

Gaseous  Disinfectants,  H.  W.  Hill,  M.  D.,  Assistant  Director  Laboratory 
Minnesota  State  Board  of  Health,  Minneapolis,  Minn. 

Fumigation  for  the  Destruction  of  Insects,  H.  D.  Pease,  M.  D.,  Director 
Antitoxin  Laboratory,  New  York  State  Department  of  Health,  Albany, 
N.  Y. 

Seventh  Session,  Friday,  12  m.  : 

It  is  expected  that  a  trip  to  the  Tully  Lake  Dairy  Farms  will  be  arranged 
for  the  members  of  the  Conference  on  this  afternoon,  the  details  of  which 
will  be  announced  later. 

Eighth  Session,  Friday,  8  p.  m.  : 

Personal  Hygiene  in  the  Prevention  of  Tuberculosis,  J.  L.  Heffron,  M. 
D.,  Syracuse,  N.  Y. 

The  Home  Treatment  of  Tuberculosis,  S.  A.  Knopf,  M.  D.,  New  York 
Gty. 

Civil  Service  Examinations  for  the  State  and  County  Service. — 
The  State  Civil  Service  Commission  will  hold  examinations  on  October 
12,  1906,  for  typewriter  copyist  (male)  in  the  Kings  county  offices;  and 
on  October  13,  1906,  for  archeologist,  State  Education  Department,  $900; 
assistant  bacteriologist,  $1,500,  and  assistant  sanitary  chemist,  $720,  in 
the  State  Department  of  Health;  court  clerk,  Westchester  county;  pen 
copyist,  Kings  county  offices ;  pupil  nurse,  Erie  County  Hospital ;  trained 
nurse,  Westchester  County  Hospital. 

The  last  day  for  filing  applications  for  these  positions  is  October  8th. 
Full  information  and  application  forms  for  any  of  these  examinations  may 
be  obtained  by  addressing  the  Chief  Examiner  of  the  Commission  at 
Albany,  Charles  S.  Fowler,  Chief  Examiner. 

American  Surgical  Trade  Association. — At  a  meeting  of  the  Ameri- 
can Surgical  Trade  Association  held  in  Philadelphia,  June,  1906,  it 
was  resolved  that  after  January  1st,  1907,  the  trade  adopt  the  French 
scale  for  all  catheters,  bougies  and  sounds.    A  committee  was  ap- 


MEDICAL  NEWS 


743 


pointed  for  the  purpose  of  getting  up  a  proper  and  accurate  French 
scale  card.  Every  physician  will  see  the  importance  of  this  step 
as  you  are  all  acquainted  with  the  annoyance  of  having  catheters, 
bougies  and  sounds,  and  other  instruments  marked  in  American,  English 
or  French  numbers.  Surgeons  are  requested  to  use  only  the  French  scale 
in  ordering  such  goods  and  when  no  scale  is  specified,  orders  will  be  filled 
by  the  French  scale. 

Personal — Dr.  George  Blumer,  for  several  years  Professor  of  Pathology 
at  the  Albany  Medical  College  and  Director  of  the  Bender  Hygienic 
Laboratory,  recently  of  San  Francisco,  has  been  appointed  Professor  of 
Medicine  at  Yale  University.  On  August  20th  last  Dr.  Blumer  and  Miss 
Anna  Evans  were  married  at  San  Diego,  California,  and  have  now  taken 
residence  at  204  York  street,  New  Haven,  Conn. 

— Dr.  Edward  S.  Coyle  (A.  M.  C,  1882),  formerly  of  Ballston  Spa., 
N.  Y.,  has  removed  to  Schenectady,  N.  Y.  ( 

—Dr.  Joseph  A.  Lanahan  (A.  M.  C,  1899)  has  removed  from  31 
Jefferson  street  to  1  South  Hawk  street,  Albany,  N.  Y. 

— Dr.  Arthur  A.  Will  (A.  M.  C,  1900)  has  removed  to  437  West  12th 
street,  Oklahoma  City,  Oklahoma. 

— Dr.  Kenneth  D.  Blackfan  (A.  M.  C,  1905),  who  has  been  engaged 
in  post-graduate  study  at  the  Bender  Hygienic  Laboratory,  has  begun 
practice  at  Cambridge,  N.  Y. 

Married. — Keator-Laing. — Dr.  Frank  Keator  (A.  M.  C,  1903)  and 
Miss  Jessie  Helen  Laing  were  married  in  Albany  on  September  15,  1906. 
Dr.  Keator  is  established  in  practice  at  Kingston,  N.  Y. 

— Van  Hoesen — Gauger. — Dr.  Isaac  G.  Van  Hoesen  (A.  M.  C,  1903) 
and  Miss  Marie  Gauger  were  married  at  the  Church  of  the  Redeemer, 
Albany,  N.  Y.,  on  September  25,  1906.  Dr.  and  Mrs.  Van  Hoesen  will 
reside  at  Coxsackie,  N.  Y.,  where  he  is  well  established  in  practice. 


7 


744 


IN  MEMORIAM 


f  n  /Dcmorlam 

William  A.  Bliss,  M.  D. 

Dr.  William  A.  Bliss,  who  graduated  from  the  Albany  Medical  College 
in  1866,  died  at  home  August  19,  1906,  aged  sixty-five  years.  Dr.  Bliss 
began  practice  in  Brooklyn  in  the  spring  of  1866,  and  was  a  14  busy  physi- 
cian and  hard  worker,"  to  use  his  own  modest  words,  in  a  letter  for 
his  class  history.  In  1893  he  retired  and  moved  to  Fishkill-on-the-Hudson, 
but  returned  to  Brooklyn  in  1899,  and  remained  in  his  old  home  until 
the  time  of  his  death. 


William  D.  Walradt,  M.  D. 

Dr.  Wm.  D.  Walradt,  of  Castleton,  died  at  the  Albany  City  Hospital, 
September  6,  1906,  after  an  illness  of  about  two  weeks. 

Dr.  Walradt  was  born  in  Cherry  Valley.  He  graduated  from  the  High 
School  and  then  attended  the  Medical  College  in  Albany,  graduating 
with  the  class  of  1878.  He  practiced  for  a  short  time  in  Massachusetts, 
and  then  located  in  Castleton,  where  he  lived  for  over  twenty-five  years. 
He  was  a  successful  physician,  and  had  a  large  practice. 

Dr.  Walradt  leaves  his  widow,  one  son  and  one  daughter. 


Revnaldo  J.  Fitzgerald,  M.  D. 

Dr.  Reynaldo  J.  Fitzgerald,  a  graduate  of  the  Albany  Medical  College, 
in  the  class  of  1882,  died  at  his  home  in  Minneapolis,  August  18,  1906, 
aged  45,  as  the  result  of  disease  contracted  in  the  Philippine  Islands. 
Dr.  Fitzgerald  was  a  member  of  the  Association  of  Military  Surgeons 
of  the  United  States;  surgeon  of  the  the  Thirteenth  Minnesota  Infantry, 
U.  S.  V.,  and  on  duty  with  that  command  in  the  Philippine  Islands;  a 
member  of  the  state  and  county  medical  societies;  the  first  man  to  volun- 
teer at  the  organization  of  the  Minnesota  National  Guard  in  1882,  and 
major-surgeon  in  that  regiment  during  the  Spanish- American  War;  medi- 
cal director  of  the  Minnesota  National  Guard,  with  the  rank  of  colonel, 
on  his  return  to  the  United  States,  and  at  the  time  of  his  death  major 
and  surgeon  National  Guard  of  Minnesota  and  assigned  to  the  First 
Infantry.   He  was  a  prominent  practitioner  of  Minneapolis. 


CURRENT  MEDICAL  LITERATURE 


745 


Current  flDe&tcal  Xitcrature 

REVIEWS  AND  NOTICES  OF  BOOKS 

A  Non-Surgical  Treatise  on  Diseases  of  the  Prostate  Gland  and  Adnexa. 
By  George  Whitfield  Overall,  A.  B.,  M.  D.,  Chicago.  Rowe 
Publishing  Co.,  1906. 

This  book  of  228  pages  is  devoted  to  an  exposition  of  the  author's 
views  on  diseases  of  the  prostate  and  adnexa  and  his  special  methods  of 
treating  the  same.  He  employs  instruments,  for  the  most  part,  devised 
by  himself  and  makes  use  of  injections,  the  various  modifications  of 
electro-therapeutics,  vibrators,  etc.  The  author  is  opposed  to  surgical 
treatment  except  in  extreme  cases;  even  in  cases  of  true  hypertrophy  of 
the  prostate,  he  prefers  to  "hammer  at  the  prostate  both  through  the 
rectum  and  urethra  until  the  indurated  tissue  begins  to  soften,  then 
atrophy."  He  states  that  in  some  cases  from  six  to  twelve  months  of 
treatment  is  necessary  to  reduce  the  gland  to  that  extent  where  the 
urine  can  be  voided  without  the  use  of  a  catheter. 

There  is  an  appendix  containing  chapters  on  electro-physics,  electrolysis, 
cataphoresis  and  high  frequency  currents.  j.  m.  b. 


Anatomy,  Descriptive  and  Surgical.  By  Henry  Gray,  F.  R.  S.    Edited  by 
T.  Pickering  Pick,  F.  R.  C.  S.,and  Robert  Howden,  M.  A.,  M.  B  , 
C.  M.    New  American  Edition.    Thoroughly  revised  and  reedited 
with  additions  by  John  Chalmers  Da  Costa,  M.  D.,  illustrated 
with  1,132  elaborate  engravings.    Philadelphia  and  New  York: 
Lea  Brothers  &  Co.,  1905. 
During  the  last  fifty  years  Gray's  Anatomy  has  passed  through  numerous 
editions  but  the  present  is  the  most  extensive  revision  that  has  ever  been 
undertaken.   In  it  the  authors  have  attempted  to  represent  the  world's 
best  knowledge  and  have  thus  freely  consulted  English,  American,  French 
and  German  text-books,  monographs  and  journal  articles.    The  text  has 
been  changed  to  a  great  extent,  several  chapters  having  been  entirely  re- 
written.   The  nomenclature  adopted  by  the  international  commission  of 
anatomists  has  been  introduced  as  synonyms,  thus  adding  greatly  to  the 
value  of  the  work. 

It  has  always  been  the  aim  of  Gray  to  treat  the  subject  of  anatomy  from 
a  practical  standpoint,  especially  in  its  relation  to  surgery.  For  this 
reason  it  has  always  found  favor  with  the  majority  of  students  and  prac- 
titioners. The  scope  of  thejfsubject  matter  of  the  present  edition  is  essen- 
tially the  same  as  that  of  the  former  ones.  It  may,  therefore,  not  entirely 
meet  the  present-day  demands  of  those  who  pursue  the  study  of  anatomy 
from  a  more  general  standpoint. 

In  glancing  through  the  pages  we  note  that  Gerrish,  Cunningham, 
Toldt,  Spalteholz,  Poirier  and  Charpyfand  Testut  have  been  consulted 
freely  and  numerous  illustrations  have  been  borrowed  from  these  works. 

G.   E.  B. 


746 


CURRENT  MEDICAL  LITERATURE 


A  Laboratory  Manual  of  Physiological  Chemistry.  By  Elbert  W.  Rock- 
wood,  M.  D.,  Ph.D.,  Professor  of  Chemistry  and  Toxicology  and 
Head  of  the  Department  of  Chemistry  in  the  University  of  Iowa, 
etc.  Second  edition,  revised  and  enlarged.  With  one  colored 
plate  and  three  plates  of  Microscopic  preparations.  Large  i2mo, 
229  pages,  extra  cloth.  Price,  $1.00,  net.  F.  A.  Davis  Company, 
Publishers,  19 14  Cherry  Street,  Philadelphia,  Pa. 

This  second  edition  of  Professor  Rockwood's  manual  appears  in  the 
same  form  as  the  previous  one.  The  original  plan  is  retained  but  the  re- 
vision has  taken  the  course  of  addition  of  new  subject  matter  to  cover  the 
advances  made  in  physiological  chemistry  during  the  past  few  years. 
The  author  has  succeeded  in  making  the  various  topics  under  discussion 
exceptionally  complete,  and  the  student  who  performs  all  of  the  experi- 
ments outlined  should  obtain  a  rather  comprehensive  grasp  of  the  subject. 
Unfortunately  in  most  of  our  medical  schools,  the  time  allotted  in  the 
curriculum  would  fall  far  short  of  that  necessary  to  encompass  the  work 
suggested.  The  explanation  of  the  work  is  clear  and  concise  and  no 
difficulty  should  be  found  in  following  the  directions  even  without  the  aid 
of  special  instruction.  The  book  should  continue  to  be  used  as  a  satis- 
factory manual.  h.  c.  j. 


Golden  Rules  of  Surgery.  Medical  Guides  and  Monographs  Series.  Aphor- 
isms, Observations  and  Reflections  on  the  Science  and  Art  of  Sur- 
gery. Being  a  guide  for  Surgeons  and  those  who  would  become 
Surgeons.  By  Augustus  Charles  Bernays,  A.  M.,  M.  D., 
Hdlbg.,  M.  R.  C.  S.,  Eng.  St.  Louis:  The  C.  V.  Mosby  Medical 
Book  Co.,  1906. 

This  little  book  of  232  pages  is  designed  by  the  author  to  be  a  guide  to 
surgery  both  for  those  who  consider  themselves  surgeons  and  for  those  who 
would  become  surgeons.  The  qualifications  of  the  author  to  write  a  book 
of  this  character  are  based  on  a  surgical  experience  of  some  thirty  years 
embracing  remembrances  of  the  pre-antiseptic  as  well  as  the  pre-aseptic 
periods  of  surgery.  The  text  is  taken  in  part  from  Fenwick's  "Golden 
Rules  of  Surgery,"  but  much  has  been  added  that  is  new  and  original. 

The  reader  finds  in  this  little  volume  much  wholesome  philosophy  and 
valuable  advice.  For  the  ignorant  or  over-zealous  there  are  numerous 
warnings  and  cautions  and  the  work  is  everywhere  permeated  with  an 
amusing  and  at  times  biting  sarcasm.  The  author  takes  the  opportunity 
to  air  some  of  his  pet  theories  and  to  bring  to  the  attention  of  the  profes- 
sion some  of  his  important  work.  He  expresses  the  hope  that  his  "philo- 
sophical casueries"  may  at  least  amuse  the  reader  if  they  fail  to  convince 
him. 

Some  idea  of  the  character  of  the  work  can  be  conveyed  by  quoting  the 
titles  of  the  various  sections.    They  are  as  follows: 

"The  Education  of  a  Surgeon,"  "On  Scientific  Contributions  to  the 
Literature  of  Medicine  and  Surgery,"  "Science  and  Surgery,"  "On  Ways 
and  Means  of  Building  Up  a  Practice,"  "About  Fees,"  "Off  with  the  Cloak 


CURRENT  MEDICAL  LITERATURE 


747 


of  Superstition,"  "Some  Golden  Rules  of  Surgery,"  "Away  with  Inflam- 
mation and  the  Confusion  it  has  Caused." 

The  book  closes  with  an  interesting  section  on  "Reminiscences"  of  the 
author's  medical  studies  in  Germany  under  the  great  anatomist  Gegen- 
bauer,  the  great  surgeon  Langenbeck  and  other  famous  contemporaries. 

j.  M.  B. 


Diseases  of  the  Eye.  A  Handbook  of  Ophthalmic  Practice.  By  G.  E. 
deSchweinitz,  M.  D.,  Professor  of  Opthalmology  in  the  University 
of  Pennsylvania.  Fifth  edition,  revised  and  enlarged.  Octavo  of 
894  pages,  313  text-cuts  and  6  chromo-lithographic  plates.  Phila- 
delphia and  London:  W.  B.  Saunders  Company,  1906.  Cloth, 
$5.00  net;  Half  Morocco,  $6.00  net. 

The  preparation  of  this  edition  constitutes  a  part  of  the  good  work  for 
which  the  profession  is  indebted  to  the  author.  The  purpose  of  the  work 
is  very  modestly  stated  in  the  first  paragraph  of  the  preface — that  it  is 
for  the  use  of  those  who  desire  to  begin  the  study  of  ophthalmology.  Many 
ophthalmic  practitioners  will  study  the  work  advantageously.  Of  course 
no  author  of  such  a  treatise  can  properly  claim  to  have  distanced  all  rivals, 
nor  is  it  fair  to  claim  for  this  book  a  value  entirely  peculiar  to  itself.  Yet 
it  excels,  as  its  former  editions  have,  in  some  special  ways.  It  suggests 
the  ways  in  which  advance  is  prospective — an  important  encouragement 
to  the  "busy  practitioner"  as  well  as  to  the  careful  student,  at  any  stage 
of  advancement.  The  consideration  of  seemingly  irremediable  affections 
is  not  summarily  dismissed,  but  the  reader  is  told  what  is  hoped,  by 
reputable  investigators,  will  prove  to  aid  toward  or  effect  a  cure.  In  the 
prefaces  of  the  first  and  last  editions,  leadership,  in  the  matters  which  they 
have  discussed  in  the  book,  is  conceded  to  men  like  Jackson  and  Wallace. 
This  redounds  to  deSchweinitz 's  honor;  he  could,  doubtless,  discuss  those 
same  matters  well,  himself,  but  the  reference  of  the  matters  in  question  to 
men  who  are  generally  admitted  to  have  devoted  peculiarly  successful 
attention  to  them,  shows  that  the  author  seeks  the  best  for  students  of  his 
book.  The  simplified  spelling  in  the  work  is  not  very  peculiar  nor  exag- 
gerated, but  modern  enough  to  be  exemplary  and  harmonize  with  the 
general  spirit  of  the  book.  Its  freedom  from  ultra-scientific  dryness  is 
another  praiseworthy  feature  of  the  treatise. 

Saunders  Company  has  done  its  part  of  the  book's  preparation  well. 
All  books  should  have  very  legible  type,  as  this  one  has.  A  book  about 
human  eyes  has  a  somewhat  special  duty,  in  this  respect.  The  paper  is 
thin  enough  to  avoid  the  annoying  feeling  of  grossness  that  too  heavy 
paper  has,  while  it  is  thick  enough  that  the  legend  of  the  next  page  is  not 
legible  till  the  leaf  is  turned.  The  illustrations  are  really  representative. 
The  aggregate  will  make  a  valuable  part  of  the  library  of  any  ophthal- 
mologist;  the  reviewer  wishes  he  might  be^surely  warranted  in  sub- 
stituting every  for  any  in  the  preceding  sentence.  c.  m.  c. 


748 


CURRENT  MEDICAL  LITERATURE 


Case  Teaching  in  Medicine.  A  series  of  graduated  exercises  in  the 
differential  diagnosis,  prognosis  and  treatment  of  actual  cases  of 
disease.  By  Richard  C.  Cabot,  M.  D.,  Instructor  in  Medicine  in 
the  Harvard  Medical  School  and  Physician  to  Out-Patients  at  the 
Massachusetts  General  Hospital.  A  book  of  214  pages,  published 
by  D.  C.  Heath  &  Co.,  Boston,  Mass.,  1906. 

Seventy-eight  cases  are  presented  in  this  work.  The  history  of  each 
case  is  first  given,  together  with  the  results  of  the  physical  examination 
and  clinical  findings.  This  is  followed  by  a  series  of  questions  as  to  the 
significance  of  the  various  data,  and  then  the  diagnosis,  prognosis  and 
treatment  are  discussed.  An  index  is  present,  first  of  the  signs  and  symp- 
toms, and,  secondly,  of  the  symptoms  arranged  by  systems  of  organs. 

The  method  of  using  the  cases  is  as  follows : 

(1)  .  The  teacher  reads  aloud  the  case  to  be  discussed,  while  the  students 
follow  it  in  their  case  books  from  which  the  diagnoses  and  answers  to 
all  questions  are  omitted. 

(2)  .  A  member  of  the  class  is  next  called  upon,  by  name,  to  summarize 
the  case,  point  out  whether  it  is  acute  or  chronic  and  what  organs  or 
systems  are  especially  involved. 

(3)  .  The  students  are  given  five  or  ten  minutes  to  think  over  the  case 
and  then  each  writes  and  hands  in,  on  a  slip  of  paper,  a  tentative  diagnosis 
and  one  or  two  alterations,  signed  by  his  name. 

(4)  .  The  case  is  now  discussed,  the  various  diagnoses  handed  in  are 
considered  and  the  reasons  for  or  against  each  one. 

(5)  .  The  actual  diagnosis  of  the  case  as  proved  by  operation,  autopsy 
or  the  course  of  the  symptoms  is  then  given. 

(6)  .  Finally  the  prognosis  and  treatment  are  considered. 

The  cases  presented  are  those  which  are  likely  to  be  encountered  by  the 
general  practitioner. 

The  author  states  that  "the  most  important  lesson  to  be  learned  by 
every  student  of  medicine  is  the  art  of  recognizing  the  physical  signs  of 
disease — a  displaced  cardiac  apex,  a  succusion  sign,  an  Argyll-Robertson 
pupil,  a  malarial  parasite.  With  these  basic  facts  one  can  become  familiar 
only  by  direct  contact  with  patients  and  by  long  practice." 

"The  art  of  recognizing  the  physical  signs  of  disease"  is  undoubtedly 
a  most  important  lesson,  but  are  there  not  others  so  important  that  the 
above  mentioned  one  can  not  be  considered  the  most  important  one? 
Only  by  a  knowledge  of  pathological  processes  and  how  they  alter  the 
normal  anatomy,  thus  giving  rise  to  pathological  anatomy  and  how  this, 
in  turn,  alters  the  normal  physiology,  causing  pathological  physiology, 
can  the  student  correctly  interpret  the  physical  signs  of  disease.  These 
important  lessons  in  the  science  of  disease  form  the  rational  basis,  not 
only  for  the  interpretation  of  the  physical  signs  as  detected  by  the  art 
of  physical  examination,  but  also  in  the  diagnosis,  prognosis  and  treat- 
ment of  diseased  conditions. 

As  correctly  stated  by  Dr.  Cabot,  the  data  gained  from  a  study  of  a 
case  have  to  be  interpreted  and  worked  up  into  a  diagnosis  by  a  reason- 
ing process  and  this  process  needs  practice.    The  object  of  this  book  is 


CURRENT  MEDICAL  LITERATURE 


749 


to  aid  the  teacher  in  training  his  pupils  in  the  practice  of  thinking  clearly, 
cogently  and  sensibly  about  the  data  gathered  by  physical  examination. 
The  idea  is  an  excellent  one  and  deserving  of  a  more  general  adoption 
in  all  branches  of  medicine  than  has  been  accorded  it  in  the  past,  for 
it  makes  the  student  think  and  reason,  rather  than  try  to  remember.  Case 
teaching,  as  presented  by  Dr.  Cabot,  is  a  most  admirable  method  of 
testing  the  student's  ability  to  use  what  he  has  acquired  in  previous 
important  lessons  and  making  him  review  these  lessons,  for  truly  only  by 
practice  does  he  become  proficient. 

We,  the  medical  profession,  and  especially  those  of  us  who  teach,  are 
indebted  to  the  author  of  this  book  for  presenting  it  to  us  and  for  his 
many  valuable  suggestions  derived  from  his  experience  in  case  teaching 
exercises  during  the  past  eight  years. 

J.  A.  S. 


A  Treatise  on  Surgery.  In  two  volumes.  By  George  R.  Fowler,  M.  D., 
Examiner  in  Surgery,  Board  of  Medical  Examiners  of  the  Regents 
of  the  University  of  the  State  of  New  York;  Emeritus  Professor 
of  Surgery  in  the  New  York  Polyclinic,  etc.  Two  imperial  octavos 
of  725  pages  each,  with  888  text  illustrations  and  4  colored  plates, 
all  original.  Philadelphia  and  London:  W.  B.  .Saunders  Company, 
1906.    Per  set:  Cloth,  $15.00  net;  half  morocco,  $17.00  net. 

The  second  volume  of  this  excellent  work  is  devoted  to  a  continuation 
of  the  consideration  of  Regional  Surgery,  the  first  three  sections  of 
this  subject,  viz.,  the  sections  on  the  surgery  of  the  head,  neck  and  thorax, 
having  been  considered  in  Vol.  I.  Vol.  II  is  made  up  of  five  sections  with 
subject  titles  as  follows:  "  Surgery  of  the  Dorsal  and  Lumbar  Vertebrae." 
"  Surgery  of  the  Abdominal  and  Pelvic  Regions."  "  Surgery  of  the  Female 
Pelvic  Organs."  "  Surgery  of  the  Upper  Extremity."  "  Surgery  of  the 
Lower  Extremity." 

This  second  volume  shows  the  same  general  character  of  work  as  did 
Vol.  L  The  text  is  concise,  direct  and  clear  and  is  not  overburdened 
with  differentiations  and  discussions  of  discarded  or  worthless  theories. 
In  the  consideration  of  the  operative  treatment  of  the  various  surgical 
diseases  no  attempt  is  made  to  describe  all  the  operative  measures  for 
their  relief;  only  those  operations  are  discussed  which  are  generally  con- 
sidered to  be  the  best.  Frequently  the  author  confines  himself  to  the 
description  of  only  one  operative  method  of  treatment;  the  one  which, 
in  all  probability,  he  considers  the  best.  The  book  as  it  stands  is  a  work- 
ing surgery.  The  reader  feels  that  the  author  knows  what  he  is  writing 
about  from  personal  experience.  The  illustrations  of  this  volume  have 
the  same  high  degree  of  excellence  which  characterizes  those  in  volume  I. 
They  are  all  original. 

Certain  paragraphs  and  statements  in  the  book  are  of  interest  as  showing 
the  author's  views  on  various  subjects. 

It  is  now  being  generally  conceded  that  carcinoma  of  the  stomach  is 
as  much  a  surgical  as  a  medical  disease.    The  author  says:  "The 


75© 


CURRENT  MEDICAL  LITERATURE 


symptoms  and  diagnosis  of  cancer  of  the  stomach  are  usually  relegated 
to  the  domain  of  internal  medicine.  It  is  well,  however,  for  the  surgeon 
to  bear  in  mind  the  following  points:  (i)  the  ordinary  methods  of 
diagnosis  of  the  physician,  particularly  laboratory  methods,  are  usually 
untrustworthy  in  the  stage  of  the  disease  when  surgical  art  can  be  of 
the  greatest  help  to  the  patient;  (2)  exploratory  incision  is  a  trustworthy, 
practically  dangerless  and  almost  indispensable  diagnostic  resource;  (3) 
to  wait  for  the  development  of  a  palpable  tumor  is  to  condemn  to  death 
the  large  majority  of  these  cases;  (4)  cancer  of  the  stomach  can  not  be 
excluded  because  of  the  absence  of  symptoms  of  pyloric  obstruction, 
since  advanced  disease  of  the  body  of  the  organ  may  be  present;  (5)  a 
history  of  previous  gastric  ulcer,  instead  of  delaying  should  rather  arouse 
suspicion  of  cancer.  It  is  now  believed  that  ulcer  of  the  stomach  is  an 
important  factor  in  the  causation  of  cancer. 

The  most  important  indication  for  radical  operation  in  cancer  of  the 
stomach  is  movability  of  the  involved  parts. 

The  author  advocates  exploratory  incision  and  when  radical  operation 
is  not  indicated  he  advocates  gastro-enterostomy  as  a  palliative  operation. 
In  performing  the  operation  of  gastro-enterostomy  the  author  advises 
entero-enterostomy  below  to  avoid  the  complication  known  as  vicious 
circle. 

The  subject  of  appendicitis  receives  careful  attention.  A  quotation  in 
regard  to  the  prognosis  of  appendicitis  is  as  follows  :  "  The  prognosis 
of  appendicitis  is  unfavorable  in  the  cases  treated  without  operation  in 
proportion  to  the  severity  of  the  infection ;  in  the  cases  treated  operatively, 
other  things  being  equal,  the  prognosis  is  unfavorable  in  proportion  to 
the  delay  in  performing  the  operation."  In  operating  for  appendicitis 
where  no  pus  is  present  the  author  favors  the  intermuscular  incision 
and  describes  and  illustrates  McBurney's  method  and  his  own.  In  the 
treatment  of  general  peritonitis,  he  advocates  the  upright  position  follow- 
ing incision  and  drainage;  but,  contrary  to  some  surgeons  of  to-day,  he 
advocates  irrigation  of  the  peritoneal  cavity. 

The  chapter  on  hernia  is  well  written  and  the  illustrations  are  numerous 
and  well  chosen  and  add  much  to  the  value  of  the  text. 

The  author  states  that  Edebohl's  operation  of  decapsulation  of  the 
kidneys  for  chronic  Brights  disease  has  not  been  generally  accepted  by 
the  profession  up  to  the  present  time. 

In  the  diagnosis  of  enlarged  prostate  the  author  believes  that  the  use 
of  the  cystoscope  does  not  give  material  aid  and  may  be  injurious.  He 
gives  a  gloomy  outlook  for  cancer  of  the  prostate.  "  Radical  operative 
measures  have  heretofore  failed,  the  patients  who  have  recovered  from 
the  operation  having  died  within  a  few  months  of  recurrence." 

The  two  last  sections  in  this  volume  are  on  the  "  Surgery  of  the  Upper 
Extremity "  and  "  Surgery  of  the  Lower  Extremity."  The  manner  of 
treatment  of  these  subjects  and  the  numerous  helpful  and  original  illus- 
trations make  these  sections  two  of  the  most  valuable  in  the  whole  book. 

The  volume  closes  with  an  index  of  names,  subject  index  and  a  general 
index  for  the  two  volumes.  J.  m»  b. 


CURRENT  MEDICAL  LITERATURE 


751 


OBSTETRICS 

Edited  by  James  P.  Boyd,  M.  D.,  and  H.  Judson  Lipes,  M.  D. 

Metrorrhagia  Myopathica. 

Brooke  M.  Anspach.    The  American  Journal  of  Obstetrics,  January,  1906. 

Metrorrhagia  myopathica  is  defined  by  the  writer  as  that  form  of 
uterine  bleeding  which  is  independent  of  the  usual  causes  of  metrorrhagia, 
and  is  produced  by  a  pathologic  condition  of  the  uterine  muscle.  This 
symptom  usually  manifests  itself  toward  the  close  of  the  child-bearing 
period  when  excessive  uterine  haemorrhage  between  the  periods,  in  the 
absence  of  the  accepted  causes  of  this  abnormality,  often  remains  an 
enigma.  The  terms  apoplexia  uteri,  endometritis,  senilis,  preclimacteric 
bleeding,  et  cetera,  are  often  loosely  applied.  Apoplexia  uteri  presupposes 
arteriosclerotic  changes  in  the  uterine  arteries,  with  an  actual  rupture  of 
•ne  of  these  unhealthy  vessels.  The  writer  has  not  observed  this  condi- 
tion in  the  examination  of  over  three  hundred  uteri  and  consequently 
believes  it  to  be  exceedingly  rare.  Even  if  this  condition  existed  Reincke 
holds  that  it  alone  cannot  account  for  persistent  metrorrhagia,  and  in  some 
cases  where  the  vessels  showed  arteriosclerotic  changes  there  was  no 
metrorrhagia.  In  the  uterus  arteriosclerosis  normally  the  result  of  the 
development  and  subsequent  involution  is  indelibly  associated  with  preg- 
nancy. 

In  considering  the  normal  anatomy  the  writer  quotes  Pick,  who  has 
drawn  particular  attention  to  the  arrangement  of  the  elastic  tissue  in 
the  uterus  which  is  of  greatest  importance  in  the  consideration  of  this 
subject.  The  preponderance  of  the  fibrils  in  the  subserous  and  supra- 
vascular  layers,  their  definite  direction  (centripetal)  towards  the  endo- 
metrial cavity,  their  fine  subdivision  so  that  in  the  outer  layer  they  sur- 
round each  individual  muscle  cell,  all  of  this  he  believes  shows  they  have 
a  very  well  defined  purpose,  that  is,  the  support  of  the  blood  and  lymph 
capillaries  and  the  nerves,  and  further  they  reinforce  the  muscular  action 
of  the  uterus,  protect  it  from  being  overstretched  and  make  easier  its 
return  to  a  passive  state  after  either  distention  or  contraction. 

If  there  is  an  atrophied  parenchyma  the  vis  a  tergo  is  supplied  by  the 
new  formed  elastic  tissue.  That  this  preservation  of  uterine  tone  is 
necessary  during  menstrual  life  and  that  the  increase  of  elastic  tissue 
which  accompanies  the  diminution  of  the  muscle  elements  is  a  provision 
of  nature  cannot  be  gainsaid.  The  contractile  power  of  the  uterus  plays 
an  important  part  in  the  phenomena  of  menstruation  as  it  does  in  any 
haemorrhage  from  the  uterus. 

It  is  natural,  therefore,  at  the  close  of  menstrual  life,  that  the  muscular 
elements  having  no  further  uses  should  undergo  atrophy,  and  that  the 
intra-vascular  area  of  the  organ  should  be  diminished  by  sclerotic  changes 
in  the  blood-vessel  walls,  and  that  this  should  be  furthered,  as  it  is  in 
other  organs,  by  an  increase  of  elastic  tissue  which  helps  contract  the 
vessels  and  takes  the  place  of  lost  parenchyma.  It  is  easy  to  see,  therefore, 
that  a  failure  in  the  normal  increase  of  elastic  tissue  or  a  failure  in  the 


753 


CURRENT  MEDICAL  LITERATURE 


normal  obliterative  changes  of  the  vascular  channels,  or  an  excessive 
hypertrophy  of  connective  tissue  (making  firm  contraction  of  the  uterus 
and  compression  of  the  blood  vessels  more  or  less  faulty)  might  result 
in  disturbances  of  the  endometrial  circulation  and  produce  profuse 
menorrhagia  or  metrorrhagia. 

The  writer  reports  a  number  of  cases  of  uncontrollable  metrorrhagia 
only  three  of  which  he  classifies  under  "  metrorrhagia  myopathica."  In 
the  remaining  cases  conditions  were  found  after  operation  which  might 
explain  the  trouble  upon  other  grounds. 

After  a  careful  study  of  these  cases  the  author  reached  the  following 
conclusions : 

(1)  Metrorrhagia  myopathica  stands  for  a  distinct  class  of  cases,  which 
have  heretofore  been  variously  and  incorrectly  grouped  under  apoplexia 
uteri,  endometritis  senilis  and  preclimacteric  bleeding. 

(2)  Metrorrhagia  myopathica  is  a  symptom  immediately  dependent 
upon  an  anatomical  or  a  physiological  lesion  of  the  uterine  muscle. 

(3)  No  anatomical  lesion  has  as  yet  been  demonstrated,  but  it  will 
probably  be  found  in  the  elastic  tissue  constituents  of  the  vessel  walls  and 
the  subserous  and  supra-vascular  layers. 

(4)  The  physiological  lesion  is  most  likely  an  insufficient  contractile 
power  of  the  uterus.  It  is  possible  that  the  condition  is  purely  functional 
and  that  there  is  no  anatomical  change  which  can  be  recognized. 

(5)  In  cases  of  metrorrhagia  myopathica  the  uterus  is  enlarged  and 
softened;  the  os  is  patulous. 

(6)  Metrorrhagia  myopathica  does  not  occur  in  nulliparous  women 
and  therefore  it  must  have  some  connection  with  the  child-bearing  process. 

(7)  The  diagnosis  of  metrorrhagia  myopathica  is  only  justified  when 
all  other  possible  causes  for  uterine  haemorrhage  have  been  excluded. 
This  cannot  be  too  strongly  urged,  especially  in  reference  to  carcinoma. 

(8)  The  terms  apoplexia  uteri,  senile  endometritis,  and  preclimacteric 
bleeding  as  applied  to  these  cases  are  incorrect  and  unscientific. 

(9)  While  currettement,  atmocausis,  etc.,  has  little  effect  in  cases  of 
metrorrhagia  myopathica,  palliative  measures  should  always  be  tried  before 
adopting  hysterectomy. 

Obliteration  of  the  endometrial  cavity  by  means  of  destructive  atmo- 
causis is  the  alternative  of  hysterectomy  in  these  cases.  It  is,  however, 
harder  to  perform  correctly  and  more  dangerous  than  hysterectomy, 
which  is  the  operation  of  choice. 


Fibroma  Molluscum  Gravidarum,  a  New  Clinical  Entity. 
Brickner.     American  Journal  of  Obstetrics,  February,  1906. 

The  writer  appreciates  the  fact  that  it  is  a  precarious  undertaking 
to  hazard  the  description  of  a  new  clinical  entity  although  the  study  em- 
bodied in  his  report  has  been  most  scrupulously  and  zealously  threshed 
out,  and  the  search  of  the  literature  has  been  as  complete  as  the  facilities 
have  permitted.    To  the  condition  described  he  has  given  the  name  of 


CURRENT  MEDICAL  LITERATURE 


753 


fibroma  molluscum  gravidarum,  for  the  reasons  that  clinically  and  patho- 
logically the  lesion  corresponds  with  fibroma  molluscum  as  known  and 
described  by  dermatologists  and  that  the  form  discussed  in  his  paper 
appears  only  during  pregnancy.  The  author  has  observed  nine  cases. 
This  condition  first  appears  usually  about  the  fourth  or  sixth  month  of 
pregnancy,  as  small,  slightly  pigmented  or  non-pigmented  sessile  or 
pedunculated  excrescences,  which  increase  slowly  in  number  as  pregnancy 
advances,  until  at  full  term  there  may  be  as  many  as  forty  or  fifty,  or 
they  may  appear  in  limited  number,  not  increasing  or  diminishing  during 
the  further  period  of  gestation.  The  previous  state  of  the  patient's 
cutaneous  health  has  no  bearing  upon  the  appearance  of  these  fibrous 
nodules.  Within  from  a  few  weeks  to  a  few  months  after  delivery  these 
excrescences  lose  their  pigment,  assuming  the  color  of  the  adjacent 
skin,  and  gradually  disappear.  No  symptoms,  apart  from  the  eruption, 
are  observed.  There  is  no  pain,  nor  itching,  nor  any  discomfort.  No 
sensitive  nerve,  nor  inflammation. 

In  regard  to  the  distribution  of  these  lesions,  they  are  found  on  the 
sides  of  the  neck,  and  in  front  of  it  near  the  sterno-clavicular  articulation, 
sometimes  between  the  clavicles  and  breast  or  under  the  breast.  In 
the  ordinary  fibroma  molluscum,  the  distribution  is  general  over  the 
body  and  is  even  seen  on  the  mucous  membranes.  The  later  position 
has  never  been  noted  in  fibroma  molluscum  gravidarum.  The  lesions 
differ  also  from  those  of  the  common  variety  in  that  they  do  not  attain 
large  size.  Until  regeneration  begins  they  do  not  attain  the  color  of 
the  normal  skin  and  upon  their  disappearance  they  leave  no  traces  what- 
ever. This  is  not  true  of  the  ordinary  form  since  the  later  lesions 
leave  behind  an  empty  little  bag  of  skin  representing  the  degenerated 
growth. 

The  etiology  is  obscure  but  the  condition  probably  arises  from  some 
disturbance  of  metabolism. 

The  histological  description  shows  that  the  excised  tumors  are  round 
or  oblong  in  shape,  somewhat  irregular  or  papillomatous  on  the  surface 
and  measure  from  1.5  to  3  mm.  in  their  long  axis.  Sections  were  cut 
both  transversely  and  longitudinally,  and  stained  by  a  large  variety  of 
special  methods,  as  well  as  by  the  ordinary  histological  stains. 

When  viewed  by  the  lower  power,  the  sections  appear  to  have  a  lightly 
stained  central  portion  entirely  surrounded  by  normal  epidermis,  except 
in  some  places,  where  it  is  slightly  thickened  and  thrown  into  folds. 
In  some  of  the  sections  which  are  cut  longitudinally,  a  moderate  degree 
of  hypertrophy  of  the  pnckle-cell  layer  is  noted.  The  chief  feature, 
however,  seems  to  be  a  distinct  hypertrophy  of  the  papillary  layer  of 
the  corium.  An  enlongated  appearance  of  the  papillae  is  noted  in  places, 
due  to  a  growth  downwards  into  the  corium  of  the  interpapillary  pro- 
cesses. With  the  high  power,  the  papillary  layer  shows  an  increase  in 
the  amount  of  collagenous  tissue,  the  bundles  of  which  are  irregularly 
interlaced,  but  not  closely  packed  together.  In  the  meshes  are  numerous 
connective  tissue  cells,  blood  vessels,  and  a  few  lymph  spaces.  The 
general  appearance  of  this  part  of  the  section  is  that  of  a  soft  fibroma, 
moderately  rich  in  connective  tissue  cells.    No  muscle  or  nerve  fibres  can 


754 


CURRENT  MEDICAL  LITERATURE 


be  seen.  The  base  of  the  tumor  at  its  junction  with  the  normal  skin  was 
carefully  examined  for  nerve  tissue;  but  it  also  was  impossible  to  demon- 
strate any  fibres  at  this  situation.  The  blood  vessels  are  rather  abundant, 
most  of  them  being  dilated  capillaries  with  thin  walls.  The  connective 
tissue  cells  seem  rather  more  numerous  in  the  vicinity  of  the  blood 
vessels  than  elsewhere,  and  occasionally  a  polynuclear  leucocyte  is  seen, 
but  no  evidence  of  inflammation  is  observed.  Here  and  there  a  branching 
connective  tissue  cell,  filled  with  minute  pigment  granules  may  be  seen; 
only  a  few  atrophic  elastic  fibres  are  present,  but  no  mast  cells  or  plasma 
cells  can  be  found.  Hair  follicles  as  well  as  glands  and  adipose  tissue 
are  absent  from  the  growth. 

The  epithelial  elements  of  the  epidermis  are  all  well  preserved,  and  quite 
natural  in  appearance.  The  stratum  corneum  is  not  apparently  thickened, 
but  the  layer  of  prickle-cells  in  some  of  the  sections  shows  a  slight 
tendency  to  proliferation.  The  cells  of  this  layer  in  places  are  rather 
large,  but  no  mitotic  figures  are  seen.  The  stratum  granulosum  is  well 
marked  in  some  places,  with  abundant  keratohyaline  granules,  while  in 
other  situations  this  layer  cannot  be  distinguished.  The  basal  layer  of 
cylindrical  cells  is  intact,  but  markedly  pigmented.  As  this  layer  ap- 
proaches the  normal  epidermis  at  the  point  of  excision,  the  pigment  is 
no  longer  seen.  None  of  the  pigment  granules  anywhere  in  the  sections 
react  to  the  tests  for  homosiderin. 

To  classify  these  tumors  properly ,  a  few  points  must  be  considered.  The 
chief  elements  noted  are:  An  absence  of  hyperkeratosis,  a  moderate  degree 
of  hypertrophy  of  the  prickle-cell  layer,  an  intact  basal  layer,  a  hyper- 
trophy of  the  collagenous  tissue  with  atrophy  of  the  elastic  fibres,  an 
increase  in  cellular  elements  and  blood  vessels  of  the  corium,  and  an 
absence  of  nerve  fibres.  Accordingly  the  growth  can  be  placed  only 
under  the  general  type  of  soft  fibromata.  The  ordinary  form  of  hard 
fibromata,  as  well  as  the  neurofibromata,  do  not  come  into  consideration. 

The  verrucous  growths  (warts)  are  also  excluded  on  account  of  the 
absence  of  hyperkeratosis.  The  tumors,  therefore,  are  soft  fibromata, 
and  come  under  the  group  of  fibroma  molluscum. 


On  the  Freezing  Point  and  Amount  of  Chlorines  in  the  Blood  and  in 
the  Urine  in  the  Puerperal  State,  and  Particularly  in  Eclampsia. 

Mace  and  Pierra.      Bulletin  de  la  Societe    d'Obstetrique   de  Paris, 

November,  1905. 

This  is  a  record  of  an  investigation  which  has  been  proceeding  for 
more  than  a  year.  The  authors  have  studied  the  freezing  point  and  the 
amount  of  chlorines  in  the  urine  in  four  different  classes  of  women: 

(1)  in  non-pregnant  women  (5  cases)  ; 

(2)  in  normal  pregnancies  (5  cases)  ; 

(3)  in  pregnancy  with  albuminuria  (7  cases)  ; 

(4)  in  eclampsia  (27  cases), 

and  in  these  last  the  serum  of  the  blood  drawn  off  in  the  bleedings  which 


CURRENT  MEDICAL  LITERATURE 


755 


were  usually  practiced  has  been  utilized  for  the  investigation  of  the  same 
two  points. 

The  whole  investigation  is  recorded  in  a  series  of  tables  which  cover 
more  than  thirty  pages.  It  will  only  be  possible  here  to  mention  shortly 
the  conclusions  reached  by  the  authors,  which,  being  based  upon  a 
piece  of  work  so  careful  and  elaborate,  cannot  be  lightly  dismissed. 

In  regard  to  non-pregnant  women  the  authors  confirm  the  figures 
arrived  at  by  other  investigators  and  in  consequence  feel  able  to  use 
them  for  purposes  of  comparison. 

The  pregnant  women  examined  were  all  nearly  at  term.  They  found 
the  volume  of  urine  increased  while  the  specific  gravity  remained,  on 
the  average,  the  same  as  in  the  non-pregnant  state.  The  mean  freezing 
point  was  1.150,  as  compared  to  1.250  in  the  preceding  table.  The  amount 
of  NaCl  in  the  litre  was  slightly  less  than  in  the  non-pregnant  state,  but 
the  amount  secreted  in  twenty-four  hours  was  considerably  more, 
17.5  to  12.5.  The  figures  given  in  the  table  indicate  great  activity 
of  the  renal  circulation. 

In  pregnancy  with  albuminuria  the  women  were  examined  on  six 
consecutive  days.  They  received  on  the  first  three  days  an  ordinary  diet, 
and  on  the  second  three  days  a  rigid  milk  diet.  The  conclusions  reached 
are  that  the  milk  diet  lowers  the  specific  gravity  of  the  urine,  the  mole- 
cular concentration,  and  the  amount  of  chlorines,  both  per  litre,  and  in 
twenty-four  hours.  The  milk  diet  moderates  the  activity  of  the  renal 
circulation. 

So  far  the  tables  are  general,  but  in  the  cases  of  eclampsia  full  details 
are  given  of  the  clinical  course,  and  of  the  autopsy  when  a  fatal  result 
occurred,  which  was  not  often,  as  well  as  of  the  particular  investigation 
of  the  blood  and  the  urine. 

The  twenty-seven  cases  are  divided  into  two  series.  The  first  seventeen 
received  the  following  treatment:  bleeding,  subcutaneous  injections  of 
normal  saline  for  twenty-four  to  thirty-six  hours,  and  then  rigid  milk 
diet.  The  remaining  ten  were  treated  as  follows :  bleeding,  abundant 
saline  purgation,  intestinal  irrigation,  and  sterilized  water  only  for  the 
first  forty-eight  hours,  when  milk  was  introduced  into  the  diet  in  small 
quantities  at  first,  and  diluted. 

Chloroform,  chloral  and  morphia  were  not  given,  save  in  one  or  two, 
just  at  the  moment  of  delivery.    The  authors  conclude  as  follows: 

(A.)  For  the  blood:  (The  serum  was  obtained  from  the  bleeding  made 
on  entrance  to  the  clinic  before  any  treatment.)  The  average  freezing 
point  was  0.61 0  which  is  considerably  more  than  in  normal  pregnancy,  or 
non-pregnant  women,  and  corresponds  to  a  renal  insufficiency. 

The  amount  of  chlorines  was  in  the  mean  7.3  for  1,000  c.  c,  which  is 
notably  more  than  the  average  quantity  of  NaCl  in  the  blood.  There 
appears  therefore  to  be  in  the  majority  of  cases  a  pathological  retention 
of  chlorines  in  the  serum. 

In  only  two  cases  was  a  second  bleeding  practical,  and  the  authors  state 
that  it  is  difficult  to  base  anything  on  such  small  figures,  but  so  far  as 
they  go  they  confirm  the  view  that  successive  bleedings  diminish  the 
molecular  concentration  of  the  serum,  and  the  amount  of  chlorines. 


756 


CURRENT  MEDICAL  LITERATURE 


(B.)  For  the  urine:  The  prognosis  in  eclampsia  is  rendered  favorable 
to  diuresis,  by  dilution  of  the  urine,  by  a  molecular  concentration  normal 
or  diminished,  and  by  the  equilibrium  of  the  chlorine  exchanges.  But 
from  the  observations  it  results  that  with  injections  of  normal  saline  (i) 
the  volume  of  urine  passed  is  diminished;  (2)  the  dilution  is  less  great; 
(3)  the  freezing  point  is  lower,  and  in  consequence  the  molecular  concen- 
tration greater;  (4)  the  quantity  of  chlorines  eliminated  remains,  for 
several  days  at  any  rate,  inferior  to  that  of  the  chlorines  absorbed. 

The  final  conclusion  of  their  investigation  is  that  the  injections  of 
normal  saline  solution  ought  to  disappear  from  the  treatment  of  eclampsia. 
The  milk  regime  itself  appears  dangerous  to  the  authors,  because  it 
necessarily  carries  with  it  its  contingent  of  chlorines.  A  pure  water  diet 
ought  to  be  preferred,  and  should  be  established  as  soon  as  possible,  to 
facilitate  elimination,  and  by  this  means  to  prevent  the  recurrence  of 
fits. 

At  a  time  like  the  present  when  the  treatment  of  eclampsia  varies  in 
every  hospital,  and  in  the  hands  of  every  individual,  these  views,  whether 
they  be  accepted  or  not,  are  worthy  of  careful  consideration. 


Comparative  Histological  Investigations  on  the  Occurrence  of  Glandular 
Formation  in  the  Ovarian  Stroma. 

Fraenkel,  (L.)    Archiv  fur  Gyndkologie ,  Bd.  Ixxv.,  H.  3,  5".  443. 

The  above  is  a  very  valuable  contribution  to  a  much  vexed  question 
as  to  the  function  of  the  tissue  designated  glande  interstitielle  de  I'ovaire 
by  Limon.  The  article  is  a  very  long  one,  occupying  as  it  does  sixty- 
five  pages  of  the  Archiv.  The  first  seven  pages  are  taken  up  by  an 
account  of  the  work  done  by  French  writers  on  this  subject,  principally 
by  Limon  and  Bouin,  and  also  by  Forneaux,  Ed.  van  Beneden,  and  v. 
Winiwarter.  The  author  states  that  very  little  literature  relating  to  the 
question  is  to  be  found  in  German  publications,  but  he  is  able  to  quote 
extensively  from  Cohn  and  von  Ebner  in  Kolliker's  Handbook  on  the 
study  of  human  tissues,  likewise  from  Rabl  and  Nagel. 

The  author's  own  work  is  supplementary  to  that  for  which  his  name 
is  already  famous,  in  which  he  has  shown  that  the  corpus  luteum  is  a 
gland  with  an  internal  secretion.  In  his  desire  that  this  theory  shall 
be  accepted  as  a  fact  he  is  careful  to  add  that  further  anatomical  and 
physiological  investigations  are  needed  to  support  it.  In  the  present  work 
Fraenkel  has  asked  himself  the  question — is  any  other  part  of  the  ovary 
capable  of  affording  an  internal  secretion?  and  in  order  to  answer  it 
he  has  made  an  exhaustive  anatomical  research  on  the  tissue  known  as 
Limon's  "glande  interstitielle  de  I'ovaire."  For  this  purpose  he  has 
studied  serial  sections  of  human  ovaries  obtained  from  gravid  and  non- 
gravid  subjects,  and  from  cases  of  chorioepithelioma,  vesicular  mole, 
osteomalacia,  and  myomata.  To  this  he  adds  the  comparative  study  of  the 
ovaries  obtained  from  forty-five  animal  species  comprised  in  the  orders 


CURRENT  MEDICAL  LITERATURE 


757 


Marsupials,  Ungulates,  Carnivora,  Rodents,  Insect  eaters,  Cheiroptera 
and  Apes. 

After  describing  his  histological  technique  he  devotes  thirty-three 
pages  to  a  description  of  the  naked  eye  and  microscopical  characters  of 
this  vast  amount  of  material,  into  the  details  of  which  it  is  impossible 
to  enter.  Only  eight  illustrations  have  been  allowed,  which,  considering 
the  variability  in  type  of  the  tissue  under  discussion,  seems  little  enough. 
It  is  clear  from  Limon's  work  and  the  researches  of  Fraenkel,  that  a 
tissue  has  been  demonstrated  to  exist  in  the  ovary,  having  nothing  to 
do  with  the  true  corpus  luteum,  which,  from  its  histological  features, 
might  well  be  considered  as  capable  of  affording  an  internal  secretion. 
This  tissue  consists  of  cells,  polyhedral  in  shape,  and  rich  in  markedly 
granular  protoplasm,  which  present  nuclei  showing  a  chromatin  network. 
These  cells  are  present  in  groups,  and  strands  forming  loculi  and  lobes. 
They  aggregate  to  form  large  masses  of  highly  packed  or  loosely  arranged 
tissue,  which  is  permeated  by  a  capillary  system  and  a  variable  amount 
of  fine  connective  tissue.  In  many  animals  this  tissue  occupies  one  to 
nine-tenths  of  the  entire  ovary,  in  fact  it  may  quite  displace  the  original 
stroma  of  the  gland.  The  cells  have  a  yellow  or  green  colour.  Con- 
sidered as  a  whole  this  tissue  is  comparable  to  that  of  a  corpus  luteum. 
The  latter,  however,  is  limited  by  a  circular  theca  externa,  whilst  the 
cells  of  the  "  interstitial  gland  "  are  not  thus  circumscribed.  The  cells 
of  the  corpus  luteum  are  larger  and  are  more  intimately  related  to 
capillaries.  Whilst  the  cells  of  the  "  interstitial  gland "  may  be  green 
in  colour,  those  of  the  corpus  luteum  are  always  yellow.  Owing  to  the 
richer  blood  supply  of  the  corpus  luteum  this  structure  is  of  looser 
texture  than  the  "gland."  The  relationship  of  the  latter  to  atresic 
Graafian  follicles  is  discussed.  Whilst  as  already  stated  the  "gland" 
is  quite  separate  and  distinct  from  the  corpus  luteum,  it  may,  in  some 
animals,  be  definitely  traced  to  originate  in  retrogressive  follicles.  But 
here  arises  a  point  of  obscurity,  for  the  author  refuses  to  express  an 
opinion  upon  the  nature  of  the  relationship — he  says  there  is  a  relation- 
ship— between  the  cells  of  the  "interstitial  gland"  and  those  of  an 
atresic  follicle.  To  settle  this  point  an  extensive  research  on  embryonic 
tissues  is  necessary,  and  another  difficulty  arises  from  the  fact  that  under 
the  term  "atresic  follicle"  various  structures,  histogenetically  very  unlike 
each  other,  are  included. 

Another  tissue  which  bears  some  resemblance  to  that  in  question  is 
the  so-called  "  medullary-strands  "  found  in  the  hilum  of  the  ovary,  but 
for  differentiation,  the  position  of  this  tissue  is  decisive,  and  moreover  the 
cells  and  their  nuclei  are  smaller,  they  lack  the  green  or  yellow  colour; 
they  more  resemble  the  cells  of  a  primordial  follicle,  and  their  blood 
supply  is  not  so  great. 

In  twenty-four  animal  species  the  characteristic  interstitial  gland  cells 
were  found  by  Fraenkel  to  be  absent.  In  no  order  was  it  found  in 
all  the  species,  and  in  closely  allied  species  there  were  signs  of  incons- 
tancy, take  for  one  example — the  Bears.  In  the  Ursidae  it  was  present, 
in  Procyonidae  absent  It  occurs  most  frequently  in  Rodents.  In  Mar- 
supials four  species  out  of  six  examined  possessed  it    In  Carnivora  it 


753 


CURRENT  MEDICAL  LITERATURE 


was  found  in  nine  and  not  in  six.  In  Apes  two  examples  were  found  in 
six  examined.  In  Ungulata  it  was  not  found.  From  the  above  facts 
the  author  draws  the  first  conclusion  of  his  summary,  viz:  (i)  the 
inconstancy  of  the  "  glande  interstitielle." 

His  next  point  of  note  is  that:  (2)  the  topographical  distribution  «f 
this  tissue  is  very  variable.  It  can  completely  fill  the  ovary,  but  it  generally 
leaves  the  outer  layers  of  the  cortex  free.  The  primordial  follicles  often 
lie  completely  in  this  tissue  (cat,  marten,  fox).  The  hilus  is  generally 
free  from  it. 

The  zone  of  medullary  stroma  seems  to  be  the  site  of  election.  Again: 

(3)  The  character  and  position  of  the  cells  vary  enormously.  Accord- 
ing to  Fraenkel  there  are  the  following  types : 

(a)  The  principal  type.  The  greater  part  of  the  ovary  is  taken  up 
with  this  tissue.  It  unites  cortex  to  hilum  by  loculi  and  lobules.  The 
cells  are  closely  packed,  are  dark,  granular,  and  contain  fine  droplets 
(?  fat).  These  are  seen  best  in  rodents,  such  as  rabbits,  guinea-pigs  and 
in  long-tailed  monkeys. 

(b)  The  cells  are  loose,  the  septa  finer,  the  loculi  are  round  and  con- 
tain many  centrally  situated  degenerate  ova,  best  seen  in  wombat,  polecat, 
fox,  shrew,  mouse. 

(c)  The  cells  are  clear,  large  and  contain  vacuoles  (stoat,  marten,  civet, 
cat,  domestic  cat). 

(d)  The  cells  are  small,  somewhat  larger  than  ovarian  stroma  cells, 
and  only  distinguishable  from  these  by  the  presence  of  a  well  arranged 
capillary  network  (mouse,  rat,  bear). 

(4)  As  regards  the  nuclear  structure,  it  varies  within  very  wide  limits. 
Chromatin  was  most  abundant  in  the  form  of  granules  and  threads,  or 
it  filled  up  the  nuclei  by  clusters.    Mitoses  were  rare. 

(5)  The  capillary  supply  varied;  it  was  seldom  so  abundant  as  in  the 
corpus  luteum;  it  was  often  very  sparse.  The  size  of  the  cells, the  amount 
of  their  protoplasm,  the  general  contents  bore  no  relation  to  the  capillary 
blood  supply.  The  least  highly  differentiated  cells  had  the  best  capillary 
system  (marten,  and  stoat,  as  opposed  to  polecat  and  wombat). 

(6)  The  septa  and  trabeculae  varied  in  width,  direction  of  the  nuclei, 
and  colouring.  In  some  animals  each  seemed  to  occupy  a  separate  com- 
partment shut  off  by  delicate  septa  from  the  adjacent  cells. 

Ten  of  the  animals  from  which  ovaries  were  taken  were  gravid.  This 
fact  made  no  difference  to  the  character  or  amounts  of  interstitial  gland 
tissue. 

Fraenkel  finds  no  trace  of  the  interstitial  gland  tissue  in  human  ovaries, 
or  in  the  highest  apes  and  largest  mammals.  He  therefore  comes  to  the 
conclusion  that  it  cannot  serve  any  great,  general  or  important  function, 
and  in  comparing  it  with  the  corpus  luteum,  he  remarks  that  whilst  the 
latter  has  most  constant  anatomical  characters  such  as  we  associate  with 
an  organ  having  a  definite  function,  the  former  is  most  inconstant. 


Vol.  xxvii 


NOVEMBER,  1906 


No.  11 


ALBANY 
MEDICAL  ANNALS 


$ridinal  Communication* 

ADDRESS 

Delivered  at  the  Opening  of  the  Seventy-sixth  Session  of  the  Albany  Medical 
College,  September  25,  1906. 

By  SAMUEL  B.  WARD,  M.  D., 

Dean  of  the  Faculty  and  Professor  of  Theory  and  Practice  of  Medicine. 

Gentlemen  of  the  Medical  Class: — The  pleasant  duty  of  de- 
livering the  address  opening  the  seventy-sixth  annual  session  of 
our  College  devolves  this  year  upon  me.  With  some  such  words 
as  these  it  is  customary  for  the  speaker  on  this  day  to  commence 
his  discourse.  Whether  the  duty  is  from  all  points  of  view  a 
pleasant  one  I  am  not  quite  clear.  It  certainly  is  pleasant  to 
welcome  you  back  from  your  vacations  to  begin,  or  to  continue, 
the  study  of  the  profession  that  you  have  chosen,  and  to  heartily 
wish  you  Godspeed  in  your  winter's  work ;  to  assure  you  that 
your  teachers  will  do  all  in  their  power  to  help  you  up  the  hills 
that  you  will  certainly  encounter,  and  through  the  various  and 
numerous  sloughs  of  despond  in  the  pathway  of  every  student ; 
to  encourage  you  to  believe  that  difficulties  which  to  you  may 
seem  insurmountable  are  not  really  so ;  that  if  others  have  con- 
quered them  you  also  can  ;  that  the  course  is  so  arranged  that 
nothing  is  necessary  on  your  part  except  steady,  honest,  judicious 
work,  but  that  that  is  an  absolute  necessity.  You  all  look  fresh 
and  hearty  now,  full  of  ambition,  and  glad  to  get  at  work  again. 
I  think  that  we  are  all  of  us  almost,  not  quite,  as  glad  when  the 
session  begins  as  when  it  closes. 

But  if  the  duty  of  addressing  you  to-day  is  really  an  unalloyed 
pleasure,  I  want  to  congratulate  you  on  having  the  most  un- 
selfish and  self-denying  body  of  men  on  your  faculty  that  were 
ever  collected  together.    When  at  our  last  meeting  in  May  the 


760 


ADDRESS 


Registrar  announced  that  it  was  my  turn  to  open  the  session 
I  at  once  pleaded  another  engagement  for  this  date,  and  gen- 
erously offered  the  opportunity  to  each  man  around  the  table 
in  turn.  You  may  believe  me  fully  when  I  tell  you  that  not 
a  single  one  of  them  even  looked  as  if  he  entertained  for  a 
moment  the  selfish  notion  of  desiring  to  take  my  place. 

If  we  stop  a  moment  to  enquire  why  the  duty  is  not  altogether 
a  pleasant  one  I  can  find  in  my  own  case  two  reasons.  One 
is  that  this  has  to  be  written  during  one's  summer  vacation  when 
he  has  really  no  business  to  be  doing  any  mental  work  at  all, 
but  should  devote  his  entire  attention  to  the  more  important 
matters  of  shooting  partridges,  trapping  rabbits  and  more 
especially  catching  trout.  Perhaps  you  think  that  evenings 
might  be  devoted  to  it,  when  fishing  is  out  of  the  question.  But 
I  hasten  to  assure  you  that  fishing  is  not  at  all  out  of  the  ques- 
tion at  that  hour;  that  by  moonlight  trout  will  often  take  very 
well  indeed,  when  all  the  afternoon  they  have  thoroughly  despised 
your  most  fascinating  flies. 

There  are  many  lessons  to  be  learned  from  trout  fishing. 
There  has  been  much  discussion  for  many  years  as  to  the  best 
time  to  catch  trout.  In  most  waters  it  is  undoubted  that  about 
sunset — just  before  and  just  after — is  their  favorite  feeding-time. 
It  is  contended  by  some  that  sunrise  is  an  equally  good  hour ; 
but  the  inconveniences  attending  the  putting  that  proposition  to 
the  test  are  so  manifold  and  so  manifest  that  I  confess  that  I 
have  not  for  years  undertaken  to  establish  or  disprove  it.  It 
is  deliberately  stated  by  some  writers  that  trout  will  never  take 
during  a  thunder-shower,  nor  for  some  hours  after  one.  This 
is  sometimes  the  case  no  doubt :  but,  on  the  other  hand,  I  never 
saw  trout  take  faster  or  more  eagerly  than  during  and  after 
one  of  the  most  violent  thunder-storms  that  I  ever  saw,  while 
I  have  cast  diligently  for  a  couple  of  hours  at  sunset  without 
getting  a  single  rise.  There  is  but  one  infallible  rule  for  catch- 
ing trout  and  that  is  to  go  after  them  when  they  will  take  your 
fly.  From  this  you  may  learn  an  invaluable  lesson — opportuni- 
ties will  not  come  to  you  at  your  bidding ;  take  advantage  of  them 
promptly  and  diligently  when  they  offer.  You  are  young  now — 
vigorous  and  healthy,  mentally  and  physically,  and  now  is  your 
golden  opportunity.  Improve  it,  and  improve  it  n 0 w;  neglected 
now,  it  will  never  return. 

But  to  go  back  to  the  preparation  of  this  address.    I  have 


SAMUEL  B.  WARD 


761 


told  you  one  reason  why  evenings  ought  not  to  be  spent  on  it ;  but 
there  is  another.  If  you  want  to  have  pleasure  and  success 
attend  upon  your  trout-fishing,  you  must  be  properly  and  fully 
prepared  for  it  when  the  critical  moment  arrives.  These  prep- 
arations, and  the  hopes  that  they  will  enable  you  to  net  the 
biggest  trout  of  the  season,  constitute  no  mean  part  of  the  pur- 
suit. You  must  spend  much  time  in  selecting  your  flies,  some 
modestly  arrayed  in  brown  and  gray,  and  even  in  black ;  some 
gaudily,  in  blue,  and  red.  and  yellow.  You  must  test  your  leaders 
and  be  sure  that  they  will  stand  the  necessary  strain.  You  must 
be  sure  that  your  rod  has  not  been  split  or  injured  and  that  it 
does  not  need  varnishing.  No  less  important  is  it  that  your 
line  has  not  become  frayed,  or  rotten,  and  that  your  reel  works 
just  right — will  not  stick  or  jam.  Now  preparation  for  the 
practice  of  medicine  deserves  even  more  serious  attention  than 
trout-fishing,  which  is  saying  a  great  deal.  Look  well  to  jour 
anatomy  as  you  would  to  your  rod ;  to  your  physiology  as  you 
would  to  your  line ;  to  your  bacteriology  as  you  would  to  your 
leader ;  to  your  materia  medica  as  you  would  to  your  flies ;  to 
your  chemistry  as  you  would  to  your  reel.  I  am  not  giving 
you  this  advice  on  grounds  of  religion,  or  morality,  or  ethics ; 
but  on  the  homely,  practical  ground,  which  will  appeal  even  to 
those  who  have  no  higher  motives — the  ground  that  it  will  pay 
you.  As  you  would  start  on  a  fishing-trip  with  no  tackle  that 
was  not  thoroughly  reliable,  of  your  own  personal  knowledge, 
so  do  not  undertake  to  start  out  in  the  practice  of  medicine 
without  the  proper  equipment.  Learn  all  that  you  can  from 
your  books  and  your  lectures,  as  you  would  purchase  your  rod 
from  a  dealer  of  reputation,  and  then  in  the  clinics,  and  at  the 
bedside  of  the  patient  put  to  the  test,  or  see  tested,  the  reliability 
of  what  you  have  heard  or  read. 

Even  with  the  most  thoughtful  and  elaborate  preparation  a 
day's  fishing  will  wear  out  flies,  and  fray  and  weaken  your 
leaders ;  your  reel  will  rust  at  times  and  your  rod,  perchance, 
start  to  split.  All  these  little  points  require  attention  during 
the  evening  hours  if  you  want  to  save  valuable  time  the  next 
day.  Just  as  truly  you  will  find  after  you  have  obtained  your 
diplomas  that  preparation  for  practice,  no  matter  how  elaborate, 
will  not  last  forever.  Some  time  will  have  to  be  spent  in  un- 
learning a  few  of  the  theories  which  have  been  taught  you. 
Well-observed  facts  will  not  change ;  but  theories,  owing  to  in- 


762 


ADDRESS 


sufficient  foundations,  will  frequently  topple  over,  and  have  to 
be  abandoned.  You  must  always  guard  against  confusing  edu- 
cational prejudice  with  a  sound,  underlying  principle  of  action. 
Rapid  advances  are  also  now  being  daily  made,  and  in  your  pro- 
fessional life  every  evening  and  all  your  other  leisure  hours  will 
have  to  be  devoted  to  preparing  for  the  work  of  the  days  to 
come  if  you  entertain  the  faintest  hope  of  success.  After  you 
get  into  practice  take  at  least  two  or  three  first-class  medical 
journals,  and  as  many  more  as  you  can  afford,  and  read  them 
regularly  and  carefully.  New  books  come  out  from  time  to 
time,  some  of  which  you  must  get  and  "  read,  learn  and  inwardly 
digest  " — make  a  part  of  yourself — if  you  intend  to  keep  abreast 
of  the  times. 

Perhaps  yc/u  think  that  rainy  days  might  have  profitably  been 
spent  in  preparing  for  this  occasion.  But  often  trout  are  more 
attentive  to  business  on  cloudy  or  rainy  days  than  they  are  on 
bright  ones.  Besides  it  is  always  disconcerting  to  try  to  write 
while  others  are  talking  around  you,  and  this  is  especially  true 
if  the  conversation  is  more  or  less  unintelligible.  For  example 
as  I  am  writing  I  hear  one  man  ask  "  How  many  did  you  take?" 
And  a  few  moments  later  another  says  "  They  are  no  good  at 
all  against  a  full  house."  Of  course  this  jargon  means  nothing 
whatever  to  me ;  but  it  is  a  sort  of  temptation  to  go  over  and 
find  out  what  it  is  all  about,  largely  alloys  the  pleasure  of  trying 
to  write  anything  like  a  serious  address  during  one's  vacation, 
and  amply  justifies  my  friends  on  the  Faculty  for  not  desiring 
to  take  my  place. 

The  other  reason  why  I  dreaded  this  address  is  because  I  sup- 
pose that  I  am  expected  to  give  you  some  good  advice.  Of 
course  good  advice  is  not  necessarily  advice  to  be  good.  That 
is  generally  accredited  with  being  worth — like  most  other  things 
in  this  world — just  exactly  what  it  costs — nothing  at  all.  Besides 
you  will  get — or  I  hope  you  will — all  that  is  necessary  every 
Sunday  morning,  and  sometimes,  I  am  afraid,  more  than  you 
will  really  put  into  practical,  everyday  use.  Recollect  that  the 
"Sabbath  was  especially  instituted  as  a  day  of  rest,  and  this 
reason  for  its  existence  is  stated  in  detail.  If  there  be  among 
you  individuals  who  are  well  rested  by  going  to  church  and  Sun- 
day school  three  or  four  times,  that  is  precisely  the  thing  for 
you  to  do.  But  I  fear  that  in  these  degenerate  days  there  may 
be,  even  among  you,  comparatively  few  such.    Indeed  consider- 


SAMUEL  B.  WARD 


763 


ing  the  number  of  clergymen  whom  I  have  heard  complain  of 
"  blue  Monday,"  it  might  seem  as  if  they  were  greater  violators 
of  the  fourth  commandment  than  some  of  the  rest  of  us. 

Rest,  however,  is  not  by  any  means  to  be  confounded  with 
idleness.  For  all  of  us,  rest,  and  change  of  occupation,  are 
almost  synonymous  terms.  It  is  said  of  a  German  philologist, 
who  had  devoted  his  life  to  the  consideration  of  the  Greek 
definite  article,  that  on  his  death-bed  he  regretted  that  he  had 
been  so  diffuse  and  had  not  confined  his  attention  to  the  dative 
case  only.  Specializing  is  all  very  well,  and  vast  advances  have 
unquestionably  been  made  by  those  who  have  limited  the  field 
of  their  labors  by  a  comparatively  small  circle.  But  do  not 
for  an  instant  forget  that  the  man  with  the  best  general  educa- 
tion— the  man  with  the  largest  fund  of  general  information — 
is  bound  to  make  the  best  specialist.  He,  and  he  only,  can 
adequately  judge  of  the  relative  importance  and  inter-relation 
of  observed  facts  and  from  them  deduce  general  principles. 

Change  is  the  law  of  the  mental  world,  as  it  is  of  the  natural. 
The  ground  must  have  the  winter's  rest  if  it  is  to  bear  the 
summer's  crop,  and  you  must  have  the  rest  of  the  Sabbath  to 
enable  yon  to  do  well  the  work  of  the  remainder  of  the  week. 
Go  to  church  Sunday  morning,  because  after  having  listened 
to  anatomy,  and  physiology,  and  surgery,  and  obstetrics  all  the 
week  nothing  could  possibly  be  a  more  radical  or  grateful 
change.  The  hymns  and  the  prayers  will  certainly  do  you  good, 
and  the  sermon  ought  to  also.  Once  in  a  while  it  may  make 
you  mad — -no.  we  will  not  say  that — it  may  fill  you  with  a 
righteous  indignation,  which  is  more  appropriate  to  the  day,  but 
even  that  will  do  you  no  permanent  harm  and  may  start  up  other 
trains  of  thought  that  will  do  you  a  lot  of  good.  As  to  the 
rest  of  the  day  I  have  no  special  advice  to  give,  except  this — 
that  you  put  your  medical  books  on  their  shelves  when  you  go 
to  bed  on  Saturday  night  and  don't  touch  one  of  them  again 
until  Monday  morning.  By  the  time  you  are  fifty  years  old 
you  will  know  more  medicine,  and  be  much  more  useful  all- 
around  practitioners,  if  you  follow  this  advice  than  if  you  do 
not — and  yet  it  is  "  ducats  to  doughnuts  "  that  not  one  in  ten 
of  you  will.    "  Such  fools  these  mortals  be." 

While  we  are  on  this  subject  let  me  say  also  that  it  will  pay 
you  well  to  get  plenty  of  rest  every  week-day  also.  I  well  know 
that  it  is  told  of  the  great  Napoleon  that  he  never  slept  more 


764 


ADDRESS 


than  three  hours.  One  of  the  most  eminent  medical  men  of  the 
day  tells  me  that  for  more  than  twenty  years  he  worked  habitu- 
ally from  seven  o'clock  in  the  morning  until  three  o'clock  in  the 
morning.  And  an  ex-Governor  of  this  State  for  many  years 
slept  only  four  or  five  hours,  and  worked  hard  almost  eyery 
other  minute  of  the  day.  I  have  had  no  recent  opportunity — 
perhaps  it  may  be  considered  fortunate — of  communicating  with 
the  great  military  chieftain ;  but  each  of  the  other  two  has  told 
me  that  he  can  now  do  more  work  on  eight  or  nine  hours  sleep 
than  he  can  on  less.  Undoubtedly  some  of  you  require  less  sleep 
than  others ;  but  each  of  you  should  find  out  for  himself  how 
many  hours  it  takes  to  refresh  him — to  permit  him  to  get  up 
wide-awake  and  feeling  like  going  to  work  again, — and  should 
then  habitually  allow  himself  that  number.  Emergencies  will 
occasionally  arise  to  necessitate  your  doing  with  less  for  a  few 
days.  But,  for  pity's  sake,  don't  for  a  moment  count  cramming 
for  examinations  among  such  emergencies.  Cramming  your 
mind  is  more  illogical  even  than  cramming  your  stomach.  You 
might  much  better  eat  at  one  meal  the  food  required  for  a  week, 
than  cram  for  an  examination.  If  there  is  any  time  in  your 
career  as  a  student  when  you  want  to  have  your  memory  respond 
promptly  to  the  calls  made  upon  it,  to  have  your  intellect  clear 
and  alert,  to  have  your  wits  about  you,  it  is  when  you  are  to 
undergo  an  examination.  I  am  not  at  all  sure  that  examinations 
are  not  a  pure  invention  of  the  adversary  at  any  time.  Were  it 
not  for  the  laziness  and  tendency  to  procrastination,  which  appear 
to  be  inherent  in  most  minds,  I  should  certainly  be  in  favor  of 
abolishing  them  entirely,  in  professional  schools  at  least.  I 
sympathize  with  you  in  fearing,  however,  that  they  will  not  go 
during  your  student-life.  Let  me  tell  you,  therefore,  that  the 
best  way  to  prepare  for  an  examination  is  to  do  every  day  and 
every  week,  honestly  and  faithfully,  the  work  laid  out  for  you 
in  the  curriculum  ;  do  what  reviewing  you  can  during  the  time 
allowed  you  for  that  purpose ;  and  then  during  the  day  or  two 
preceding  the  examination  get  plenty  of  exercise  in  God's  fresh 
air  and  sunshine,  go  to  the  theater,  or  if  your  conscience  will 
not  permit  that,  amuse  yourself  in  some  more  innocent  way,  if 
you  can  find  one — at  any  rate,  make  it  a  point  to  come  into  the 
examination-room  fresh  and  ruddy,  mentally  and  physically. 
Of  course,  I  know  that  not  a  single  one  of  you  will  do  this — 
but,  it  would  pay  you  if  you  would. 


SAMUEL  B.  WARD 


7^5 


Sleep  is  not  the  only  rest  you  need  during  the  week — that  is 
rest  from  study.  You  cannot  possibly  study  to  the  greatest 
advantage  unless  you  keep  your  body  in  first-rate  physical  con- 
dition. If  you  are  really  well,  study  should  be  a  joy  to  you — 
not  a  bore.  The  acquisition  of  new  facts,  the  satisfaction  of 
understanding  and  following  out  new  processes  of  reasoning  to 
their  legitimate  conclusions,  the  admiration  of  the  wonders  of 
the  microscopic  world,  should  all  fill  you  with  intense  interest 
and  joy.  The  moment  you  cease  to  enjoy  your  labors  you  are 
working  at  an  immense  disadvantage  and  should  take  immediate 
steps  to  remedy  the  condition. 

The  illustrious  Abernethy  said  that  "  no  man  ever  died  happy 
with  disease  below  the  diaphragm.''  It  might  truly  be  added 
that  no  such  man  ever  lived  happy.  Your  liver  and  digestive 
apparatus  are  to  be  as  carefully  looked  after  in  a  medical  way, 
as  the  devil  in  theology.  Both  will  offer  you  all  kinds  of  tempta- 
tions and  woe  betide  you  if  you  yield  to  either.  Living  as  most 
of  you  do  just  now  I  do  not  know  that  it  is  very  necessary  to 
caution  you  against  overindulgence  in  pate  de  foie  gras  and 
plum-pudding  at  your  boarding-houses.  But  physical  exercise, 
regularly  every  day,  rain  or  shine,  and  plenty  of  it,  will  pay  you 
well.  The  hours  devoted  to  it  are  not  wasted,  are  not  stolen 
from  study.  With  a  proper  amount  of  it  you  will  do  more  men- 
tal work — will  accomplish  more  in  the  year — and  will  do  it  cheer- 
fully and  joyfully — than  you  possibly  can  without  it. 

The  late  Dr.  Frank  Hamilton  used  to  say  that  the  best  thing 
for  the  inside  of  a  man  was  the  outside  of  a  horse.  In  his  own 
case  he  practiced  what  he  preached,  and  certainly  his  mental  and 
physical  alertness  and  vigor  at  an  advanced  age  bore  loud  testi- 
mony to  the  truth  of  his  assertion.  I  agree  with  him  entirely. 
But  unfortunately,  for  a  variety  of  reasons,  comparatively  few 
of  us  can  ride  a  horse  every  day,  and  fortunately  "  shank's 
mare  "  is  an  excellent  substitute.  You  must  all  of  you  recollect 
occasions  when  after  poring  over  a  text-book  for  hours,  in  a 
close,  stuffy  room,  the  atmosphere  very  possibly  laden  with 
tobacco  smoke,  the  feeling  has  come  over  you  that  you  could 
not  recollect  a  word  you  read ;  you  have  closed  your  book,  thrown 
open  your  windows,  put  on  your  hat  and  gone  for  an  hour's 
walk  in  the  fresh  air  and  sunshine.  Do  you  not  recollect  what 
a  different  aspect  the  whole  world  presented  on  your  return,  with 
your  old  liver  well  shaken  up  and  the  cobwebs  brushed  out  of 


766 


ADDRESS 


your  brain?  In  a  minor,  but  no  less  important  degree,  out-door 
exercise  every  day,  for  an  hour  at  least,  will  enable  you  to  do 
more  work  and  do  it  easily  and  with  pleasure.  There  are  forms 
of  concentrated  exercise  in-doors,  in  gymnasiums,  squash-courts, 
and  the  like,  which  induce  and  enable  you  to  get  more  muscular 
exercise  and  fatigue,  in  less  time.  They  are  infinitely  better  than 
nothing,  and  during  inclement  seasons  are  invaluable ;  but  in  tUe 
long  run  my  observation  is  that  they  do  not  at  all  equal  riding 
and  walking  in  the  open  air. 

Another  most  important  habit  for  you  to  acquire  is  that  of 
mental  concentration.  Sitting  at  a  table  with  a  text-book  open 
before  you  and  running  your  eye  along  the  lines,  while  your 
mind  is  occupied  with  recollections  of  the  good  times  of  yester- 
day, or  plans  for  those  of  to-morrow,  or  day-dreams  of  what 
your  best  girl  may  be  doing  at  that  moment,  is  not  study.  If 
you  do  not  already  know  how,  you  should  learn  to  so  exclude  all 
outside  thoughts  and  so  fix  your  attention,  by  a  determined  effort 
of  the  will,  on  the  page  before  you,  that  reading  it  once,  or  twice 
at  most,  will  put  you  in  possession  of  every  fact  there  recorded. 
I  do  not  mean  to  say  that  you  will  be  able  to  repeat  the  page 
verbatim,  but  the  facts  will  become  yours.  You  may  think  this 
a  gross  exaggeration ;  I  assure  you  it  is  not.  At  first  it  will  re- 
quire a  determined  effort  of  your  will,  and  the  effort  may  have 
to  be  repeated  twenty  times  on  the  first  page.  But  in  a  period 
so  short  that  it  will  surprise  you  the  habit  will  be  formed  and 
thereafter  no  conscious  effort  need  be  made.  The  economy  of 
time  is  prodigious  and  ample  leisure  will  be  left  you  for  exercise 
and  amusement. 

I  have  just  spoken  of  amusement.  Among  our  Pilgrim  fore- 
fathers there  seems  to  have  been  a  very  general  impression  that 
any  occupation  that  was  agreeable  and  pleasant  was  an  invention 
of  the  Evil  One  and  therefore  to  be  always  shunned,  and  under 
no  circumstances  permitted.  According  to  their  standards 
"  everything  nice  was  naughty,"  and  their  chief  satisfaction  in 
life  seemed  to  consist  in  making  themselves  miserable.  But 
times  have  changed  and  we  have  changed  with  them.  The  truth 
of  the  saying  is  now  recognized  that  "  all  work  and  no  play 
makes  Jack  a  dull  boy,"  and  to-day  I  scarcely  know,  or  know 
of,  a  single  man  who  could  lay  claim  to  having  achieved  success 
or  greatness  who  has  not  some  favorite  form  of  amusement — 
who  does  not  devote  a  part  of  his  time  to  some  occupation  because 


SAMUEL  B.  WARD 


7O7 


it  affords  him  pleasure.  Again  a  change  of  occupation  affords 
rest,  and  enables  a  man  to  go  back  to  his  chosen  life-work 
with  renewed  energy,  zest  and  success.  I  know  two  men  who 
find  their  pleasure  in  reading  the  Greek  and  Latin  classics  in  the 
languages  in  which  they  were  written.  I  know  others  who 
change  off  to  Macaulay,  Thackeray  or  Dickens ;  others  to  chess, 
checkers,  the  theater,  back-gammon,  or  cards.  One  of  the  most 
successful  and  prominent  business-men  of  the  day  is  said  to  be 
a  devoted  admirer  of  Miss  Milliken.  She  is  elusive  and  caprici- 
ous, as  is  supposed  to  be  the  right  of  her  sex,  but  always  fascinat- 
ing. And  just  therein  lies  the  danger  of  all  these  things — that 
they  may  prove  too  fascinating.  Use  them  but  don't  abuse 
them — don't  allow  yourself  to  be  flirting  with  Miss  Milliken 
when  you  should  be  considering  miscarriages. 

As  to  playing  games  for  money  I  am  not  of  those  who  believe 
that  the  men  who  do  it  thereby  necessarily  lose  all  chance  of 
getting  to  heaven,  besides  destroying  all  their  chances  of  useful- 
ness in  this  world.  If  you  could  always  be  sure  of  playing 
with  personal  friends  only,  and  for  a  stake  so  small  that  anyone 
at  the  table  could  perfectly  well  afford  to  lose  and  not  win,  there 
might  be  no  particular  harm  in  it.  I  hope  that  there  is  no  need 
of  impressing  upon  you  the  fact  that  any  man  who  goes  to  a 
gambling-house  "  to  try  his  luck  "  is  a  natural,  born  fool,  dyed 
in  the  wool.  The  men  who  run  those  establishments  are  not  in 
business  for  the  benefit  of  their  health,  but  the  game,  even  when 
you  are  sure  that  it  is  conducted  with  perfect  honesty,  is  so 
arranged  every  time,  to  a  mathematical  certainty,  that  the  lamb 
is  bound  to  be  fleeced  in  the  end;  and  no  one  will  despise  your 
lack  of  ordinary  intelligence  more  thoroughly  than  he  who  takes 
your  money,  for  ever  having  thought  that  you  could  possibly 
win.  Of  course  this  argument  does  not  hold  against  a  friendly 
game  of  poker.  Almost  any  man  thinks  that  he  can  afford  to 
go  into  a  little  game  with  a  penny  ante  and  five  or  ten  cent  limit. 
The  trouble  is  that  such  restrictions  do  not  at  all  permit  the 
development  of  the  possibilities  of  the  game,  and  it  will  not  be 
long  before  everyone  will  be  wishing  to  have  them  removed. 
There  is  no  possibility  of  denying  that  gambling — playing  games 
for  gain,  and  not  for  amusement  or  recreation — has  for  many 
men  a  perfectly  infernal,  horrid  fascination,  which  leads  them 
to  their  ruin.  I  recollect  on  one  occasion  to  have  seen  five  hun- 
dred dollars  on  the  table,  the  ownership  to  be  decided  by  the 


768 


ADDRESS 


superiority  of  a  single  hand,  when  there  was  only  one  man  at  the 
table  who  had  an  income  exceeding  five  thousand  dollars  a 
year,  and  only  one  other  who  did  not  have  a  wife  and  family  to 
support.  Now,  gentlemen,  in  all  reason,  can  you  imagine  a 
more  silly,  irrational,  idiotic,  wicked  performance  than  that? 
If  you  get  into  the  habit  of  playing  for  money  at  all,  the  tempta- 
tion to  take  unwarrantable  risks,  which  has  proved  too  strong 
to  be  resisted  by  many  and  many  a  man  of  just  as  much  firmness 
and  principle  as  you  think  that  you  have,  may  prove  your  un- 
doing. There  are  hundreds  of  perfectly  safe  ways  of  getting 
amusement  and  recreation :  therefore  I  advise  you  not  to  play 
games  for  money,  on  the  same  old  ground — that  it  does  not  pay. 

I  do  not  suppose  that  you  want  any  advice  on  the  subject 
of  alcohol,  nor  have  I  any  reason  to  suppose  that  any  one  of 
yon  needs  any.  But  you  are  being  prescribed  for  in  various 
directions  to-day  and  you  may  as  well  take  this  dose  along  with 
the  rest.  I  am  not  going  into  any  long  scientific  discussion 
as  to  whether  alcohol  is  to  be  classified  as  a  food,  a  stimulant  or 
a  narcotic.  In  point  of  fact  its  varied  action  depends  on  two 
things — the  condition  of  the  man  who  takes  it,  and  the  dose.  If 
intended  as  a  food,  directly  or  indirectly,  or  as  a  narcotic,  it  will 
be  prescribed  for  you  by  some  one  else  when  yon  are  ill,  and 
then  you  will  take  it  of  course.  For  my  own  part  for  over 
forty  years  now  I  have  not  taken  an  alcoholic  drink  without  the 
knowledge  of  a  physician  in  active  practice,  and  yet  I  am  by 
no  means  sure  that  his  consent  was  always  judicious. 

I  have  just  told  you  that  the  effect  of  alcohol  will  depend  in 
part  on  the  condition  of  the  individual  who  takes  it.  Sometimes 
the  run-down  state  of  a  sick  person  may  demand  it  as  a  drug; 
its  administration,  and  in  what  seems  enormous  doses,  may  save 
a  life;  and  none  but  a  fanatic  could  possibly  object  to  its  use. 
In  1874  I  published  the  history  of  a  case  of  gangrene  of  the  leg, 
the  result  of  arterial  embolism,  in  the  person  of  a  rather  frail 
American  woman,  of  thirty-one,  who  had  never  been  in  the  habit 
of  taking  alcoholics  in  any  form.  For  several  weeks  her  daily 
allowance  consisted  of  one  quart  of  brandy,  a  half-pint  of  sherry 
and  a  pint  of  champagne.  She  never  showed  the  least  symptom 
of  any  effect  of  alcohol  on  the  performance  of  the  mental  functions 
and  after  her  recovery  resumed  her  previous  habit  as  a  total- 
abstainer.  It  may  be  interesting  to  add,  in  passing,  that  during 
the  weeks  that  she  hung  between  life  and  death  the  pain  was 


SAMUEL  D.  WARD 


769 


so  severe  that  she  frequently  took  as  much  as  four  ounces  of 
laudanum  in  the  twenty-four  hours  for  its  relief.  If  in  such  a 
case  as  this  you  decide  to  give  alcohol,  as  a  stimulant,  you  will 
have  to  give  much  more  than  the  usual  dose  to  produce  the 
desired  effect ;  but  always  bear  in  mind  that  other  point  that 
just  as  soon  as  any  symptoms  of  exhilaration  have  been  pro- 
duced too  much  has  been  given. 

The  case  just  mentioned  is  not  by  any  means  an  isolated  one, 
and  from  such  we  learn  that  when  alcohol  is  really  needed 
enormous  doses  may  be  tolerated  and  indeed  given  with  advant- 
age. On  the  other  hand  I  want  to  warn  you  also  that  when  you 
are  not  seriously  ill,  but  so  far  as  you  know  in  your  ordinary 
good  health,  the  ingestion  of  quite  an  ordinary  amount  of  alcohol 
— say  a  couple  of  glasses  of  beer,  or  an  ounce  of  whiskey, 
diluted  with  water — an  amount  which  would  ordinarily  produce 
no  other  effect  than  one  of  a  mild  exhilaration, — may  prove  de- 
cidedly intoxicating.  No  one  who  ever  takes  a  drink  at  all  can 
be  sure  that  the  next  one  will  not  have  far  more  effect  on  his 
brain  action  than  he  desires  or  has  reason  to  expect. 

It  would,  of  course,  be  perfectly  superfluous  for  me  to  enter 
into  argument  against  the  continuous  and  excessive  use  of 
alcohol.  You  have  all  of  you  seen,  or  will  see,  in  the  autopsy- 
room  its  effects  on  the  blood-vessels,  the  kidneys  and  the  liver. 
The  number  of  lives  that  are  ruined,  and  the  poverty  and  distress 
brought  upon  whole  households,  by  excessive  indulgence  in  alco- 
hol, are  such  common  matters  of  record  that  they  have  un- 
fortunately almost  ceased  to  have  any  effect  upon  us.  If  your 
and  my  becoming  total-abstainers  would  close  up  all  the  dis- 
tilleries and  breweries  in  the  world,  there  is  no  doubt  that  the 
human  race  would  be  better  off  if  we  signed  the  pledge  to-day. 
But,  on  the  other  hand  temperance  is  all  that  is  enjoined  on  us 
by  any  command,  human  or  divine,  with  which  I  am  acquainted, 
and  I  am  not  at  all  sure  but  that  just  as  much  illness  is  caused, 
and  just  as  many  lives  shortened,  by  pver-eating  as  by  over-drink- 
ing. I  have  not  heard  of  the  organization  of  any  society  the 
members  of  which  were  total-abstainers  from  food,  and  ever 
since  the  days  of  good  old  Noah  men  seem  to  have  had  as 
natural  a  craving  for  the  juice  of  the  grape  as  for  food.  My 
impression  is  that  they  always  will  have,  and  that  you  and  I 
cannot  hasten  the  advent  of  the  millennium,  which  will  come 
only  in  God's  good  time.    Efforts  have  been  repeatedly  made 


77o 


ADDRESS 


to  legislate  men  into  total-abstinence,  and  into  honesty,  and  into 
industry ;  but  they  have  always  and  signally  failed,  and  they 
always  will. 

But  if  you  do  not  feel  called  upon  to  become  total-abstainers 
there  can  be  no  doubt  that  it  is  your  bounden  duty,  in  every 
way,  by  precept  and  by  example,  to  encourage  temperance.  It 
will  not  require  very  extensive  travel  and  observation,  or  very  ex- 
tensive reading,  on  your  part  to  show  you  that  in  countries  where 
light  beers — the  so-called  lagers — and  light  wines  are  exclusively 
used  as  beverages,  intoxication  is  practically  unknown,  while  in 
countries  where  heavy  ales  and  beers  and  distilled  liquors  are  in 
habitual  use  it  is  unfortunately  common.  Therefore,  if  you 
will  drink  at  all,  eschew  distilled  liquors. 

If  one  of  you  should  ask  me  whether  I  thought  that  the  daily 
drinking  of  even  beer  would  be  of  benefit  to  you — whether  I 
would  advise  it — I  should  be  obliged  to  answer,  no.  I  believe 
that  any  man,  under  fifty  years  of  age,  and  in  ordinarily  good 
health,  is  better  off  in  the  end  by  not  indulging  in  its  daily  use. 
I  do  not  think  that  my  friends  would  classify  me  as  a  pessimist, 
but  I  am  one  as  far  as  the  universal  attainment  of  total-absti- 
nence is  concerned.  By  the  way  Hamilton  Mabie,  I  think  it  was, 
defined  a  pessimist  as  "  a  man  who  when  he  was  offered  the 
choice  of  two  evils  took  them  both ;"  and  a  year  ago  I  heard 
a  Western  orator  define  him  as  "  a  man  who  when  he  looked 
at  a  doughnut  saw  nothing  but  the  hole."  Now  I  think  that  I 
can  see  the  rim  of  the  doughnut  as  well  as  the  hole.  I  do  not 
believe  the  indulgence  in  an  occasional  glass  of  beer  or  wine  is 
an  unadulterated  evil,  and  I  am  fully  persuaded  that,  if  I  advised 
you  never  to  touch  alcohol  in  any  form,  you  would  be  much  more 
apt  to  follow  my  example  than  my  advice.  But  let  me  urge 
upon  you  that  you  must  guard  yourselves  strictly  against  over- 
indulgence, and,  if  by  any  chance  you  come  to  a  point  where 
you  cannot  take  an  occasional  glass  without  taking  too  much, 
then  stop  it  at  once  and  forever.  All  experience  shows  that 
there  is  no  middle  ground  for  such. 

I  had  thought  that  I  might  say  something  to  you  about  smok- 
ing. But  I  ought  to  leave  something  for  the  man  who  is  to  fill 
this  hour  next  year,  and,  if  he  is  at  present  on  the  Faculty, 
he  will  not  be  half  "  as  much  embarrassed  by  a  knowledge  of 
his  subject "  as  I  would  be.  Temperance  is  not  to  be  urged 
upon  you  as  to  alcohol  alone.    It  is  to  apply  to  your  tobacco, 


SAMUEL  B.  WARD 


771 


your  amusements,  your  eating,  your  study  even — let  "  temper- 
ance in  all  things  "  be  your  motto. 

We  have  had  a  good  deal  to  say  about  the  fact  that  rest  and 
change  of  occupation  were  necessary  from  day  to  day  in  order 
to  enable  you  to  do  the  most  and  the  best  professional  work.  It 
is  a  generally  recognized  fact  in  all  institutions  of  learning, 
undergraduate  as  well  as  professional,  that  in  addition  to  this, 
a  more  or  less  prolonged  summer  vacation  is  desirable.  In 
some  cases,  as  in  that  of  this  College,  the  holiday  is  so  long  that 
to  spend  the  whole  of  it  in  idleness  would  be  an  unwarrantable 
waste  of  valuable  time.  I  well  know  that  many  of-  you  are 
obliged  to  engage  in  some  pecuniarily  remunerative  pursuit  dur- 
ing these  months  in  order  to  meet  the  expenses  of  the  ensuing 
winter.  But  let  me  advise  you,  if  you  can,  during  your  student 
life,  and  especially  after  you  get  to  be  busy  practitioners,  to  get 
at  least  one  month  in  every  twelve  free  from  business  anxieties, 
worries  and  cares.  You  will  live  longer,  be  happier,  and  be 
of  more  use  in  the  world  if  you  do  than  if  you  don't.  Again — 
it  will  pay  you  well. 

Let  me  advise  you,  in  your  earlier  years,  to  spend  a  part  at 
least  of  these  vacations  in  travel.  Reading  makes  a  learned 
man  and  travel  makes  a  wise  one.  Spending  all  your  life  in  one 
village,  or  city,  or  State,  leaves  you  necessarily  with  very  narrow 
views  of  art,  of  architecture,  of  scenery,  of  many  things  that  go 
to  make  life  beautiful  and  enjoyable,  that  round  it  out  and  fill 
it  up,  that  render  you  most  useful  and  most  successful.  See 
your  own  continent  first.  Those  of  you  who  pass  over  the 
Canadian  Pacific  Railroad  and  stop  at  Banff  and  Lake  Louise 
will  have  revealed  to  your  vision  scenes  that  will  fill  your  eye 
with  a  magnificence,  grandeur  and  beauty  which  no  man's  pen 
can  adequately  describe,  of  which  no  pictorial  representation 
can  possibly  convey  any  proper  idea,  and  which  are  surpassed 
no  where  in  the  world  if,  indeed,  they  are  equalled.  In  Yellow- 
stone Park  you  will  again  find  wonders  and  beauties  that  will 
give  you  food  for  reflection  the  rest  of  your  lives.  When  you 
reach  San  Francisco  reflect  that  you  have  gone  from  New  York 
less  than  half  way,  in  longitude,  to  the  confines  of  your  own 
United  States,  and  go  on,  if  you  can,  to  Alaska.  With  its 
glaciers,  its  fjords,  and  its  hundreds  and  thousands  of  miles  of 
solitude,  you  cannot  fail  to  be  impressed.  And  when  you  are 
on  your  travels  do  not  forget  to  study  the  people.    All  through 


772 


ADDRESS 


the  West  you  will  find  displayed  an  energy,  a  self-reliance  and  a 
persistence  which  will  account  for  their  wonderful  progress  and 
success  in  the  face  of  enormous  difficulties  and  discouragements 
and  which  cannot  fail  to  inspire  you.  u  The  highest  study  of 
mankind  is  man." 

Having  seen  your  own  country  you  will  naturally  want  to 
visit  Europe,  and  very  possibly  continue  your  trip  around  the 
world.  Time  does  not  permit  me  to  dilate  on  the  advantages 
to  be  gained  from  professional  post-graduate  study  abroad  and 
fortunately  there  is  no  necessity  for  my  so  doing.  They  have 
already  been  laid  before  you  over  and  over  again. 

But  in  your  professional  life  there  will  come  times  when  the 
strain  on  your  powers,  mental  and  physical,  has  been  so  great 
that  you  absolutely  need  rest,  when  even  travel  would  be  tire- 
some and  not  answer  the  purpose.  Let  me  advise  you  at  such 
times  to  get  away  from  the  vile  haunts  of  men  absolutely — get 
into  camp  either  alone  or  with  one  congenial  companion  at  most 
— and  if  you  have  a  companion  get  away  even  from  him  for 
hours  at  a  time.  No  one  who  has  not  tried  the  experiment  of 
being  absolutely  alone — not  even  being  able  to  indulge  in  an 
ordinary  conversation  for  hours  or  days  at  a  time — coupled 
with  plenty  of  exercise  in  the  open  air,  has  any  idea  of  what 
real  rest  is.  In  many  localities  a  guide  will  be  a  necessity ;  if 
so,  select  one,  physically  capable  of  course,  but  who  would 
probably  be  killed  by  the  shock,  if  a  new  idea  should  chance 
to  strike  him.  A  week  of  such  life  will  do  more  to  restore  you 
than  a  month  of  any  other  that  I  know  of,  and  I  have  tried 
many. 

Of  course  you  will  camp  on  the  border  of  a  lake  selected  on 
account  of  the  fishing  it  affords,  and  good  old  Isaack  Walton's 
recreation  will  be  yours.  Besides  the  many  other  advantages 
which  this  kind  of  vacation  affords,  let  me  say  to  you  in  con- 
clusion that  if  a  man  ever  finds  himself  in  a  frame  of  mind  to 
enjoy,  appreciate  and  be  thankful  for  the  beauties  of  nature — 
the  woods  and  the  mountains,  the  sky  and  the  water,  the  sunset 
and  the  moon-rise — and  to  look  thro  nature  up  to  nature's 
God  with  feelings  of  adoration  and  true  worship,  it  is  when  amid 
surroundings  such  that  he  will  surely  have  a  fly-book  in  his 
pocket  and  a  light  rod  in  his  hand. 


HYPERNEPHROMA  OF  THE  KIDNEY 


773 


HYPERNEPHROMA  OF  THE  KIDNEY. 
With  Report  of  a  Case. 

By  J.  M.  BERRY,  M.  D., 

Troy,  N.  Y. 
From  the^Cluett  Pathological  Laboratory. 

Keen  defines  hypernephroma  as  a  tumor  arising  from  adrenal 
tissue  whether  in  the  normally  situated  gland  or  in  ectopic  frag- 
ments of  the  organ  known  as  adrenal  "  rests." 

The  term  hypernephroma  was  first  applied,  by  Birch-Hirsch- 
feld  in  1896,  to  a  class  of  tumor  thought  to  have  its  origin  in 
suprarenal  gland  tissue,  but,  as  is  well  known,  Grawitz  in  1883 
was  the  first  to  call  attention  to  the  fact  that  a  large  class  of 
renal  tumors  had  their  origin  in  the  adrenal.  Prior  to  the  year 
1883  this  class  of  tumor  had  been  variously  diagnosed  as  lipoma, 
sarcoma,  adenoma,  angioma,  angio-sarcoma,  adeno-carcinoma, 
myxoma,  endothelioma,  etc.  At  the  present  day,  only  a  few 
pathologists  deny  the  adrenal  origin  of  these  tumors. 

The  so-called  adrenal  "  rests  "  are  of  very  frequent  occurrence. 
They  have  been  reported  to  have  been  found  in  ninety  per  cent, 
of  all  post  mortems.  The  embryological  kidney  is  lobulated 
and,  to  a  certain  extent,  encloses  the  adrenal  gland ;  it  is  there- 
fore easy  to  understand  how  portions  of  the  adrenal  might  be- 
come detached  and  enclosed  in  the  inter-lobular  structure  of 
the  kidney.  Adrenal  "  rests  "  are  by  no  means  confined  to  the 
kidney  but  are  found  in  various  other  parts  of  the  genito- 
urinary tract  and  body.  It  is  possible,  therefore,  to  have 
hypernephroma  of  organs  other  than  the  kidney. 

Smallwood  reports  the  finding  of  a  tumor  in  the  kidney  of  a 
frog  similar  to  hypernephroma  in  man. 

The  frequency  of  these  tumors  is  demonstrated  in  Keen's 
paper  published  in  1904.    He  had  collected  163  cases  since  1890. 

Hypernephroma  is  not  usual  in  patients  under  thirty  years  of 
age.  Sex  does  not  seem  to  be  of  much  account  but  the  tumor 
is  more  frequent  in  the  adult  male.  Traumatism  has  been  men- 
tioned as  an  etiological  factor. 

The  pathology  of  hypernephroma  is  as  yet  not  wholly  clear; 
nevertheless  two  types  of  tumor,  a  benign  and  a  malignant,  can 
be  demonstrated.  In  the  last  edition  of  von  Bergmann's  surgery 
4 


774 


HYPERNEPHROMA  OF  THE  KIDNEY 


there  is  an  excellent  summary  of  the  present  knowledge  of  this 
subject." 

Small  tumors  situated  in  the  renal  cortex  and  containing  fat, 
which  are  wholly  composed  o£  tissue  resembling  the  cortex  or 
pigmental  zone,  or  even  the  medullary  portion  of  the  suprarenal 
gland,  are  to  be  considered  misplaced  fragments  of  that  gland 
rather  than  tumors. 

The  benign  type  of  hypernephroma  are  lobulated  tumors  con- 
taining fat  and  having  a  whitish,  yellowish  or  brownish  color, 
and  solid  consistence.  They  are  found  beneath  the  capsule  of 
the  kidney  and  are  divided  by  connective  tissue  into  smaller 
and  larger  lobules  and  are  separated  from  the  renal  parenchyma 
by  a  connective  tissue  capsule.  Microscopically,  they  are  made 
up  of  a  delicate,  vascular  stroma  within  the  meshes  of  which 
are  characteristic  cylinders  or  groups  of  cubical,  rounded  or 
polygonal  cells  of  the  epithelial  type.  The  cylinders  of  cells 
are  often  parallel  to  one  another.  There  is  no  lumen  present. 
The  cells  are  all  about  of  the  same  size,  the  nuclei  stain  well  and 
the  cell  bodies  contain  few  to  many  fat  drops  and  also  glycogen, 
as  shown  by  the  brown  color  produced  by  iodine.  The  cells  are 
stained  yellowish  or  brownish  with  a  solution  of  potassium 
bichromate,  a  reaction  which  is  peculiar  to  the  medullary  portion 
of  the  suprarenal  gland.  There  are  areas  of  softening, 
haemorrhagic  areas  and  areas  of  myxomatous  degeneration. 
Such  a  tumor  is  analogous  to  an  adenoma  of  the  suprarenal 
gland. 

Von  Bergmann  distinguishes  a  group  of  benign  tumors  char- 
acterized by  the  presence  of  giant  cells,  also  a  group  which 
seems  to  owe  their  origin  to  the  cells  of  the  medullary  portion 
of  the  suprarenal  gland. 

Some  hypernephromas  never  manifest  any  malignancy,  others 
are  very  malignant.  It  is  sometimes  difficult  to  distinguish  be- 
tween a  benign  and  malignant  hypernephroma ;  just  as  a  carci- 
noma may  lie  dormant  for  years  so  may  a  hypernephroma.  At 
times  one  cannot  differentiate  microscopically  between  a  benign 
and  malignant  tumor. 

Malignancy  is  shown  by  local  extensive  invasion  of  the  kidney 
and  surrounding  parts,  and  also  by  metastasis.  Metastasis  is 
said  to  always  occur  by  means  of  the  blood  vessels  instead  of  the 
lymphatics  ;  it  not  uncommonly  occurs  by  invasion  of  the  renal 
vein.    In  several  cases,  thrombosis  of  the  vena  cava  has  been 


J.   M.  BERRY 


775 


reported.  Metastasis  occurs  especially  in  the  lungs,  liver  and 
bone,  but  almost  all  the  tissues  of  the  body  have  been  known  to 
be  involved. 

The  structure  of  a  malignant  hypernephroma  is  well  described 
by  von  Bergmann :  "A  nodular  tumor  of  yellowish  or  brownish 
color  with  a  harder  center  and  a  softer  periphery  either  presses 
aside  the  neighboring  tissue  or  infiltrates  it  and  destroys  it  by  the 
formation  of  new  nodules.  Sometimes  the  tumor  grows  into  the 
pelvis  of  the  kidney,  forming  polypi.  Portions  of  the  tumor  on 
section  appear  to  the  eye  translucent,  like  young  cartilage,  while 
in  other  portions  there  are  evidences  of  hyaline  degeneration. 
The  mass  of  tumor  is  made  up  of  connective  tissue  stroma  whosfe 
meshes  are  rilled  by  cubical  or  polygonal  cells  containing  fat  and 
glycogen.  These  cells  are  arranged  in  strings  and  rows  sugges- 
tive of  the  arrangement  of  cells  in  the  liver,  or  they  may 
exist  in  broader  cones  and  groups.  Sometimes  they  are  arranged 
in  the  form  of  a  tubule,  or  of  an  alveolus  more  or  less  filled 
with  cells  and  with  papillary  outgrowths,  springing  from  the 
lining  of  the  spaces.  In  the  older  portions  of  the  tumor  there 
are  often  found  cysts  of  degeneration  and  hemorrhagic  areas. 

"A  malignant  hypernephroma  can  properly  be  classed  with  the 
sarcomata  since  there  is  no  sharp  differentiation  between  stroma 
and  parenchyma,  and  because  the  connective  tissue  which  forms 
the  stroma  also  extends  in  between  the  cells  of  the  parenchyma. 
Furthermore,  while  the  younger  portion  of  the  growth  looks 
like  an  epithelial  tumor,  the  older  portions  show  an  appearance 
typical  of  sarcoma." 

Considerable  experimental  work  has  been  done  with  the  object 
of  proving  the  adrenal  origin  of  these  tumors.  Previous  mention 
has  been  made  of  the  similarity  between  the  tumor  cells  and 
adrenal  cells  in  their  fat  and  glycogen  contents,  also  as  to  chro- 
mophilic  reaction  present  alike  in  the  tumor  cells  and  the  medul- 
lary adrenal  cells.  Gotti  claims  that  the  tumor  tissue  contains 
the  same  percentage  of  lecithin  as  adrenal  tissue.  Crofton  finds 
that  both  have  the  power  to  decorolize  iodine  starch  solution  and 
that  injections  of  the  tumor  extract  would  cause  glycosuria  in 
dogs,  the  same  as  injections  of  adrenal  extract. 

The  propriety  of  using  the  name  hypernephroma  for  these 
tumors  is  well  summed  up  by  Thorndike: 

i.  "  The  situation  of  the  growth  just  beneath  the  kidney 
capsule :  the  most  common  seat  of  aberrant  suprarenal  tissue. 


776 


HYPERNEPHROMA  OF  THE  KIDNEY 


2.  "  The  similarity  of  malignant  tumors  of  the  adrenal  gland 
and  these  malignant  growths  of  aberrant  suprarenal  origin. 

3.  "  The  absence  of  any  transition  structure  between  the 
growth  and  the  renal  tissues  surrounding  it. 

4.  "  The  tendency  of  the  tumor  to  extend  along  and  to  involve 
venous  rather  than  lymphatic  channels. 

5.  "  The  resemblance  of  the  tumor  cells  to  those  of  the 
suprarenal  cortex. 

6.  "  The  presence  of  fat  drops  and  glycogen  in  the  protoplasm 
of  the  cells:  substances  which  are  by  no  means  universally  or 
even  commonly  found  in  the  adrenal  tissues  and  yet  which  are 
always  present  in  tumors  of  this  gland  so  far  as  they  are 
known. 

7.  "  The  property  of  the  nucleolus  of  staining  differently 
from  the  nucleus,  a  fact  rarely  if  ever  observed  in  cells  of  renal 
adenomata. 

8.  "  The  presence  of  giant  cells  like  those  in  the  small  hyper- 
blastic  growths  of  the  suprarenal  gland  of  which  we  have  a 
knowledge. 

9.  "  The  existence  of  an  abundant  capillary  net  work  as  seen 
in  the  suprarenal  cortex. 

10.  "  The  presence  of  lecithin  in  amounts  closely  approxi- 
mating those  characteristic  of  suprarenal  tissue." 

The  symptoms  of  hypernephroma  are  not  so  characteristic 
as  to  make  diagnosis  easy.  The  growth  may  be  latent  for  a 
long  time  and  hemorrhage  from  the  kidney  be  the  first  symptom. 
Sometimes  a  dull  pressure  in  the  lumbar  region  may  be  the 
first  symptom  to  direct  the  patient's  attention.  On  examination, 
a  large  nodular  tumor  may  be  made  out.  The  function  of  the 
kidney  may  be  interfered  with  either  by  destruction  of  renal 
substance,  by  compression  of  the  tumor  mass  or  by 
both.  When  the  tumor  has  once  started  to  grow  it  usually 
grows  rapidly.  The  question  as  to  the  raising  of  the  blood 
pressure  in  this  condition  is  still  in  dispute.  Bronzing  of  the 
skin  rarely  occurs.  Hemorrhage  takes  place  in  eighty  per 
cent,  when  the  tumor  begins  to  develop  malignancy.  The 
hemorrhage  is  due  to  vascularity  of  the  tumor  and  necrosis. 

The  treatment  of  hypernephroma  is  surgical,  and  the  same 
rules  apply  as  in  treatment  of  malignancy  in  any  part  of  the 
body. 

The  literature  on  hypernephroma  is  now  quite  extensive ;  never- 


To  Illustrate  Dr.  Berry's  Article  on  "  Hypernephroma  of  the  Kidney." 

Albany  Medical  Annals,  November,  iqo6. 


Fig.  i — a.  Capsule  around  kidney  and  tumor,    b.  Kidney,    c.  Tumor. 


J.  M.  BERRY 


777 


theless,  on  account  of  its  recent  recognition  and  its  compara- 
tive rarity,  the  report  of  a  single  case  seems  justifiable. 

The  case  to  be  reported  was  a  patient  at  different  times  of  Dr. 
H.  C.  Gordinier  and  Dr.  D.  G.  Buchanan  of  Troy. 

Patient  was  first  seen  in  June,  1905.  Patient  was  a  man  aged 
60,  a  dentist  by  occupation.  He  complained  of  lassitude, 
weakness,  shortness  of  breath  and  slight  cough. 

Family  history  negative. 

Past  history,  as  far  as  known,  was  negative. 

The  present  illness  began  some  months  previous  to  the  time 
the  patient  was  first  seen.  Patient  had  noticed  that  he  had 
shortness  of  breath  on  exertion,  that  his  ankles  swelled  somewhat 
and  that  he  had  to  urinate  several  times  during  the  night.  The 
symptoms  were  growing  progressively  worse. 

On  examination,  the  patient  was  found  to  be  a  well  built, 
well  muscled  individual.  The  skin  was  of  a  dirty,  yellow  color 
and  very  dry.  There  was  slight  cyanosis  of  the  lips  and  finger 
tips,  and  slight  oedema  of  the  ankles  and  over  the  tibiae.  Both 
the  radial  and  temporal  arteries  were  readily  palpable  and  could 
with  difficulty  be  compressed.  There  was  a  distinct  arcus  senilis 
present.    The  eve  grounds  were  normal. 

The  chest  was  well  developed  and  symmetrical ;  the  movements 
were  normal  but  the  respirations  were  slightly  increased.  There 
were  no  enlarged  veins  and  no  local  bulgings.  The  percussion 
note  was  universally  vesiculotympanitic  in  front  and  back.  On 
auscultation  the  respirations  were  prolonged  and  low  in  pitch 
especially  in  the  infraclavicular  region.  Posteriorally  in  the 
infrascapular  region  there  were  numerous  fine  moist  rales  from 
chronic  oedema. 

The  cardiac  apex  was  thrown  downward  and  outward  into 
the  sixth  interspace  and  two  centimeters  outside  the  mammary 
line.  The  impulse  was  heaving.  The  aortic  second  was 
markedly  accentuated  and  there  was  a  systolic  apex  murmur 
conducted  into  the  axilla.  There  was  a  definite  epigastric 
pulsation  but  no  pulsation  of  the  jugular  veins. 

The  abdomen  was  full,  symmetrical  and  presented  no  enlarged 
veins  or  no  local  bulgings.  It  was  universally  tympanitic,  per- 
fectly soft  on  palpation  and  there  were  no  herniae  present.  The 
superficial  liver  dullness  was  displaced  by  a  tympanitic  note. 
The  liver  was  palpable  two  inches  below  the  costal  margin,  its 


77» 


HYPERNEPHROMA  OF  THE  KIDNEY 


border  being  round  and  smooth.  The  spleen  was  not  palpable  or 
percussable. 

There  were  no  lesions  of  the  nervous  system  demonstrable. 

The  arterial  tension  which  was  taken  at  the  time  of  the  first 
examination  and  many  times  afterwards  was  always  -h 

The  urine  was  large  in  amount  and  of  a  low  specific  gravity. 
There  was  a  trace  of  albumen  with  hyaline  and  granular  casts 
but  no  blood.  Frequent  examinations  of  the  urine  were  made 
at  various  times  during  the  patient's  illness  with  the  same  result. 

There  was  a  progressive  increase  of  all  the  symptoms  and  the 
patient  developed  very  marked  oedema  of  the  lower  extremity. 
Some  fluid  collected  in  the  abdomen  and  a  moderate  hydrothorax 
developed.  During  the  progress  of  the  case,  there  were  several 
attacks  of  acute  oedema  of  the  lungs  which  were  promptly  re- 
lieved by  moderate  doses  of  nitroglycerine.  At  no  time  was 
there  bleeding  from  any  mucous  surface  and  there  was  never 
any  haematuria. 

The  case  was  diagnosed  as  one  of  chronic  interstitial  nephritis. 

The  patient  died  in  December,  1905.  For  a  week  or  ten  days 
previous  to  death,  the  patient  was  confined  to  his  bed.  He  was 
troubled  with  extreme  nervousness  and  marked  shortness  of 
breath.    The  skin  had  become  of  a  greenish  yellow  color. 

A  partial  autopsy  was  performed  by  Dr.  Carey,  December  23, 
1905.  Only  the  heart  and  right  kidney  were  removed  for  ex- 
amination. Dr.  Carey's  notes  as  to  the  gross  pathology,  made  at 
that  time,  are  as  follows : 

"  Heart  measures,  14.  x  13.  x  5. cm.  Pericardium  smooth,  has 
numerous  dark  hemorrhagic  areas  averaging  about  2  cm.  in 
diameter,  located  at  apices  of  the  appendices  auriculae,  apex 
left  ventricle  and  along  interventricular  septum  on  right  side. 
The  muscle  is  very  flaccid.  Right  auricle  dilated  and  contains 
two  typical  ball  thrombi  of  pale  white  color  attached  by  delicate 
threads  to  the  wall  of  the  auricle.  The  right  ventricle  is  dilated 
and  contains  thrombi  also  in  the  masculae  pectinati.  The  valve 
leaflets  are  normal.  Left  auricle  is  dilated,  the  walls  are  smooth, 
no  thrombi.  Foramen  ovale,  open  but  competent.  Left  ventricle 
dilated,  walls  less  than  1  cm.  thick,  one  leaflet  of  the  mitral 
valve  shows  a  plaque  of  yellowish  color,  but  no  appreciable  in- 
competency of  the  valve  made  out.  There  is  a  marked  increase 
in  the  interstitial  connective  tissue  in  the  papillary  muscles. 
The  aortic  and  pulmonic  leaflets  are  normal  but  the  aorta  at  its 


J.   IE.  BERRY 


779 


origin  is  very  rough  and  atheromatous.  The  coronary  arteries 
present  an  advanced  grade  of  arterio-sclerosis,  with  ather- 
amatous  ulcers  and  calcified  plaques.  No  obliterating  thrombi 
are  seen. 

"  Kidney.  The  kidney  is  surrounded  by  a  greatly  thickened 
capsule  which,  when  stripped  off,  leaves  an  irregularly  shaped 
kidney  measuring  14  x  10  x  9  cm.  The  fibrous  capsule  strips 
easily  and  leaves  a  fairly  smooth  kidney  substance.  On  the  con- 
cave surface  about  the  hilum  is  a  fungoid  tumor  mass  measuring 
9x8x4  cm.,  extending  outward  from  the  parenchyma  with 
nodular  surface  and  soft  consistency.  The  growth  extends  into 
the  capsule,  where  it  is  limited  only  by  a  fibrous  capsule  similar  to 
that  about  the  kidney.  Its  involvement  of  the  perinephritic  tissue 
appears  more  like  an  extension  of  the  main  growth  than  an 
infiltration.  On  section  only  a  little  of  the  parenchyma  of  the 
kidney  is  left,  principally  the  cortex  with  here  and  there  a  por- 
tion of  a  pyramid.  The  pelvis  is  completely  filled  with  the  growth. 
The  blood  vessels  are  filled  with  thrombi  particularly  at  the 
upper  pole.  The  ureter  is  chronically  inflamed  but  patent, 
and  leads  into  a  small  pelvis  pushed  to  one  side  by  the  growth. 
The  renal  vein  is  completely  obstructed  by  the  growth  along 
its  lumen.  There  is  thrombosis  of  the  renal  artery  also.  The 
growth  is  soft,  friable,  has  a  yellowish  color  and  a  fairly  homo- 
geneous structure.  It  has  undergone  extensive  degeneration,  as 
shown  by  the  numerous  areas  of  hemorrhage  and  numerous 
cyst  spaces.  When  torn,  it  leaves  a  granular  surface.  Blood 
vessels  are  scarce.  Colloid  degeneration  is  present  also.  The 
adrenal  is  normal." 

The  left  kidney  was  not  removed,  but  seemed  to  be  of  normal 
size.  Photographs  of  the  gross  specimens  are  shown  in  Figs. 
1  and  2. 

Microscopically,  the  tumor  is  seen  to  be  made  up  of  polygonal 
epithelial-like  cells  held  together  by  a  scanty  connective  tissue 
stroma.  The  cells  vary  somewhat  in  size.  The  nucleus  is  large 
and  circular  and  stains  well.  The  protoplasm  is  very  granular 
looking  and  contains  occasional  vacuoles.  The  stroma  is  scanty 
in  amount  and  there  are  numerous  capillaries.  The  arrange- 
ment of  the  cells  varies  in  different  portions  of  the  growth. 
Oftentimes  the  cells  are  so  crowded  together  that  there  seems  to 
be  no  regular  arrangement  at  all ;  at  other  times  the  cells  are 
collected  into  lines  and  columns ;  again  they  may  form  cylinders 


780 


HYPERNEPHROMA  OF  THE 


KIDNEY 


and  in  places,  there  may  be  almost  a  glandular  appearance  with 
the  formation  of  small  cyst-like  cavities  and  papillomatous  in- 
growths. No  giant  cells  are  observed.  There  are  numerous 
areas  of  extravasation  of  blood  and  degeneration.  Frequently 
the  degeneration  has  progressed  so  far  that  no  structure  can  be 
made  out.  All  that  remains  is  a  granular  detritus.  The  growth 
seems  to  be  well  marked  off  from  the  kidney  substance.  There 
even  seems  to  be  a  formation  of  connective  tissue  between  the 
two.  This  connective  tissue  septum  is  in  places  thickly  infiltrated 
with  small  round  cells.  The  thrombi  in  the  renal  vessels  are 
infiltrated  with  the  growth.  The  growth  seems  to  have  broken 
through  the  vessel  wall  and  invaded  it. 

The  kidney  tissue  proper  shows  marked  increase  in  connective 
tissue  both  between  the  tubules  and  in  the  glomeruli.  The 
epithelium  lining  the  tubules  shows  marked  degeneration. 

No  metastatic  growths  were  found  in  the  thrombi  in  the  heart, 
but  in  two  instances  groups  of  tumor  cells  were  found  in  spaces 
in  the  thrombi. 

The  diagnosis  is  hypernephroma  of  the  kidney  springing  from 
the  hilum  and  involving  the  renal  vessels.  There  is  an  as- 
sociated chronic  interstitial  and  glomerular  nephritis.  Multiple 
thrombi  of  the  right  auricle  and  ventricle  with  emboli  of  tumor 
cells.  There  is  also  present  a  chronic  interstitial  myocarditis,  ad- 
vanced arerio-sclerosis  of  the  coronary  arteries  and  aorta  and  a 
dilation  of  all  the  cavities  of  the  heart. 

Bibliography. 

No  attempt  will  be  made  to  give  a  complete  list  of  the  litera- 
ture on  this  subject.  A  very  good  summing  of  the  work  done 
on  hypernephroma  up  to  1902,  is  given  in  Lubarsch  and  Ostertog. 

Some  of  the  more  important  papers  published  since  1902  are 
given  below.  The  articles  of  Thorndike.  Penchard  and  Keen, 
Pfahler  and  Ellis  are  especially  instructive  and  contain  extensive 
bibliographies. 

Bierring  Journal  of  the  American  Medical  Association,  xliii,  1904 

Crofton  Journal  of  the  American  Medical  Association,  xl.  1903. 

Keen,  Pfahler  and  Ellis         American  Medicine,  December  17,  1904. 
Lubarsch  and  Ostertog,  1902 

Penchard  American  Journal  of  Urology,  ii,  1905-1906. 

Smallwood  Anatomische  Ameiger,  xxvi,  1905. 

Thorndike  Boston  Medical  and  Surgical  Journal,  cxlix,  1903. 


To  Illustrate  Dr.  Berry's  Article  on  "  Hypernephroma  of  the  Kidney." 

Albany  Medical  Annals.  November,  iqo6. 


Fig.  2 — a.  Thrombosed  renal  veins,    b.  Ureter. 


ACNE  VULGARIS 


78l 


ACNE  VULGARIS. 

With  Special  Reference  to  its  Treatment  by  the 
General  Practitioner. 

Read  before  the  Medical  Society  of  the  County  of  Fulton,  March,  igo 5. 

By  JAMES  W.  WILTSE,  M.  D.. 

Attending  Dermatologist  at  St.  Peter's  Hospital;  Instructor  in  Diseases  of  the  Skin  and 
Genito- Urinary  System,  Albany  Medical  College. 

Mr.  President  and  Gentlemen  of  the  Fulton  County  Medical 
Society: — Acne  Vulgaris  is  probably  the  most  prevalent  of  all 
skin  diseases  in  America,  not  excepting  eczema.  Many  cases  are 
so  mild  that  they  never  present  for  treatment  while  many  others 
are  so  severe  as  to  be  a  course  of  great  mental  as  well  as  con- 
siderable physical  suffering  to  the  patient.  In  many  of  the  severe 
types  of  the  disease  scarring  is  left  which  persists  until  mature 
years  and  may  never  be  entirely  eradicated.  Occurring  at  a  time 
of  life  when  the  patient  is  most  concerned  about  his  or  her  per- 
sonal appearance  the  disease  is  often  a  source  of  much  embarrass- 
ment and  mortification  to  the  patient ;  especially  is  this  the  case 
in  young  women.  I  know  of  no  skin  lesion  in  which  the  patient 
feels  more  gratitude  to  the  physician  than  in  these  cases  of  severe 
and  disfiguring  acne  when  a  cure  has  been  effected.  It  is  not 
always  in  the  cure  of  diseases  that  are  inimical  to  life  that  the 
patient  feels  most  gratitude  for  a  cure,  and  the  physician  who 
will  patiently  go  into  the  history  of  these  minor  conditions,  treat 
them  intelligently,  and  effect  a  cure  will  be  as  highly  esteemed 
by  that  particular  patient  as  by  another,  whom  he  may  have 
carried  safely  through  a  pneumonia  or  typhoid  fever.  In  the 
past,  I  fear,  the  general  practitioner  has  been  too  prone  to  pass 
these  cases  along  with  the  assurance  that  not  much  could  be 
done  for  them ;  that  the  disease  was  due  to  the  age  of  the  patient ; 
that  when  this  period  of  adolescence  was  past  the  disease  would 
disappear,  etc.,  etc.,  the  patient  meanwhile  going  on  with  a 
disease  which,  when  located  on  the  face  as  most  of  the  cases 
are,  is  a  source  of  constant  annoyance  and  chagrin,  finally  to 
arrive  at  an  age  when,  if  the  active  lesions  cease,  unsightly  scar- 
ring is  left  which  may  persist  for  a  lifetime.  A  great  deal  of 
all  this  and  in  the  majority  of  cases  all  could  have  been  avoided 
if  the  physician  had  taken  time  to  have  gone  into  the  history  of 


782 


ACNE  VULGARIS 


the  case  and  treated  it  intelligently,  as  he  would,  if  it  had  been 
a  graver  disease. 

The  treatment  of  acne  as  we  shall  see  in  the  etiology,  has 
to  do  so  closely  with  internal  medicine  that  the  general  practi- 
tioner might,  almost,  be  the  man  of  election  to  treat  it.  Acne 
attacks  both  sexes  alike ;  it  begins  at  or  soon  after  puberty  and 
persists  until  full  adult  life  is  reached  when  its  activity  is  usually 
over.  In  some  strumous  subjects  or  in  those  of  marked 
cachexia  it  may  remain  active  in  late  adult  life.  Acne  is  often 
preceded  or  accompanied  by  seborrhoea  oleosa  and  probably 
always  by  comedones. 

The  lesions  may  be  few  in  number  and  small  or  more  numer- 
ous and  larger  in  size  with  markedly  infiltrated  bases  and  even 
induration.  They  are  situated  on  the  cheeks,  about  the  alae 
of  the  nose,  on  the  forehead,  chin,  on  the  anterior  aspect  of  the 
neck,  underneath  the  jaw,  and  on  the  shoulders,  back,  upper 
portion  of  the  chest,  and  more  rarely  on  the  limbs.  When  on 
the  last-named  location  it  is  usually  a  part  of  a  general  acne 
known  as  acne  cachecticorum.  The  acne  lesion  varies  in  size 
from  a  pin  head  to  a  split  pea.  The  lesions  are  often  seen  in 
all  stages  of  development  in  the  same  patient,  papules,  pustules 
and  tubercles  being  present  at  the  same  time.  They  are 
rounded  or  acuminate  in  shape,  the  base  infiltrated  super- 
ficially or  deeply ;  when  the  infiltration  is  deep  the  scarring  is 
correspondingly  great.  The  amount  of  suppuration  is  variable 
depending  somewhat  upon  the  subject  in  which  the  disease 
occurs  and  somewhat  upon  secondary  infection.  In  severe 
indurated  acne,  traces  of  the  disease  persist  for  years  and 
occasionally  keloid  develops  at  the  site  of  the  preceding  acne 
lesion. 

Etiology. 

Acne  is  preeminently  a  disease  of  youth  and  adolescence ;  at 
about  the  period  of  puberty  the  sebaceous  glands  and  hair  fol- 
licles take  on  an  increased  activity :  under  these  circumstances 
anything  that  disturbs  their  function  may  produce  the  disease. 
The  causes  that  predispose  to  acne  are  of  two  kinds,  local  and 
remote.  Two  conditions  which  are  almost  always  present  and 
whose  relative  importance  depends  upon  whether  one  accepts 
Unna's  or  Sabourad's  theory  of  the  specific  organism  causing 
acne,  is  the  comedo  and  seborrhoea  oleosa.  According  to  Unna 
the  specific  organism,  the  acne  bacillus,  is  present  in  the  comedo, 


JAMES  W.  WILTSE 


783 


and  therefore  we  must  first  have  the  comedo  in  order  to  produce 
acne.  Sabourad  on  the  other  hand  claims  that  the  seborrhoeic 
microbe  is  the  cause  both  of  seborrhoea  and  the  comedo  and 
that  there  can  be  no  acne  without  a  preceding  seborrhoea.  Per- 
sonally I  accept  Unna's  view,  but  the  fact  remains  that  acne 
is  very  often  accompanied  by  seborrhoea  and  if  not  directly  re- 
sponsible, such  a  skin  seems  to  be  favorable  to  the  development 
of  acne.  Other  local  conditions  are  sluggish  circulation  in  the 
parts  affected,  the  use  of  irritating  cosmetics,  exposure  to  cold 
winds,  and  certain  occupations,  such  as  workers  in  tar,  paraffin, 
chlorin,  etc.,  etc. 

Besides  these  local  causes  the  remote  or  constitutional  dis- 
orders play  an  important  part  in  the  production  of  acne.  Crocker 
states  that  more  than  fifty  per  cent,  of  his  cases  suffered  derange- 
ment of  the  alimentary  canal.  The  greater  number  suffered 
from  constipation  and  digestive  disturbances.  Uterine  and  ovar- 
ian disorders  especially  those  that  produce  irregular  or  painful 
menstruation  frequently  predispose  to  acne.  Anemia,  chlorosis, 
mental  and  physical  exhaustion,  sedentary  habits,  lack  of  exercise 
and  sunlight,  all  are  provocative  of  acne.  The  scrofulous  diathesis 
as  we  understand  that  term  to-day,  i.  e.,  latent  tuberculosis,  is 
very  prone  to  be  accompanied  by  a  severe  pustular  type  of  acne ; 
it  is  in  these  cases  that  we  see  large  and  deep  abscesses  form. 
Indiscretions  in  eating,  either  in  irregularity  or  in  the  eating  of 
improper  foods,  provoke  acne.  Beer  and  ale,  alcoholic  beverages 
of  all  kinds  when  used  to  excess,  are  excitants  to  acne,  although 
more  frequently  they  produce  acne  rosacea. 

Pathology. 

Much  light  has  been  thrown  upon  the  histology  and  pathology 
of  acne  since  the  researches  made  by  Unna  in  Hamburg  have 
been  given  to  the  medical  profession.  Formerly  it  was  supposed 
that  the  pustulation  in  acne  was  entirely  due  to  infection  of  the 
acne  lesion  by  germs  from  without,  i.  e..  pyococci;  Unna  shows 
that  it  is  not  produced  in  this  manner,  but  by  a  bacillus  resident 
in  the  comedo  which  always  precedes  the  acne  lesion.  To  quote 
from  Unna,  "  Acne  is  characterized  in  the  first  stage  by  a  super- 
ficial hyperidrosis  of  the  epidermis,  which  leads  to  the  forma- 
tion of  comedones ; "  "  While  the  sebaceous  glands  with  the 
follicles  are  stopped  by  horny  plugs  the  coil  glands  are  active ; 
indeed   there   is   often   hyperidrosis   oleosa ;  "   "  The   skin  is 


784 


ACNE  VULGARIS 


stretched  by  the  unyielding  horny  layer,  anemic,  little  movable,, 
and  on  the  face  not  easily  pinched  up ;  "  "  Pressure  causes  more 
easily  than  normal,  a  circumscribed  spastic  oedema."  On  this 
basis  (Acne  punctata),  "A  more  inflammatory  development  of 
the  disease  takes  place  in  two  directions,  one  progressive,  dry, 
and  inflammatory,  with  thickening  of  the  whole  skin,  hyper- 
trophy of  the  sebaceous  glands  and  the  formation  of  inflamma- 
tory nodes  (Acne  Indurata)  ;  the  other  accompanied  by  secon- 
dary suppuration  of  the  sebaceous  glands  (Acne  pustulosa)." 

The  former  change  leads,  in  its  highest  development,  to  acne 
hypertrophica,  the  latter  terminates  in  scars  and  the  formation 
of  double  comedones.  Simple  acne  punctata  leads,  when  most 
fully  developed,  eventually  to  the  formation  of  sebaceous  cysts, 
"  false  atheromata." 

He  further  says,  "  The  suppuration  of  the  follicles  is  a  much 
more  frequent  development  in  acne  punctata,  than  in  acne  in- 
durata. It  is  one  of  the  most  important  consequences,  which  the 
better  knowledge  of  the  ordinary  staphylococcic  impetigo  has 
produced,  that  we  can  certainly  not  attribute  the  suppuration 
of  acne  to  the  ordinary  pyococci.  The  course  of  the  suppura- 
tion in  acne  is  quite  different  to  that  in  furuncle,  so  that  we 
can  distinguish  histologically,  with  much  more  certainty  than 
clinically,  true  furuncle  from  suppurating  acne  nodules.  The 
difference  between  the  causes  of  suppuration  in  the  two  affec- 
tions could  have  been  already  concluded  from  the  fact,  that 
acne  pustulosa  has  no  tendency,  like  sycosis,  to  develop  into 
general  furunculosis.  Indeed,  it  is  remarkable  that  the  ordinary 
pustular  affections  of  the  skin  are  not  often  combined  with  acne 
pustulosa." 

He  then  goes  on  to  show  that  the  cause  of  pustular  acne  is 
the  acne  bacillus  found  in  the  interior  of  the  comedo.  The 
whole  question  as  studied  and  elaborated  by  Unna  is  very  in- 
teresting, but  is  much  too  exhaustive  to  be  incorporated  in  an 
article  of  this  length. 

Diagnosis. 

As  a  rule  the  diagnosis  of  acne  presents  few  difficulties.  The 
age  of  the  patient,  the  distribution  of  the  lesions,  the  accompany- 
ing comedones,  the  chronicity  of  the  disease,  all  present  a  picture 
which  is  not  easily  mistaken.  The  one  lesion  which  it  most 
closely  simulates  and  one  for  which  it  may  be  mistaken  unless 
other  comcomitant  symptoms  are  present  is  the  small  papulo- 


JAMES  W.  WILTSE 


785 


pustular  syphilid  of  the  face.  I  have  seen  such  syphilids  very 
closely  resembling  the  acne  lesion.  In  the  absence  of  chancre 
or  where  it  cannot  be  found,  and  this  is  not  unusual  in  women, 
the  characteristic  dull  red  color  of  the  syphilid,  its  tendency  to 
group  in  distribution,  the  presence  of  sclerosed  lymphatic  glands, 
history  of  sore  throat,  headache  or  mucous  patches  in  the  oral 
cavity,  will  be  sufficient  to  clear  up  the  diagnosis.  Sycosis  of  the 
face  is  confined  to  the  bearded  portion  of  the  face  and  attacks 
the  hair  follicles,  so  that  it  cannot  easily  be  mistaken  for  acne. 
Sycosis  is  never  found  on  the  forehead,  about  the  alae  of  the  nose 
or  other  non-hairy  portions  of  the  face,  whereas  acne  is  often 
found  in  these  locations. 

Treatment. 

The  treatment  of  acne  to  be  successful  must  be  both  local  and 
constitutional  except  in  a  small  minority  of  cases  where  the  disease 
seems  to  be  due  to  local  causes  pure  and  simple.  Van  Har- 
lingen  says  "  In  order  to  treat  a  case  of  acne  with  any  hope 
of  success,  we  must  first  ascertain  the  causes  which  have  operated 
in  bringing  it  about.  The  foundation  of  the  successful  treat- 
ment of  acne  lies  in  the  knowledge  of  its  etiology." 

"  The  patient  should  be  carefully  examined  regarding  every 
•organ  and  function.  The  habits  of  life,  the  surroundings  and 
the  occupation  of  the  patient  should  all  be  known  to  the  physician, 
who  should  also  study  the  case  well,  to  discover,  if  possible, 
what  is  the  exact  cause  or  group  of  causes  of  which  the  acne 
eruption  is  the  expression  and  result.  Without  this,  little  can 
be  hoped  for;  and  acne  is  one  of  the  minor  opprobria  of  medicine, 
chiefly  because  the  physician  cannot  or  will  not  take  the  trouble 
to  enter  into  the  patient's  case  with  the  persevering  thorough- 
ness which  is  indispensable."  Only  in  a  relatively  small  num- 
ber of  cases  will  local  treatment  alone  suffice  to  cure  and  keep 
cured  the  lesions  of  acne.  Each  case  must  be  studied  and 
treated  according  to  the  indications.  If  constipation  is  present 
it  must  be  relieved ;  if  digestive  disturbances,  flatulency,  eructa- 
tions of  gas,  hyperacidity  of  the  stomach,  etc.,  etc.,  complicate 
the  case  proper  means  must  be  employed  to  correct  them. 
In  the  same  way  anemia,  chlorosis,  functional  menstrual 
disturbances,  scrofulosis  and  in  fact  any  condition  which  seems 
from  the  history  to  have  a  bearing  on  the  disease  must  be  com- 
batted.  If  constipation  alone  be  present  without  other  disturb- 
ance of  the  alimentary  tract  an  occasional  dose  of  blue  mass  at 


786 


ACNE  VULGARIS 


bedtime,  followed  by  a  saline  or  some  one  of  the  cathartic  waters 
in  the  morning  may  be  given,  or  if  more  persistent  cascara 
sagrada,  aloin,  strychnine  and  belladona  pill  at  bedtime.  If  hyper- 
acidity and  eructation  of  gas  are  complained  of  an  alkali  such  as 
the  mistura  rhei  et  sodii  bicarbonatis  of  the  U.  S.  P.  or  equal 
parts  of  sodii  bicarbonas  and  magnesia  calcinata  (light)  in 
drachm  doses  may  be  given  after  meals;  the  latter  being  given 
in  a  full  glass  of  water.  In  flatulency,  pancreatin,  oxgall,  nux 
vomica  and  asafoetida  are  useful.  In  anemia  and  chlorosis 
chalybeates  and  other  blood  and  tissue  builders  are  indicated. 

Where  these  conditions  exist  with  constipation  as  frequently 
happens,  the  "  mistura  ferri  acida  "  of  Startin  is  a  useful  remedy. 
Its  formula  is  about  as  follows : 

9  Magnesii  sulphatis  3  i. 
Ferri  sulphatis  3  i. 
Acidi  sulphurici  diluti  3  iv. 
Infusi  quassiae.  q.  s.  ad  3  iv. 

Sig.  Tablespoonful  in  a  goblet  of  water  before  breakfast. 

Other  chalybeates  being  given  after  meals.  In  scrofulous 
patient,  cod  liver  oil,  hypophosphites,  out-door  life  and  exercise 
are  to  be  recommended.  A  remedy  recommended  by  Fox  to  be 
used  in  conjunction  with  cod  liver  oil  in  scrofulous  and  cachetic 
patients  showing  pustular  lesion  and  abscesses,  is  the  following: 

IJ.  Quiniae  sulphatis  gr.  viii. 
Acidi  sulphurici  diluti  M  x. 
Ferri  sulphatis  gr.  xxxii. 
Magnesii  sulphatis  3  iii. 
Tincturae  zingiberis  3  ii. 
Aquae  q.  s.  ad  §  viii. 

Sig.  Tablespoonful  in   tablespoonful  of  water  with  a  table- 
spoonful  of  cod  liver  oil  floating  on  top,  night  and  morning. 

This  is  an  excellent  remedy  which  I  have  used  many  times 
with  splendid  results.  Many  other  combinations  and  formulae 
will  suggest  themselves  to  the  practitioner  to  suit  the  case  in 
hand.  Among  other  internal  remedies  arsenic,  especially  in  the 
form  of  Fowler's  solution,  is  highly  recommended  by  some  der- 
matologists, but  I  have  rarely  used  it  because  of  the  gastric  irrita- 
tion v/hich  so  frequently  follows  its  use.  In  some  cases  a  com- 
bination of  the  chlorides  of  iron,  quinine,  arsenic  and  mercury 
has  given  good  results 

Local  Treatment. 
Local  treatment  should  be  begun  by  the  opening  of  all  pus- 
tules and  abscesses,  and  expression  of  comedoes  under  aseptic 


HYSTEROPEXY  FOLLOWED  BY  REPORTED  PREGNANCIES  787 

conditions.  The  removal  of  comedoes  is  especially  important 
as  they  are  the  forerunner  of  the  acne  lesion.  The  remedies 
to  be  applied  locally  are  usually  incorporated  in  ointments 
or  dissolved  or  suspended  in  lotions.  The  combinations  pro- 
posed for  the  local  treatment  are  almost  legion.  I  have  found, 
however,  that  the  intelligent  use  of  a  few  well-tried  remedies 
has  sufficed  to  produce  a  cure  in  most  cases.  Sulphur  is 
undoubtedly  the  most  generally  useful  of  all  drugs  used  locally 
and  is  a  constituent  of  most  formulae  so  used.  Ichthyol,  Beta 
naphthol,  ammoniated  mercury,  zinc  sulphide,  bichlorid  of  mer- 
cury and  resorcin  are  some  of  the  other  remedies  used  locally. 
Sulphur  when  used  in  ointment  form  is  used  in  the  propor- 
tion of  one  drachm  or  two  drachms  to  the  ounce;  when  used 
in  lotions  one  drachm  in  four  fluid  ounces.  It  does  not  seem 
necessary  in  this  paper  to  go  into  the  formulae  for  local 
use  as  they  can  be  obtained  from  any  work  on  derma- 
tology, and  the  object  of  this  paper  has  been  not  to  lay  down 
any  hard  or  fast  rules  for  the  treatment  of  acne,  but  a  plea  for 
the  better  understanding  and  treatment  of  these  cases  by  the 
family  physician. 

HYSTEROPEXY  FOLLOWED  BY  REPEATED 
PREGNANCIES. 

Report  of  Three  Cases. 

The  Vice-President's  Address  to  the  Medical  Society  of  the  County  of  Albany, 
Delivered  at  the  Semi- Annual  Meeting,  October  10,  iqo6. 

By  J.  D.  MONTMARQUET,  M.  D., 

Cohoes,  N.  Y. 

Mr.  President,  Gentlemen: — I  wish  to  report  three  cases  in 
which  hysteropexy  has  been  performed  for  retroversion;  and  in 
which  pregnancy  occurred  repeatedly  and  went  on  to  full  term 
without  interruption.  In  all  these  cases,  miscarriage  occurred 
before  the  suspension  was  performed ;  and  after  the  operation, 
pregnancies,  two  in  one  case,  three  in  the  other,  and  one  in  the 
last,  went  on  to  a  happy  termination  and  labor  was  as  easy  in  all 
cases  as  it  ever  was  before  their  respective  operations. 

Mrs.  T.,  native  of  the  United  States,  housewife  and  mill  operative  by 
occupation;  at  other  times,  when  unable  to  go  to  the  mill  on  account  of 


788       HYSTEROPEXY  FOLLOWED  BY  REPORTED  PREGNANCIES 


her  being  pregnant  ,  was  obliged  to  take  in  washing  and  ironing  in  order  to 
keep  starvation  from  her  door.  Family  history  clear  as  far  as  she  can 
remember.  Was  married  at  age  of  nineteen.  Was  confined  for  the  first 
time  a  year  after,  normal  delivery,  no  accident  occurring,  recovery 
perfect  in  about  two  weeks.  Next  baby  was  born  five  years  later;  after 
this  baby,  she  complained  of  severe  backache  and  sensation  of  dragging 
and  pressure  on  the  rectum.  Two  years  after  she  again  became  pregnant ; 
and  when  about  two  and  a  half  or  three  months,  I  was  called  in  for  pain 
she  felt  in  her  back  and  severe  constipation  and  frequent  micturition; 
on  making  a  vaginal  examination,  I  found  pelvis  blocked  by  the  body 
of  the  uterus,  and  by  using  gentle  pressure  that  globe  slipped  above  the 
promontory  of  the  sacrum  and  all  the  above  symptoms  she  complained  of 
were  relieved  and  she  was  confined  in  due  time;  after  her  confinement  I 
tried  postural  treatment  and  rest  in  bed  for  about  four  weeks.  This 
pregnancy  was  followed  by  three  miscarriages  in  space  of  about  two  years ; 
in  two  of  these  miscarriages  I  had  to  do  some  curetting  in  order  to  get 
away  some  detritus  caused  by  her  mishaps.  I  constantly  urged  an 
operation.  She  finally  consented  and  the  operation  for  ventro-suspension 
was  performed  April  23,  1903,  by  myself  assisted  by  Dr.  Archambault. 
On  examination  of  the  pelvic  organs,  the  right  ovary  was  found  cystic  and 
was  removed,  a  small  cyst  was  found  on  the  left  ovary  and  was  removed 
by  taking  away  a  wedge-shaped  section  of  the  same.  Her  recovery  was 
complete  and  very  [rapid  ;  in  four  weeks  she  returned  to  her  home.  Since 
her  operation  she  became  pregnant  twice  and  is  now  about  to  be  confined 
again  for  the  second  time ;  she  has  had  no  return  of  the  backache,  has  had 
no  difficulty  at  childbirth,  the  uterus  has  remained  in  a  very  good  position, 
and  she  never  complained  of  dragging  or  pulling  at  the  seat  of  the  incision, 
during  her  pregnancies.  She  is  enjoying  good  health,  except  for  a  floating 
kidney  which  troubles  her  when  she  is  not  pregnant,  but  when  she  is 
about  at  the  fourth  month  of  pregnancy  she  is  entirely  relieved.  This 
trouble  came  to  her  during  the  early  months  of  the  first  pregnancy  follow- 
ing her  operation. 

The  second  case  that  I  wish  to  report  is  that  of  Mrs.  M.,  age  thirty-three, 
native  of  the  United  States,  mother  of  nine  children.  Her  family  history 
is  good  as  far  as  it  can  be  searched.  In  her  personal  history,  it  should  be 
stated  that  she  began  to  menstruate  at  sixteen,  and  married  at  seventeen. 
Prior  to  her  operation  she  bore  six  children  and  had  three  miscarriages. 
The  first  miscarriage  occurred  ten  months  after  being  married,  in  the 
seventh  or  eighth  week  of  gestation,  without  known  cause.  The  second 
miscarriage  occurred  after  the  birth  of  the  second  child  and  travelling 
was  considered  the  main  factor  in  its  occurrence.  It  was  attended  with 
severe  hemorrhage  and  faulty  involution,  as  a  consequence  of  which  the 
uterus  was  dragged  back  in  a  state  of  retroversion.  The  third  mis- 
carriage followed  on  this  and  was  thought  to  arise  from  the  faulty  position 
of  the  organ.  When  the  next  pregnancy  (the  third)  occurred,  threatening 
of  abortion  took  place  about  the  fourth  month,  when  the  organ  suddenly 
dislocated  itself  from  under  the  promontory  of  the  sacrum  and  cleared  up 
and  above  the  upper  brim;  from  this  on,  gestation  went  on  to  full  term 
without  any  further  disturbance.    From  this  childbirth  until  after  the 


J.  D.  MONTMARQUET 


789 


fifth,  the  uterus  remained  in  good  position.  Some  months  after  the 
fifth  childbirth,  the  uterus  was  again  found  in  a  state  of  retroversion,  but 
free  in  the  pelvis,  movable  and  causing  but  little  annoyance.  The  sixth 
pregnancy  took  place  while  in  this  condition  and  went  on  to  full  term, 
childbirth  occurring  December  12,  1900.  This  time,  as  after  the  third 
childbirth,  special  care  was  taken  and  measures  resorted  to  with  the  object 
in  view  of  preventing  the  recurrence  of  the  falling  back  of  the  womb; 
the  perfect  involution  of  the  uterus  seemed,  for  a  time,  to  favor  such  an 
expectation.  In  April,  1901,  however,  or  about,  patient  began  to  com- 
plain of  pain  in  the  region  of  the  sacrum,  and  of  a  sensation  of  great 
weight  and  as  of  something  sticking  her  in  the  pelvis ;  upon  examination 
the  uterus  was  found  to  have  gone  back  into  the  posterior  cul-de-sac,  with 
a  considerable  degree  of  tenderness  in  and  about  that  direction.  Different 
lines  of  treatment  and  applications  affording  no  relief,  patient  was  again 
carefully  examined  by  Dr.  Archambault  in  July,  with  the  following 
findings:  right  ovary  enlarged,  exquisitely  sensitive  and  incarcerated 
in  Douglass'  pouch  underneath  the  retroverted  uterus;  left  side  of  pelvis 
free ;  mass  formed  by  right  ovary  and  uterine  body  only  partially  movable ; 
condition  much  aggravated  by  superficial  anal  fissure.  The  doctor  urged 
an  operation,  which  was  done  September  7,  1901 ;  it  was  a  ventro-suspen- 
sion  with  the  removal  of  the  diseased  (cystic)  ovary.  A  concomitant 
append icectomy  was  also  performed  on  account  of  a  concretion  being 
felt  in  the  appendix.  Patient  was  operated  by  Dr.  Archambaiilt :  results 
were  perfect.  Patient  went  on  thereafter  without  a  return  of  any  of  the 
preceding  symptoms,  and  she  has  been  confined  three  times  since  without 
any  trouble  either  during  her  pregnancy  or  at  the  time  of  her  confine- 
ments. 

I  must  state  here  that  a  considerable  amount  of  pain  and  soreness  was 
felt  by  both  these  patients  across  the  lower  abdomen,  during  the  early 
months  of  pregnancy. 

A  third  case,  that  of  Mrs.  A.,  native  of  the  United  States,  age  twenty- 
six,  married,  has  one  living  child,  and  has  miscarried  once,  this  occurring 
at  the  end  of  the  second  month  of  gestation. 

This  patient  is  very  thin  and  of  delicate  build;  up  to  her  tenth  year 
she  had  all  the  different  diseases  of  childhood,  but  since  then  she  enjoyed 
very  good  health  with  one  exception,  severe  dysmenorrhoea,  from  the 
age  of  thirteen,  at  which  time  she  began  to  menstruate.  She  was  married 
at  the  age  of  twenty-three  and  miscarried  about  ten  months  after,  as 
mentioned  above.  On  examination,  her  uterus  was  found  in  retro- 
version. The  abnormality  was  thought  to  be  the  cause  of  her  mis- 
carriage. It  was  also  held  responsible  for  her  dysmenorrhoea,  and  the 
severe  pain  she  felt  extending  from  the  pelvis  and  region  of  the  hip  down 
the  left  leg,  during  her  pregnancy.  She  recovered  from  her  miscarriage 
very  rapidly,  but  the  pain  persisted  in  the  leg;  it  was  quite  severe  while 
in  bed,  and  never  absent  while  up  and  around,  rendering  locomotion 
quite  difficult  and  at  times  even  impossible.  She  menstruated  again 
October  24,  1904,  being  unwell  for  about  five  days,  and  during  this  period 
she  suffered  from  an  aggravated  attack  of  the  leg  pain.  Examination 
made  after  her  menstruation  revealed  the  uterus  well  down  in  Douglass' 
I 


790       HYSTEROPEXY  FOLLOWED  BY  REPORTED  PREGNANCIES 

cul-de-sac.  Patient  was  advised  to  have  the  defect  corrected.  She  was 
admitted  to  the  hospital  by  Dr.  Archambault  and  operated  by  him, 
assisted  by  myself  and  Dr.  Mitchell.  Hysteropexy  was  performed. 
The  adnexa  were  found  normal.  The  wound  was  closed  in  the  ordinary 
way  and  primary  union  resulted;  patient  made  a  very  nice  and  rapid 
recovery. 

In  Februrary  1905,  she  became  pregnant  again,  and  carried  the  fruit 
of  her  conception  to  full  term,  without  any  trouble. 

I  attended  her  in  her  confinement  November  30,  1905.  It  was  a 
normal  and  spontaneous  delivery.  Since  her  confinement  she  has  had 
none  of  the  symptoms  she  complained  of  previous  to  her  operation. 

The  report  of  these  three  cases  does  not  establish  a  very  large 
experience  and  I  do  not  know  that  any  very  great  deduction  can 
be  drawn  from  them,  but  the  Kelly  operation  has  been  subjected 
to  so  severe  criticism,  it  has  been  called  so  unscientific,  it  has 
been  so  energetically  proclaimed  as  only  deserving  of  being  wiped 
out  from  all  gynecological  text-books,  that  it  has  appeared  not  out 
of  place  to  put  on  record  the  absolutely  satisfactory  results  which 
we  have  seen  follow  its  use.  Of  course,  it  is  well  conceded  that 
the  Alquie-Alexander  operation  is  the  ideal  operation,  the  opera- 
tion the  most  physiological,  but  the  cases  for  its  application  are 
fewer  and  of  more  delicate  choice ;  it  is  in  our  opinion  the 
"  select "  operation  of  selected  cases.  As  to  the  majority  of 
cases  the  hysteropexy  of  Kelly  remains  for  us  superior  to  all 
the  other  procedures,  including  the  different  methods  of  liga- 
mentopexy,  such  as  Ruggi-Wylie,  Mann,  Bode,  Polk,  Dudley- 
Baudoin,  Dartigues-Caraven,  and  less  likely  to  be  followed  by 
failure  or  unsatisfactory  results. 

Gentlemen,  in  calling  me  to  be  vice-president,  I  received  at 
your  hands  an  honor  which  I  appreciate  very  much,  but  which 
I  have  found  rather  onerous,  however  I  thank  you  just  the  same. 
I  thank  you  also  for  your  kind  attention  this  evening. 


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E&ttortal 

"I  think,"  said  Mrs.  Britain,  applying  herself  to  her 
pockets  and  drawing  forth  an  immense  bulk  of  thin 
books  and  crumpled  papers;  a  very  kennel  of  dogs'- 
ears:  "I've  done  everything.  Bills  all  settled — 
turnips  sold — brewer's  account  looked  into  and  paid — 
'bacco  pipes  ordered — seventeen  pound  four,  paid  into 
the  Bank — Doctor  Heathfield's  charge  for  little  Clem — 
you'll  guess  what  that  is — Doctor  Heathfield  won't 
take  nothing  again,  Ben." 

"I  thought  he  wouldn't,"  returned  Britain. 

"No,  he  says  whatever  family  you  was  to  have, 
Ben,  he'd  never  put  you  to  the  cost  of  a  half-penny. 
Not  if  you  was  to  have  twenty. " 

Mr.  Britain's  face  assumed  a  serious  expression,  and 
he  looked  hard  at  the  wall. 

"An't  it  kind  of  him?"  said  Clemency. 

"Very,"  returned  Mr.  Britain.  "It's  the  sort  of 
kindness  that  I  wouldn't  presume  upon,  on  any 
account." 

The  Battle  of  Life.  Charles  Dickens. 

*      *  * 


On  another  page  of  this  issue  of  the  Annals  is 
a  synopsis  of  the  work  done  by  the  Guild  during 

TheGuildny  the  laSt  six  months-  11  shows  that  the  veyy  large 
number  of  eight  thousand  and  more  visits  have  been 
made  by  the  nurses  during  that  time,  and  that  six 
hundred  and  eighty-six  new  cases  applied  for  assistance,  with  a 
total  of  seven  hundred  and  eighty-six  cases  under  care.  Thirteen 
nurses  were  employed,  of  whom  five  were  graduate  registered 
nurses.  The  other  nurses,  known  as  "  assistant  nurses,"  or 
"  pupil  nurses,"  are  undergoing  a  course  of  instruction  by  the 
Guild.  They  serve  for  three  years  and  then  receive  a  certificate 
of  qualification  from  the  Guild.  This  plan  enables  the  Guild  to 
place  nurses  in  houses  where  they  are  needed,  in  some  cases  as 
a  matter  of  charity,  in  others,  at  a  cost  less  than  that  of  the 
graduate  trained  nurse.  The  subordinate  place  of  the  assistant 
nurse  is  recognized,  and  her  work  is  done  under  the  supervision 
and  direction  of  the  trained  nurses ;  who  make  daily  visits  for 
inspection  and  instruction.  The  patients  thus  under  care  have  the 
benefit  of  the  experience  of  graduate  nurses  at  a  moderate  ex- 
pense.   The  assistant  nurses  thus  employed  are  required  to  give 


EDITORIAL 


three  years  to  the  work  of  the  Guild  before  receiving  a  certifi- 
cate of  qualification.  The  plan  is  an  excellent  one,  has  proved 
successful  and  has  been  highly  commended.  That  the  inspiration 
to  be  derived  from  teaching  by  physicians  may  not  be  lost,  courses 
of  lectures  covering  the  three  years  have  been  arranged,  and  the 
physicians  of  the  city  have  responded  generously  to  this  demand 
upon  their  time.  That  eighty-four  physicians  have  called  upon 
the  Guild  for  assistance  is  a  noteworthy  indication  of  the  value 
placed  upon  this  excellent  organization. 

*    *  * 

For  opportunity  to  publish  the  following  letter, 

from  the  papers  of  the  late  Dr.  Alden  March,  the 

An  Historical  Annals  is  indebted  to  Mr.  Alden  March,  his  grand- 
Letter 

son.  The  reference  to  the  "class"  will  recall  in  affec- 
tionate remembrance  to  students  of  forty  years  ago 
the  devotion  to  his  college  work  manifested  by  Dr.  Armsby. 
The  expression  of  loyalty  to  the  Government  and  the  exaspera- 
tions incident  upon  the  Civil  War  suggest  a  very  instructive 
episode  in  the  experiences  of  Americans  abroad  in  that  troublous 
time,  and  the  comments  upon  Parisian  surgeons  and  physicians 
whose  names  and  works  are  now  classical  will  familiarize  the 
reader  with  the  personalities  which  have  been  impressed  upon 
the  practice  of  medicine  for  all  time. 

Paris,  October  31,  1861. 

My  Dear  Friend: — I  felt  many  regrets  at  leaving  a  home  where 
I  have  spent  more  than  half  my  life,  but  none  more  keenly  than 
a  separation  from  one  with  whom  I  have  been  so  intimately 
associated  for  nearly  thirty  years.  In  joy  and  sorrow,  in  trial 
and  success,  our  hopes,  our  struggles,  our  sympathies  have  been 
closely  allied,  and  if  God  spares  my  life  to  return,  I  hope  to  be 
permitted  to  labor  on  with  you  in  the  good  work  to  which  you 
have  so  long  and  so  successfully  devoted  yourself.  If  I  never 
return,  I  wish  once  more  to  testify  in  stronger  terms  than  I  can 
express,  my  deep  and  enduring  gratitude  for  your  kindness,  your 
sympathy,  your  aid,  while  I  was  a  student  under  your  instruction 
and  during  the  early  struggles  of  my  professional  life.  I  was 
sorry  I  could  not  meet  the  class  once  more  before  leaving,  but 
my  strength  was  not  equal  to  the  effort.  The  least  excitement, 
or  extra  effort,  threatened  a  recurrence  of  my  complaint,  and  I 


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felt  quite  weak  and  debilitated  when  I  went  on  board  the  ship. 
You  may  say  to  the  class,  whose  faces  are  still  fresh  before  my 
mind,  I  hope  to  meet  them  again  in  our  own  redeemed  and  happy 
country,  and  until  then  I  shall  pray  for  their  welfare  and  happi- 
ness. 

We  had  a  rough  and  stormy  passage  of  thirteen  days,  and 
suffered  much  from  sea-sickness  and  cold.  The  Edinborough,  a 
screw  steamer  that  left  New  York  the  same  day  we  did,  kept  us 
company  until  the  tenth  day ;  a  very  remarkable  circumstance 
on  the  wide  ocean.  We  remained  at  Havre  a  few  hours  and  then 
proceeded  on  to  Rouen  where  we  remained  over  one  day  to  look 
at  the  fine  old  churches  and  other  monuments  with  which  that 
ancient  Capital  of  Normandy  abounds.  The  country  all  the  way 
from  Havre  to  Paris  has  improved  surprisingly  since  I  was  last 
here.  The  Seine  is  lined  by  large,  and  many  of  them,  new  manu- 
facturing towns.  New  vineyards  and  new  forests  have  been 
planted.  I  had  passed  four  times  over  the  same  route  before, 
and  was  surprised  at  the  vast  improvements  and  evidences  of 
prosperity.  Paris,  too,  has  nearly  doubled  in  population  and  ex- 
tent since  you  were  first  here.  New  streets,  squares  and  parks 
have  been  opened  and  embellished  on  the  most  magnificent  scale. 
The  Emperor  is  popular  with  the  people,  for  he  has  given  a 
stable  government  and  unexampled  prosperity  to  France. 

It  is  said  there  are  200,000  foreigners  in  Paris.  The  number 
of  Americans  is  less  than  usual,  in  consequence  of  the  war.  Mr. 
Yancey,  Commissioner  from  the  Rebel  "  Confederate  "  States,  is 
here,  and  many  other  Southerners,  who  are  active  in  misrepresent- 
ing the  issues  which  divide  our  country.  But  they  can  effect 
nothing  in  France,  though  Galignani's  Paper,  the  only  English 
publication  in  France,  is  daily  filled  with  articles  in  favor  of  the 
Rebels.  They  find  most  sympathy  in  England,  and  have  con- 
gregated in  large  numbers  at  Liverpool,  where  they  are  active  in 
prejudicing  the  Public  Mind  against  the  Government.  The 
American  medical  students  who  are  here  from  the  North  are 
loyal  and  eager  to  return  and  give  their  services  to  their  country. 
There  are  several  from  the  South  who  cannot  return.  They  are 
equally  active  in  favor  of  their  cause.  They  are  guarded  in  their 
conversation  with  me.  Dr.  Sims  is  here  and  is  repaying  the 
kindness  so  profusely  lavished  upon  him  by  his  Northern  friends 
with  the  basest  ingratitude.    He  will  not  take  the  Oath  of 


794 


EDITORIAL 


Allegiance  and  of  course  cannot  get  his  passport.  He  might 
return  without  one  if  he  would  not  obtrude  his  traitorous  senti- 
ments so  publicly  and  freely.  But  on  every  occasion  he  is  con- 
demning the  Government  and  declaring  his  adhesion  to  the  Con- 
federate States. 

I  have  devoted  my  mornings  to  the  hospitals,  beginning  with 
the  La  Charite.  I  had  been  in  the  hospital  but  a  few  moments 
when  Velpeau  entered  in  his  white  apron  and  black  velvet  cap, 
looking  just  as  he  did  nineteen  years  ago.  I  followed  him 
through  the  wards  and  was  introduced  as  he  entered  the  theater. 
He  enquired  if  I  had  been  in  Paris.  I  replied,  "  I  followed  you 
here  in  1842,  and  you  seem  no  older  than  at  that  time."  He  said, 
"  No,  no,  Monsieur,  I  am  more  old,  seventy-four,  and  almost 
done."  He  was  active,  quick  in  his  speech  and  movement  and 
really  seemed  no  older  than  when  I  saw  him  first,  almost  twenty 
years  ago. 

After  the  Clinique  we  went  into  the  operating  room  and  Sims 
operated  for  vesico-vaginal  fistula.  After  the  operation  he  ex- 
hibited his  instruments  and  explained  their  use.  Malgaine  and 
Langier  were  present.  Malgaine  is  pale,  sharp  featured,  wears 
a  black  wig  and  spectacles.  His  eye  is  sharp,  playful  and  rest- 
less. Sims  says,  "  this  is  my  Virgin  speculum,"  taking  up  a 
small  one.  Malgaine  says,  "  What  produces  the  disease  in  the 
Virgin?"  Sims  spent  most  of  his  time  in  giving  a  history  of 
his  inventions  and  of  the  efforts  of  his  rival  to  steal  his  discovery. 
Do  not  think  I  wish  to  underrate  Dr.  Sims,  but  I  felt,  with  all 
the  loyal  Americans  present,  that  Dr.  S.  should  have  left  politics 
behind  him  if  he  wished  to  be  regarded  as  an  American  citizen. 

At  Hotel  Dieu,  I  saw  Jobert,  his  face  the  same,  but  his  hair 
and  whiskers,  which  were  black  when  I  last  saw  him,  are  quite 
thin  and  grey.  He  does  not  do  much  at  the  hospital  now,  since 
he  is  Surgeon  to  the  Emperor.  I  also  saw  at  the  Hotel  Dieu, 
Trousseau,  Robert,  Grissolle  and  Guineau  de  Mussy.  The  latter, 
a  young  man  when  I  last  saw  him,  has  now  reached  the  summit, 
as  the  Hotel  Dieu  is  considered.  I  also  met  Jarmain  the  anato- 
ist,  and  Duchenne  the  electrician,  who  is  curing  all  disease  with 
his  new  apparatus.  At  La  Pitie  I  saw  Maisonneuve,  Goupil  and 
Marotte;  Maisonneuve  is  using  the  chloride  of  zinc  for  almost 
everything,  as  an  escharotic.  He  has  little  wedged-shaped  pieces 
called  Fleches,  of  this  size,  about  as  thick  as  a  penny,  which  he 


EDITORIAL 


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"s\^^  inserts  in  the  scfft  parts  after  making  an  incision.  He 
j>  surrounds  tumours,  separates  them  from  the  healthy 
parts  by  a  slough  and  then  inserts  the  Fleches  in  the 
tumour  itself  and  thus  destroys  them.  The  profession  here  do 
not  sanction  this  practice,  but  tolerate  it  in  him  on  account  of  his 
high  position.  Becquerel  is  also  at  La  Pitie.  He  is  now  out 
of  the  city  and  is  said  to  be  insane.  At  the  clinique  I  heard 
Pagot,  one  of  the  most  eloquent  men  in  Paris.  At  St.  Louis  I 
saw  Denouville,  Verneuil,  Hardy  and  Bazin.  The  two  last  are 
authors,  and  devoted  to  skin  diseases.  They  cure  the  itch  in  one 
hour;  first  a  warm  bath,  then  rub  the  surface  one  hour  with  an 
ointment  of  Carbonate  of  Potash,  Sulphur  and  Lard.  This  is 
sometimes  left  on  twenty-four  hours  and  then  another  bath  and 
the  cure  is  said  to  be  complete. 

Cuzean  the  obstetrician  is  insane  from  hard  labour,  it  is  said. 
At  the  Hospital  Lariboisiere  I  saw  Chaissagnac  operate  several 
times  with  his  ecraseur  and  introduce  his  perforated  tubular 
issues.  Nelaton  was  out  of  the  city.  He  and  Jobert  stand  at 
the  head  of  surgery,  but  they  have  no  Larrey,  Dupotheris,  Roux 
or  Lisfrancks  now,  nor  an  Andral  or  Louis.  Curvelhier  is  living 
but  does  not  lecture. 

I  trust  you  will  remember  me  to  the  class  and  all  inquiring 
friends,  and  believe  me  ever  and  truly, 

Yours,  J.  H.  Armsby. 

P.  S. 

No  new  hospital  has  been  built  in  Paris  for  many  years.  There 
is  no  good  operating  room  that  I  have  seen,  nor  a  lecture  room 
with  backs  to  the  seats.  The  hospitals  are  all  imperfectly  venti- 
lated and  erysipelas  is  generally  prevalent  after  surgical  opera- 
tions. The  beds  have  the  same  dirty  white  curtains,  and 
cerates  and  mercurial  ointments  are  used  as  freely  as  ever. 
They  have  a  perforated  cloth  for  cerates  and  ointment  which  is 
very  good.  I  visited  the  instrument  shops  but  saw  no  new  or 
improved  instruments.  If  I  had  been  on  my  return,  I  could  have 
bought  a  great  variety  of  morbid  specimens  of  bones  of  the 
successor  to  Guy  Ani.  I  shall  look  at  the  hospitals  of  Turin, 
Milan,  Venice,  and  write  you  again  when  we  get  to  Naples. 
They  have  a  famous  hospital  and  Medical  University  at  Naples, 
in  which  I  hope  to  find  much  to  interest  me. 

Ever  affectionately  yours, 

J.  H.  Armsby. 


796 


LITTLE  BIOGRAPHIES 


During  a  visit  to  the  patients  of  a  prominent  hos- 
pital for  the  insane,  a  physician  asked  one  of  the 

theErperta  mmates  to  PrePare  for  mm  a  definition  of  sanity, 
stating  that  men  outside  of  institutions  had  taken 
full  liberty  to  express  their  ideas  as  to  what  con- 
stituted insanity,  but  that  no  characterization  of  the  outside  citi- 
zens had  yet  been  given  by  the  men  behind  the  gate.  In  reply 
the  following  definition  was  at  once  given,  and  taken  down  ver- 
batim'- 

"Sanity  is  a  depreciation  of  the  tissues  of  the  human  body,  by 
which  the  urine  is  extracted  from  the  system  and  the  foeces  are 
rejected  from  the  colon ;  the  operation  of  the  colon  promotes 
perspiration.  The  colon  can  be  evacuated  by  using  Atwood's 
Jaundice  Bitters." 


Xittle  JBioorapbtes 

XL  SANTORIXI. 

GIOVANNI  DOMINICO  SANTORINI,  whose  name  is 
familiar  to  us  through  its  connection  with  the  small 
conical  cartilages  mounted  on  the  Arytenoids  and  the 
Muscilus  Risorius,  was  born  in  Venice  in  1680,  the 
son  of  an  apothecary. 

After  finishing  his  classic  studies  he  went  to  Pisa  under  Mal- 
pighi,  Bellim  and  Delfini. 

Under  these  masters  his  progress  was  very  rapid  and  at  the 
finish  of  his  course  he  returned  to  his  native  city,  where  he  was 
appointed  Professor  of  Philosophy.  Although  not  yet  twenty- 
five,  he  published  some  short  works  on  medicine,  in  which  he 
demonstrated  an  ability  for  keen  observation.  Later  he  was 
appointed  Prosector  in  Anatomy  and  afterwards  Professor. 

His  lectures  and  his  unequaled  dexterity  in  dissection  drew 
to  him  students  from  all  parts  of  Europe.  Through  all  his  other 
work  he  continued  a  large  medical  practice. 

His  writings,  which  were  published  in  Venice  and  in  Rotter- 
dam, included  treatises  concerning  the  structure  and  action  of 
nerves,  the  nutrition  of  animals,  concerning  piles,  and  of  the 
catamenia. 

In  the  Observations  Anatomiccc,  1724,  Santorini  deals  with  the 
color  of  negroes,  the  seat  of  which  he  finds  in  the  reticular  tissue 


SCIENTIFIC  REVIEW 


797 


and  which  he  is  forced  to  attribute  to  the  abundance  of  the  secre- 
tion of  gall.  The  other  chapters  are  devoted  to  descriptions  of 
the  ear,  brain,  lachrymal  gland,  larynx,  nose  and  pharynx,  the 
viscera  of  abdomen  and  pelvis.  Other  works  include  the  history 
of  a  foetus  delivered  from  the  anus,  observations  concerning 
obliteration  of  the  rectum,  rupture  of  the  uterus  and  of  the 
ovaries,  etc. 

He  started  seventeen  tables  descriptive  of  the  structure  of  the 
mammary  glands  and  of  the  tunica  vaginalis  testis,  but  these  he 
was  unable  to  finish.  They  were  completed,  however,  by  Girardi, 
thirty-eight  years  after  his  death,  which  occurred  in  1736,  in  his 
fifty-sixth  year.  E.  V.  Frederick. 


Scientific  1Rex>tew 

Amebiasis  :  Its  Etiology,  Pathology,  Symptomatology 
and  Treatment. 

1.  Amebas:  Their  Cultivation  and  Etiologic  Significance  by  W.  E.  Mus- 
grave,  M.  D.,  and  Moses  T.  Clegg,  M.  D.  Publications  of  the  Bureau 
of  Government  Laboratories ,  No.  18,  October,  1904. 

2.  The  Pathology  of  Intestinal  Amebiasis,  by  Paul  G.  Woolley,  M.  D., 
and  W.  E.  Mus grave,  M.  D.  The  Journal  of  the  American  Medical 
Association,  1905,  XLV,  137 1. 

3.  Symptoms,  Diagnosis  and  Prognosis  of  Uncomplicated  Intestinal 
Amebiasis  in  the  Tropics,  by  W.  E.  Musgrave,  M.  D.,  Journal  of 
the  American  Medical  Association,  1905,  XLV,  830. 

4.  Treatment  of  Intestinal  Amebiasis  (Amebic  Dysentery)  in  the  Tropics, 
by  W.  E.  Musgrave,  M.  D.  Publications  of  the  Bureau  of  Govern- 
ment Laboratories,  No.  18,  October,  1904. 

Musgrave  and  Clegg's  studies  carried  out  in  the  Government 
Laboratories  in  the  Philippines  have  contributed  much  to  our 
knowledge  of  dysentery  and  have  made  more  clear  certain 
doubtful  points  in  the  etiology  and  pathology  of  this  disease. 
They  suggest  the  term  Amebiasis  for  infection  with  amebas 
and  this  term  undoubtedly  should  be  adopted  as  it  is  in  keeping 
with  the  nomenclature  which  sanctions  Uncinariasis,  Try- 
panosomiasis, Filariasis,  etc.  Their  work  includes  the  study 
of  amebas  in  cultures,  in  human  subjects  during  health  and  in 
those  suffering  from  dysentery  (amebic)  and  also  in  inocu- 
lated animals. 

As  matters  of  diagnostic  technique  they  recommend  the 
examination  of  the  fluid  stool  caused  by  a  saline  cathartic  and 


798 


SCIENTIFIC  REVIEW 


that  a  diagnosis  should  never  be  made  unless  motility  of  the 
amebas  is  observed. 

In  their  study  of  cultures  they  found  that  the  organisms  are 
most  easily  and  constantly  grown  in  the  presence  of  bacteria 
and  although  many  different  media  were  tried  the  most  satisfac- 
tory was  that  composed  of  agar  20  parts,  sodium  chloride  and 
beef  extract  each  0.3-0.5  parts.  The  most  favorable  reaction 
was  one  per  cent,  alkaline  to  phenolphthalein. 

As  to  the  presence  of  amebas  in  the  normal  colon  they  are 
very  skeptical  and  conclude  that  no  intestine  containing  them 
should  be  considered  healthy  until  after  microscopic  examination 
of  the  stool.  It  is  possible  that  they  may  occasionally  be  present 
in  the  normal  intestine,  but  presence  for  a  period  equal  to  the 
greatest  incubation  period  of  the  disease  has  not  been 
demonstrated. 

As  to  the  occurrence  of  pathogenic  and  non-pathogenic  varie- 
ties the  investigators  state  that  they  have  made  no  observation 
which  justifies  the  conclusion  that  non-pathogenic  amebas  are 
propagated  in  the  normal  intestine.  Therefore,  the  only  safe 
rule  would  be  to  consider  that  all  amebas  are  or  may  become 
pathogenic. 

Inoculation  experiments  with  cultures  were  convincing  for  the 
most  part  in  proving  the  amebas  to  have  a  causative  relation  to 
the  intestinal  lesions.  Of  the  various  animals  used  the  monkey 
was  the  most  susceptible  and  amebic  dysentery  was  produced  in 
several  of  these  animals  and  in  man,  in  one  instance,  by  the 
ingestion  of  cultures  grown  with  nonpathogenic  bacteria.  An 
opportunity  to  compare  the  early  lesions  in  animals  with  the  early 
lesions  of  man  was  afforded  by  a  group  of  cases  of  amebic 
dysentery  in  which  death  occurred  early  in  the  disease  as  the 
result  of  an  intercurrent  epidemic  of  pneumonia.  The  experi- 
mental lesions  were  found  to  be  identical  with  those  of  man. 
Upon  these  observations  they  base  their  conclusion  that  the 
ameba  is  the  etiological  factor  in  amebic  dysentery. 

As  a  direct  continuation  of  the  studies  in  etiology,  Woolley 
and  Musgrave  have  made  an  exhaustive  study  of  the  pathology 
of  the  disease.  Among  the  many  articles  in  the  literature  on 
amebiasis  those  of  Councilman  and  Lafleur,  Harris,  Howard 
and  Rogers  are  considered  to  be  the  most  valuable  and  with  the 
general  conclusions  of  these  authorities  Woolley  and  Musgrave 
are  in  accord. 


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They  found  that  for  the  simple  diagnosis  of  amebas  in  tissues 
hardened  in  alcohol,  the  eosin  toluidin-blue  and  thionin-oxalic 
acid  methods  were  most  satisfactory.  For  detailed  examination 
and  cytologic  study  Borrel's  stain  after  sublimate  preservation 
gives  clear,  distinct  pictures  and  is  only  surpassed  in  definition 
and  delicacy  by  Heidenhain's  iron  haematoxylin. 

Gross  lesions.  They  found  that  while  in  certain  cases,  per- 
haps the  majority,  the  macroscopic  lesions  were  pathogno- 
monic, there  were  others  in  which  the  picture  was  deceptive. 
A  truly  pathognomonic  picture  is  presented  when  the  mucous 
membrane  shows  all  the  types  of  lesions  and  the  walls  of  the 
gut  are  thickened  and  oedematous. 

For  convenience  in  description,  they  have  arbitrarily  classified 
the  various  stages  as  follows: 

1.  Pre-ulcerative  lesions.  These  are  the  "small  raised  dots" 
of  Rogers.  They  vary  in  size  from  0.5  to  2  millimeters  and  are 
intensely  injected.  Erosions  of  the  superficial  layers  of  the 
mucous  membrane  with  moderate  injection  are  usually  also 
present.  Thickening  of  the  submucosa  is  not  common  in  this 
stage.  These  lesions  affect  all  portions  of  the  afTected  gut  and 
although  they  may  be  seen  in  chronic  cases  are  most  numerous 
in  the  more  acute  cases. 

2.  Ulceration.  A.  The  type  of  Harris :  These  lesions  although 
rarer  than  the  classic  type  are  not  uncommon.  They  may  be  an 
intermediary  stage  between  the  pre-ulcerative  lesions  and  the 
undermined  ulcer.  The  ulcers  are  round  or  oval,  with  abrupt 
edges,  which  are  thickened  and  intensely  congested.  The 
bases  are  clean,  greyish  and  oedematous,  often  situated  at  the 
apices  of  the  intestinal  folds,  and  have  a  tendency  to  extend 
along  the  short  axis  of  the  bowel.  These  ulcers  generally  in- 
volve the  submucosa  and  rarely  the  circular  muscle,  but  never 
extend  deeper.   This  is  the  most  common  type  in  the  ileum. 

B.  Undermined  or  classic  ulcers.  In  the  early  stage  these 
are  seen  as  minute,  yellowish  or  greyish  spots  in  the  mucosa, 
frequently  in  the  center  of  the  "  small  raised  dots  "  of  Roger, 
described  as  the  pre-ulcerative  stage.  The  process  extends  :n 
the  submucosa  parallel  with  the  surface  in  all  directions ;  the 
base,  as  a  rule,  being  formed  by  the  circular  muscle  and  the 
edges  by  the  overhanging  mucous  membrane.  The  submucosa 
becomes  thickened  and  oedematous  as  may  also  the  muscular  and 
peritoneal  coats.    The  ulcers  vary  in  size  from  pin-head  depres- 


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sions  to  losses  of  substance  as  large  as  the  palm  of  the  hand  and 
may  coalesce  beneath  or  on  the  surface.  Very  early  in  the 
ulcerative  stage  the  omentum  may  be  found  adherent  to  the 
peritoneal  surface  of  the  gut,  so  playing  an  important  protective 
part.  Secondary  infection  may  modify  the  course  of  the  disease. 
Perforations  in  the  ulcerative  stage  may  also  occur. 

Healing.  The  healing  of  the  small  lesions  may  be  complete  in 
the  sense  of  a  more  or  less  perfect  regeneration.  Repair  of  large 
lesions  is  characterized  by  the  formation  of  scar  tissue  with 
subsequent  contraction.  Complete  cure  may  be  the  eventual 
outcome,  but  a  chronic  atrophic  or  catarrhal  enteritis  may 
result. 

Distribution  of  the  lesions.  In  the  majority  of  cases  the  entire 
large  bowel  is  involved,  except  the  extreme  lower  part  of  the 
rectum.  Occasionally  the  appendix  is  involved  and  lesions  may 
occur  in  the  small  intestine,  but  are  always  confined  to  the  lower 
ileum.  The  findings  at  necropsy  are  indicative  only  of  the  dis- 
tribution of  the  lesion  immediately  preceding  death,  for  the  course 
of  the  disease  is  undoubtedly  influenced  by  treatment. 

Histology.  The  mucous  membrane  between  the  ulcers  is  but 
little  changed  and  in  many  places  no  alteration  can  be  seen.  In 
and  about  the  lesions  there  is  a  tendency  to  glandular  hypertrophy 
with  mucoid  degeneration  and  cyst  formation.  The  cells  of  the 
mucosa  take  the  stain  more  diffusely  than  do  normal  epithelial 
cells  and  there  is  some  distortion  of  the  glands  beneath  the  sur- 
face. In  many  cases  the  cells  lining  the  glands  are  separated 
from  the  basement  membrane  and  lie  singly  or  in  clumps  in  the 
lumen.  Amebas  are  often  found  among  these  cells  and  between 
thern  and  the  basement  membrane.  The  cellular  elements  in  the 
inter-glandular  tissue  and  submucosa  are  increased ;  congestion 
and  oedema  of  these  tissues  are  constant  conditions.  A  slight 
oedema  is  about  the  only  change  noticed  in  the  muscularis  mucosa. 
In  these  lesions  bacteria  are  very  few  in  number. 

Advanced  lesions.  In  more  advanced  lesions  the  glands  of  the 
adjacent  tissue  are  hypertrophied  and  the  cells  show  mucoid 
degeneration  with  some  lymphoid  infiltration  and  congestion. 
The  cells  of  the  necrotic  mucous  membrane  are  fused  with 
leucocytes,  granular  detritus,  amebas  and  bacteria  into  a  more 
or  less  well  formed  membrane.  The  submucosa  is  more  con- 
gested and  oedematous  and  more  amebas  are  found  than  in  the 
early  lesion.    The  necrotic  process  extends  some  distance  beyond 


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80 1 


the  ulceration  and  often  beyond  the  distribution  of  the  amebas, 
but  amebas  may  in  early  lesions  be  seen  in  healthy  tissue. 

The  ulcers  have  a  granular  base  composed  of  coagulated  serum, 
degenerated  cells,  amebas,  bacteria  and  few  red  blood  corpuscles. 
The  most  important  features  of  the  advanced  lesions  are  the 
coagulative  necrosis,  lymphoid  cell  infiltration,  congestion  and 
thrombosis  with  but  relatively  few  leucocytes. 

The  character  of  the  amebas  in  the  tissues.  The  writers  dis- 
cuss the  character  of  the  amebas  in  tissues  to  some  length  and 
also  their  staining  properties.  Borrel's  stain  is  perhaps  the  most 
brilliant  and  with  this  the  amebas  are  less  deeply  stained  than  the 
surrounding  tissue.  The  edge  of  the  organism  appears  as  a  fine 
blue  line  which  is  less  distinct  about  the  pseudopodia.  The  ecto- 
plasm is  seen  as  a  finely  recticular  or  almost  hyaline  substance, 
the  granular  part  of  which  is  a  very  faint  blue.  The  endosarc 
has  a  granular  structure,  is  more  deeply  stained  than  the  ectosarc 
and  of  a  purplish  or  greenish  tinge,  according  to  the  degree  of 
decolorization.  Bacteria  may  be  present  in  the  endosarc.  The 
nucleus  is  colored  violet  or  purple  and  may  be  surrounded  by  a 
clear  space.  Its  outlines  are  sharp  and  within  it  may  occasionally 
be  seen  crimson  granules  and  a  large  round  mass,  the  nucleolus. 
Ingested  cells  may  also  be  seen  in  the  protoplasm. 

Comparing  the  amebas  in  cultures  with  those  in  tissues,  the 
relative  size  of  the  nucleus  is  the  same  as  is  also  the  relation 
between  the  protoplasm  and  the  nucleus,  but  in  the  tissues  the 
contractile  vacuole  is  not  so  distinct  and  the  nucleus  although 
the  same  relative  size  does  not  present  the  same  appearance. 

The  relation  of  amebas  to  healthy  tissues.  It  is  not  known 
whether  amebas  are  able  to  attack  or  pass  through  an  intact 
mucous  membrane.  It  seems  probable  that  in  order  to  enter  the 
deeper  layers  there  must  be  some  departure  from  the  normal 
and  that  simple  catarrhal  conditions  accompanied  by  erosion  of 
even  a  few  of  the  superficial  epithelial  cells  would  offer  the 
conditions  necessary  for  invasion.  Generally  speaking,  the 
epithelium  has  as  great  a  resistance  to  the  ameba  as  has  muscu- 
lar tissue. 

Relation  of  amebas  to  bacteria.  Bacteria  do  not  limit  the 
activity  of  the  amebas  unless  perhaps  in  the  case  of  the  pyogenic 
cocci. 

The  writers  reached  the  following  general  conclusions : 

1.  Intestinal  amebiasis  is  a  peculiar  ulcerative  condition  of  the 


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intestine  caused  by  Amoebi  coli  (Losch)  usually  confined  to  the 
large  intestine,  though  occasionally  (7  in  200  cases)  the  ileum 
is  affected  and  more  often  (14  in  200  cases)  the  appendix  is 
involved. 

2.  In  the  majority  of  cases  the  condition  affects  the  entire 
bowel  (159  in  200  cases),  though  it  may  be  limited  to  one  or 
more  portions  most  commonly  the  caecum  and  ascending  colon 
(23  in  200  cases). 

3.  The  ulcers  show  a  tendency  to  be  undermined,  due  to  the 
lack  of  resistance  on  the  part  of  the  submucous  layer  of  the 
bowel. 

4.  The  organisms  may  enter  the  blood  vessels  very  early  in 
the  disease  and  may  be  transported  to  the  submucosa  without 
lesions  of  the  muscularis  mucosa. 

5.  The  disease  is  a  subacute  chronic  inflammatory  process,  as 
shown  by  the  character  of  the  exudate,  by  the  early  forma- 
tion of  granulation  tissue  and  by  the  absence  of  leucocytic 
infiltration. 

6.  Complete  healing  may  be  accomplished,  or  a  condition  of 
chronic  atrophic  enteritis  or  chronic  catarrh  may  persist,  which 
is  known  as  sprue  or  psilosis. 

Musgrave  believes  that  the  symptomatology  of  amebic  dysen- 
tery varies  more  than  is  generally  supposed  and  therefore  dis- 
cusses the  subject  under  the  following  four  clinical  divisions 
with  particular  reference  to  early  diagnosis  and  to  the  peculiari- 
ties of  the  milder  forms : 

1.  Latent  and  masked  forms. 

2.  Mild  and  moderately  severe  forms. 

3.  Severe  cases,  including  gangrenous  and  diphtheritic  con- 
ditions. 

4.  Infection  in  children  and  the  aged. 

These  clinical  forms  often  change  from  one  to  the  other  and 
may  do  so  in  the  same  patient  several  times  during  the  course 
of  the  disease.  The  process  is  essentially  a  chronic  one,  but 
acute  symptoms  frequently  manifest  themselves. 

Latent  infections.  By  this  term  are  designated  those  cases  in 
which  there  is  a  definite  lesion  containing  amebas,  but  without 
diarrhea  or  other  symptoms  which  would  ordinarily  lead  to  a 
diagnosis.  The  course  and  outcome  as  in  other  types  varies 
greatly.  Usually  after  a  period  varying  from  a  few  weeks  to 
many  months,  more  active  symptoms  develop  and  the  symptoms 


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803 


become  those  of  a  more  or  less  severe  dysentery.  On  the  other 
hand  some  of  these  cases  go  on  to  recovery  or  death  without 
ever  showing  active  diarrhea.  The  symptoms  may  be  entirely 
absent  subjectively  and  objectively  for  considerable  periods  of 
time,  but  usually  conditions  develop  which  indicate  the  nature 
of  the  process.  Such  conditions  are  the  presence  in  the  stools 
of  mucous  mixed  with  old  blood,  tissue  elements  and  amebas. 
Also  indefinite,  dull,  aching  pains  first  noticed  during  the  night 
or  early  in  the  morning  may  attract  attention.  Indigestion,  lassi- 
tude, headache,  foul  breath,  slight  loss  of  weight  and  on  deep 
palpitation  tenderness  along  the  colon,  most  often  over  the 
caecum,  and  sometimes  a  thickened  intestine  may  be  made  out. 

A  latent  or  mild  infection  may  be  masked  by  the  clinical 
manifestations  of  several  diseases,  as  gastritis,  chronic  constipa- 
tion or  appendicitis. 

Mild  or  moderately  severe  cases.  The  larger  number  of  these 
develop  from  the  latent  cases  just  described  and  the  time  of  onset 
is  based  on  the  appearance  of  the  diarrhea.  In  the  majority  of 
properly  treated  patients  the  disease  clinically  rarely  becomes 
more  than  a  diarrhea,  but  here,  as  well  as  in  a  large  number  of 
untreated  cases,  the  diarrhea  is  only  preliminary  to  a  more 
violent  clinical  picture.  Many  cases  even  without  treatment 
never  become  dysenteric.  The  course  in  uncomplicated  cases  is 
very  chronic  and  the  outcome  rarely  recovery,  being  most  com- 
monly the  development  of  "  sprue  "  or  chronic  gastro-enteritis. 
The  most  frequent  termination  is  death  from  intercurrent 
diseases.  Following  a  gradual  onset  from  a  period  of  known 
latency,  the  diarrhea  is  usually  intermittent  and  more  marked  in 
the  mornings,  consisting  of  two,  three  or  four  soft  semi-fluid 
stools  without  mucous  or  blood  passed  without  pain.  This  con- 
dition may  last  for  one  to  several  days  and  is  usually  followed  by 
constipation.  Succeeding  outbreaks  usually  become  more  severe 
and  may  last  for  days,  weeks  or  months  and  with  finally  the 
appearance  of  blood  and  mucous.  This  is  the  stage  at  which 
the  patient  most  often  appears  for  treatment.  The  onset  may  be 
more  acute  with  the  appearance  of  blood  and  mucus  in  the  stools 
from  the  first.  Usually  the  more  acute  the  onset  the  more  rapid 
the  development  of  more  severe  symptoms.  In  not  a  few  of 
these  cases  the  sudden  outbreak  is  due  not  to  amebas,  but  to  some 
extrinsic  cause. 

Severe  cases.    These  cases  usually  develop  from  the  previously 


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existing  latent  or  milder  type.  The  cases  with  diphtheritic 
and  gangrenous  lesions  belong  to  this  class.  These  severe 
anatomical  changes  are  usually  due  to  a  concomitant  or  second- 
ary infection  with  other  organisms.  The  onset  here  is  quite 
sudden  and  characterized  by  the  symptoms  of  an  acute  bacillary 
dysentery.  The  course  is  short  and  death  may  result  from 
toxaemia,  perforation  of  an  ulcer  or  from  exhaustion.  Not 
infrequently  the  severe  symptoms  subside  under  treatment  and 
the  disease  becomes  moderate  or  even  mild  in  type. 

Infection  in  children  and  the  aged.  Musgrave  concludes  that 
children  possess  a  natural  immunity,  for  they  have  as  a  rule  but 
a  mild  type  of  the  disease  which  is  very  amenable  to  treatment. 
The  aged  also  seem  to  have  a  decided  natural  immunity,  but, 
when  once  established,  the  disease  is  usually  of  more  serious 
import  than  even  in  young  adults. 

Analysis  of  symptoms.  All  varieties  of  facial  aspect  are  seen 
from  a  healthy  aspect  in  some  of  the  rapidly  fatal  cases  to  the 
emaciated,  anaemic,  yellow  and  even  cachetic  appearance  seen 
in  some  of  the  long  standing  cases.  The  skin  early  in  the 
disease  shows  no  noticeable  change,  but  later  there  is  a  general 
wasting  and  scrawny  dull  goose  flesh  skin,  of  a  muddy  color 
or  even  jaundiced.  Frequently  there  is  a  characteristic  odor. 
In  occasional  cases  the  night  sweats  equal  those  of  tuberculosis. 
Oedema  of  the  extremities  is  not  always  indicative  of  nephritis, 
although  in  some  cases  there  is  an  associated  Bright's  disease. 

The  organs  of  digestion  bear  the  brunt  of  this  disease  and  it 
is  here  that  diagnostic  symptoms  are  most  frequently  observed. 
In  the  latent  and  milder  fcrms  the  appetite  as  a  rule  is  good. 
Later  in  the  disease  food  may  increase  the  diarrhea  and  disturb 
the  already  disordered  digestive  tract.  v 

The  tongue  is  of  a  diagnostic  importance  only  in  cases  of  sprue 
when  it  shows  small  ulcers  along  its  side  and  under  the  tip. 
Thirst  is  generally  increased  and  there  is  usually  a  burning  pain 
along  the  oesophagus  which  is  aggravated  by  acids  or  solid  food. 
Symptoms  referable  to  the  stomach  depend  on  the  various  stages 
of  catarrh  and  do  not  differ  from  those  of  catarrh  due  to  other 
cause. 

Diarrheic  or  even  dysenteric  stools  are  present  at  some  time 
during  the  course  of  the  disease  in  the  majority  of  the  cases 
which  proceed  to  a  fatal  termination  although  true  dysenteric 
stools  are  not  the  rule  in  patients  placed  under  proper  treatment 


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early  in  the  disease.  There  is  nothing  characteristic  in  the  ma- 
croscopic appearance  of  the  stools.  The  morning  specimens  are 
usually  the  first  to  have  a  diarrheic  appearance  and  are  often 
copious  with  a  tendency  to  ferment.  The  odor  of  the  feces  is 
offensive  and  all  but  characteristic.  The  next  most  important 
point  of  diagnostic  value  obtained  from  a  macroscopic  examina- 
tion is  the  indication  of  the  location  of  the  infection  by  the  char- 
acter of  the  blood  when  such  is  present. 

The  changes  in  the  blood  are  essentially  those  of  a  secondary 
anaemia.  Early  in  the  disease  the  blood  shows  little  or  no 
change;  later  the  changes  are  due  to  anaemia. 

Fever  is  usually  absent  throughout  the  course  of  the  uncom- 
plicated disease.  When  present  it  is  usually  of  an  intermittent 
type,  highest  in  the  afternoon.  Occasionally  in  advanced  cases 
the  temperature  is  subnormal,  particularly  during  the  forenoon. 

The  nervous  system  probably  does  not  suffer  much  as  a  result 
of  amebic  infection  although  the  writer's  opinion  is  based  only 
on  supposition. 

The  variety  and  intensity  of  pain  in  this  affection  is  very 
great.  It  occurs  partly  as  a  direct  consequence  of  the  local 
destruction  and  partly  as  the  result  of  more  remote  and  some- 
times inexplicable  causes.  The  genito-urinary  and  respiratory 
systems  and  the  organs  of  special  sense  rarely  exhibit  lesions  of 
any  importance  in  the  uncomplicated  disease.  The  same  is  true 
of  the  joints  and  the  osseous  system  though  complications  may 
involve  any  of  these  structures. 

Diagnosis. — There  are  no  classical  symptoms  and  hence  an 
absolute  diagnosis  can  be  made  only  from  microscopic  examina- 
tion of  the  feces. 

The  following  are  the  most  important  points  to  be  considered 
in  diagnosis. 

1.  The  bowel  evacuations  particularly  their  odor  and  the  pres- 
ence or  absence  of  blood.  Consistence,  quantity,  frequency  and 
the  presence  or  absence  of  mucus,  are  much  less  important. 

2.  Abdominal  soreness,  which  is  increased  on  pressure.  Its 
diagnostic  importance  is  greatest  when  of  maximum  intensity 
over  the  caecum  and  ascending  colon. 

3.  The  so-called  14  indigestion, 99  headache,  general  lassitude, 
with  pain  below  the  stomach  after  eating  is  of  little  importance 
taken  alone. 

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4.  Loss  of  weight  especially  in  the  presence  of  a  good  appetite 
is  quite  important  and  is  the  best  guide  as  to  the  progress  being 
made  by  the  infection.  When  taken  together  in  cases  where  care- 
ful palpation  reveals  a  thickened  tender  colon,  in  places  where  it 
may  be  felt,  they  make  the  nearest  approach  to  a  sure  diagnosis 
possible  without  microscopic  examination  of  the  feces. 

Prognosis. — Several  points  should  be  taken  into  consideration 
and  the  evidence  in  each  individual  case  carefully  weighed  before 
an  expression  of  opinion  is  justifiable.  The  principal  determin- 
ing factors  are  the  manner  of  treatment,  age,  nationality,  general 
condition  of  the  patient  and  the  duration  of  the  disease  at  the 
time  treatment  was  instituted,  reaction  to  treatment,  the  presence 
of  complications  and  associated  disease  and  the  location  of  the 
amebic  lesions. 

The  writer  concludes  that  intestinal  amebiasis  manifests  itself 
in  a  much  broader  and  more  comprehensive  clinical  picture  than 
is  generally  allotted  to  it.  Waiting  for  bloody  mucous  stools  to 
appear  before  making  a  diagnosis  and  instituting  treatment  is 
responsible  for  a  large  percentage  of  the  present  mortality  from 
the  disease.  Physicians  are  justified  in  treating  as  amebic  dysen- 
tery every  patient  in  the  stools  of  whom  motile  amebas  are  found. 

Musgrave's  discussion  of  the  treatment  of  the  disease  deals  with 
some  of  the  more  important  and  heretofore  neglected  points  in 
prophylaxis  and  is  an  attempt  to  apply  some  of  the  experimental 
facts  which  he  and  Clegg  brought  out  in  their  article  on  the  cul- 
tivation and  etiologic  significance  of  amebas. 

In  view  of  the  fact  that  the  majority  of  cases  in  the  tropics 
can  be  traced  directly  or  indirectly  to  infected  water  they  con- 
clude it  is  of  the  utmost  importance  that  all  waters  in  any  way 
brought  into  contact  with  the  human  body  shall  be  thoroughly  and 
properly  sterilized  by  heat.  This  rule  applies  also  to  vegetables 
and  fruits  or  any  other  article  of  food  which  may  have  been  in 
contact  with  water.  Personal  cleanliness  is  most  important.  Al- 
though small  quantities  of  alcohol  undoubtedly  exert  some  de- 
structive influence  on  amebas  it  has  not  been  proved  that  the 
habitual  use  of  alcohol  in  any  way  prevents  infection.  Methods 
of  protection  must  be  followed  constantly  and  the  body  must  be 
kept  in  the  best  physical  condition  by  exercise  and  proper  living. 

Routine  measures  of  treatment  will  prove  unsatisfactory  in  the 
majority  of  cases.  To  treat  the  disease  correctly  the  greatest 
stress  should  be  laid  upon  the  findings  made  at  the  physical  ex- 


SCIENTIFIC  REVIEW 


807 


amination,  the  clinical  manifestations  and  the  probable  duration 
of  the  disease  at  the  time  the  patient  comes  under  observation. 

As  it  is  obvious  that  the  nutrition  of  the  individual  must  be 
properly  maintained,  a  very  liberal  diet  should  as  a  rule  be 
allowed.  Irritating  foods  and  those  liable  to  fermentation  or 
which  may  leave  a  large  residue  in  the  large  bowel  should  be  ex- 
cluded. In  individuals  greatly  emaciated  as  the  result  of  long 
continued  disease  and  who  do  not  react  to  treatment  in  local  en- 
vironment, a  change  of  climate  is  of  special  value. 

No  drug  acts  specifically.  The  salts  of  bismuth  in  the  absence  of 
local  treatment  are  useful  but  should  never  be  given  in  conjunc- 
tion with  quinine  enemas,  as  they  are  insoluble  in  the  intestinal 
juices  and  so  form  a  tenacious  coating  about  the  ulcers  pre- 
venting other  substances  used  in  local  treatment  from  taking 
effect. 

Ipecac  while  it  may  be  of  value  in  ordinary  forms  of  dysentery, 
when  given  in  the  doses  and  manner  prescribed  by  its  most  ardent 
admirers  is  useless  and  often  dangerous. 

Magnesium  sulphate  and  other  salines  are  not  recommended 
as  routine  treatment  for  considerable  periods  of  time  and  should 
be  used  with  caution  excepting  when  an  active  cathartic  is  needed. 
A  combination  of  mineral  acids,  especially  of  hydrochloric  with 
pepsin,  is  useful  in  controlling  the  nausea  caused  by  enemas. 
The  intestinal  antiseptics  are  of  service  in  allaying  fermentation 
and  may  possibly  limit  the  number  of  bacteria.  The  more  im- 
portant are  salol,  guiacolcarbonate  and  acetozone.  The  internal 
administration  .of  quinine  even  if  malaria  co-exists  is  not  advised 
as  the  object  sought  is  better  obtained  by  quinine  enemas.  Strych- 
nine and  other  powerful  stimulants  should  be  used  with  care  dur- 
ing the  administration  of  enemas  on  account  of  their  stimulat- 
ing action  on  the  bowel. 

The  best  results  are  obtained  in  the  largest  number  of  cases 
by  local  treatment.  Each  case  requires  careful  consideration  and 
the  treatment  should  be  varied  according  to  the  indications.  The 
apparatus  used  and  the  methods  of  giving  the  enema  are  de- 
scribed in  detail  by  the  writer.  The  object  sought  is  to  give  the 
largest  quantity  of  fluid  which  can  be  administered  and  retained. 
To  secure  satisfactory  results  the  diseased  part  of  the  bowel  must 
be  distended  and  the  fluid  retained  from  five  to  fifteen  minutes. 

The  temperature  of  the  solution  often  makes  a  material  differ- 
ence in  its  tolerance.    The  most  satisfactory  temperature  is  that 


8o8 


PUBLIC  HEALTH 


of  the  body.  Although  Tuttle  reported  good  results  from  the  use 
of  ice  cold  injections  Musgrave  did  not  lind  them  universally 
satisfactory. 

Of  the  various  drugs  used  the  salts  of  quinine  have  given  by 
far  the  best  results.  They  should  be  used  in  an  acid  solution  of 
1-1500  to  1-750.  Acetozone  and  alphozone  in  acid  solution  1-5000 
or  1-2000  either  alone  or  in  combination  or  alternating  with 
quinine  also  give  very  satisfactory  results. 

In  very  chronic  cases  the  substitution  of  a  1-10  to  1-2  solution 
of  hydrogen  perioxide  for  the  quinine  enema  gives  surprisingly 
good  results  as  does  also  the  occasional  injection  of  a  silver  nitrate 
solution. 

The  writer  recommends  from  one  to  three  enemas  in  twenty- 
four  hours.  He  also  emphasizes  that  no  recommended  routine 
treatment  will  be  found  satisfactory  as  each  case  requires  care- 
ful consideration  and  a  treatment  adapted  to  special  conditions. 

Kenneth  D.  Blackfan. 


public  toealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 


Department 

of  Health- 

-Albany 

,  N.  Y. 

Abstract  of  Vital  Statistics 

for  September, 

1906. 

Deaths. 

1902 

1903 

1904 

i9°5 

1906 

16 

18 

14 

22 

9 

1 

3 

0 

2 

0 

0 

1 

0 

0 

1 

0 

Whooping  cough  

0 

0 

1 

1 

Diphtheria  and  croup  

.  .  .  .  1 

0 

0 

5 

1 

0 

0 

5 

  9 

3 

9 

5 

6 

6 

5 

3 

8 

0 

0 

2 

0 

Bright 's  disease  

7 

16 

19 

1 1 

  3 

6 

9 

10 

5 

  4 

1 2 

7 

7 

7 

8 

5 

5 

8 

1 1 

Deaths  over  seventv  years .  . 

  14 

26 

18 

28 

25 

Deaths  under  one  year  

  19 

19 

19 

23 

20 

Total  deaths  

  119 

139 

123 

165 

i35 

Death  rate  

  14.47 

16 . 90 

14.96 

20 . 06 

16.51 

Death  rate  less  non-residents  13.62 

15.8* 

12.89 

I7-7S 

1374 

PUBLIC  HEALTH 


8o9 


Deaths  m  Institutions. 

1902  x9°3  1904         J9°5  1906 

Non-  Non-  Non-  Non-  Non- 
Resi-  resi-  Resi-  resi-  Resi-  resi-  Resi-  resi-  Resi-  resi- 
dent   dent.    dent.    dent.    dent.    dent.  dent.  d;*nt.  dent,  dnt 

Albany  Hospital   3       415      6      6      911       6       5  15 

Albany  County  Jail. .. .  0000000000 
Albany  Orphan  Asylum      00  10000100 

County  House   3      23012       312  1 

Homeopathic  Hospital.  11  1111  2102 
Hospital  for  Incurables.  00  1001  2000 
House  of  Good  Shepherd  0000000000 
Home  for  the  Friendless  00  1000  000  o 
Little  Sisters  of  the  Poor      00       2000       723  2 

Public  Places   00       02       1       2       030  o 

St.    Francis  de  Sayles 

Orphan  Asylum.  ...  00  3000  000  o 
St.  Margaret's  Home.  .404010222  1 
St.  Peter's  Hospital.  ..  40  2022  234  1 
Dominican  Convent ...       00       0020       100  o 

5th  Precinct   o      o       o      o      o      o       1       o      o  o 

Births   37 

Marriages   38 

Stillbirths   5 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  one 
hundred  ninety-two  inspections  made  of  which  one  hundred  twenty-six 
were  of  old  buildings  and  sixty-six  of  new  buildings.  There  were  forty- 
eight  iron  drains  laid,  twenty-one  connections  street  sewers,  thirty-four 
tile  drains,  three  urinals,  twenty-one  cesspools,  forty-five  wash  basins, 
forty-one  sinks,  thirty-four  bath  tubs,  twenty-five  wash  trays,  three  trap 
hoppers  in  yard,  seventy-four  tank  closets,  three  slop  hoppers.  There 
were  one  hundred  fourteen  permits  issued  of  which  ninety-three  were  for 
plumbing  and  twenty-one  for  building  purposes.  There  were  sixteen 
plans  submitted  of  which  six  were  of  old  buildings  and  ten  for  new  build- 
ings. Five  houses  tested  on  complaint,  two  with  blue,  red,  and  three 
with  peppermint  and  there  were  fifteen  water  tests  made.  Twenty-three 
houses  examined  on  complaint  and  forty-four  re-examined.  Twelve 
complaints  were  found  valid  and  eleven  without  cause. 

Bureau  of  Contagious  Disease. 
Casts  Reported. 

1902      1903      1904  1905  1906 

Typhoid  fever                                        8         11         19  iS  15 

Scarlet  fever                                         1         11           1  6  7 

Diphtheria  and  croup                           33         21           9  7  20 

Chickenpox                                            2           1           3  1  o 

Measles                                                o           4           1  1  o 

Whooping-cough   01213 

Consumption                                          o           1           o  o  o 

Totals   44         5o         35         34  46 


Bio 


SOCIETY  PROCEEDINGS 


Contagious  Disease  in  Relation  to  Public  Schools. 


Reported. 
D.     S.  F. 


Deaths. 
D.     S.  F. 


'3 

20 
2 1 , 


Public  school  No. 
Public  school  No. 
Public  school  No. 
Public  school  No. 
Public  school  No. 

St.  John's  Academy   1 

Number  of  days  quarantine  for  diphtheria  : 
Longest  31    Shortest  10 

Number  of  days  quarantine  for  scarlet  fever: 

Longest  35       Shortest  21 

Fumigations:  Houses  13 

Cases  of  diphtheria  reported  20 

Cases  of  diphtheria  in  which  antitoxin  was  used  18 

Cases  in  which  antitoxin  was  not  used   2 

Deaths  after  use  of  antitoxin   4 


Average . 


i8i 


Average   28 

Rooms  31 


Society  proceedings 

Medical  Society  of  the  County  of  Albany 

Semi-Annual  Meeting,  October  10,  1906 

The  semi-annual  meeting  of  the  Society  was  held  in  Alumni  Hall, 
Medical  College,  on  Wednesday  evening,  October  10,  1906.  About  sixty 
members  were  present. 

The  following  physicians  were  elected  to  membership :  Drs.  W.  P. 
Brierly,  J.  N.  B.  Garlick,  W.  D.  B.  Lester,  Henry  F.  C.  Muller,  Harry 
Rulison  and  Luman  B.  Rulison 

The  Vice-President,  Dr.  J.  D.  Montmarquet,  gave  an  address  entitled 
"Hysteropexy  Followed  by  Repeated  Pregnancies." 

Drs.  W.  G.  Macdonald  and  J.  D.  Craig  were  elected  delegates  to  the 
State  Society,  to  serve  for  two  years ;  Dr.  A.  H.  T  raver  to  serve  for  one 
year. 

Dr.  J.  H.  Mitchell  was  elected  delegate  to  the  Third  District  Branch. 

The  committee  appointed  at  the  last  annual  meeting  to  consider  the 
question  of  bacteriological  tests  which  might  be  made  by  the  city  of 
Albany,  was  unable  to  arrive  at  a  unanimous  conclusion  and  therefore 
submitted  majority  and  minority  reports.  The  minority  report  adopted 
by  the  Society  is  as  follows: 

It  is  the  opinion  of  the  undersigned  that  the  present  method  of  making 
bacteriological  examinations  of  all  cases  of  diphtheria  and  tuberculosis, 
both  for  purposes  of  diagnosis  and  to  ascertain  the  clinical  progress  of 
these  diseases  at  public  expense,  should  be  continued.  It  is  further  the 
opinion  of  the  undersigned  that  bacteriological  tests  should  be  made  at 
public  expense  for  the  indigent  poor.    In  such  other  cases  of  contagious 


MEDICAL  NEWS 


8ll 


disease  as  may  from  time  to  time  seem  necessary  in  the  public  interest, 
and  as  may  be  determined  upon  by  the  Commissioner  of  Public  Safety 
or  his  qualified  representative.  It  is  therefore  recommended  that  an 
appropriation  be  made  by  the  city  for  such  purpose. 

An  interesting  feature  of  the  meeting  was  the  signing  of  the  by-laws 
of  the  State  Society,  the  District  Branch  and  the  County  Society  by  the 
members  present.  The  corrected  minutes  of  this  meeting  will  appear  in 
the  next  number  of  the  Annals. 

Arthur  T.  Laird,  Secretary. 


/fcefclcal  Views 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick;  Statistics  for  Sep- 
tember, 1906. — Number  of  new  cases,  122;  classified  as  follows:  dis- 
pensary patients  receiving  home  care,  5;  district  cases  reported  by  health 
physicians,  17;  charity  cases  reported  by  other  physicians,  62;  patients  of 
limited  means,  38;  old  cases  still  under  treatment,  70;  total  number  of 
patients  under  nursing  care  during  the  month,  192.  Classification  of 
diseases  (new  cases)  :  medical,  37 ;  surgical,  13;  gynaecological,  5;  obstetri- 
cal work  of  the  Guild,  32  mothers  and  30  infants  under  professional  care ; 
dental  cases,  3;  skin,  2;  transferred  to  hospitals,  7;  deaths,  9. 

Special  Obstetrical  Department. — Number  of  obstetricians  in  charge 
of  cases,  1;  attending  obstetricians,  1;  medical  students  in  attendance,  3; 
Guild  nurses,  4;  patients,  4;  visits  by  head  obstetricians,  4;  by  attending 
obstetricians,  1;  by  the  medical  students,  39;  by  the  Guild  nurses,  49;  total 
number  of  visits  in  this  department,  93. 

Visits  of  Guild  Nurses  (all  departments)  :  Number  of  visits  with  nurs- 
ing treatment,  1,333;  for  professional  supervision  of  convalescents,  223; 
total  number  of  visits,  1,556;  six  graduate  nurses  and  3  assistant  nurses 
were  on  duty.  Cases  were  reported  to  the  Guild  by  2  of  the  health 
physicians  and  by  43  other  physicians  and  by  4  dentists. 

Report  of  the  Albany  Guild  for  the  Care  of  the  Sick,  from  April 
1.  1906,  to  October  i,  1906. — Number  of  cases  on  hand  April  1,  1906,  52 ; 
number  of  cases  reported  by  City  Health  Physicians,  77 ;  number  of 
cases  reported  by  other  physicians,  609 ;  total  new  cases,  686 ;  total  number 
cases  under  Guild  care  for  the  six  months,  738. 

Classification  of  Cases. — Dispensary,  14;  district,  70;  other  charity 
cases,  313;  total  charitv  cases,  397;  limited  means,  289;  total  new  cases, 
686. 

Classification  of  Diseases. — Medical,  185;  surgical,  52;  gynaecological, 
20;  obstetrical — general  work  of  Guild,  mothers  188,  infants  183,  total  371; 
special  obstetrical  department,  mothers  20,  infants  20,  total  40;  total 
obstetrical  cases,  411;  dental,  9;  eye  and  ear,  1;  skin,  6;  throat  and  nose, 
2;  grand  total,  686.  Contagious  diseases  in  above  list,  31;  removed  to 
hospitals,  20;  died,  45.    Number  of  nurses  employed:  graduate  nurses,  6; 


8l2 


IN  MEMORIAM 


assistant  nurses,  5;  emergency  nurses,  2;  total,  13.  Number  of  physicians 
reporting  cases  to  Guild,  84.   Number  of  visits  made  by  Guild  nurses,  8,354. 

Albany  Medical  College  Alumni  Association  of  New  England. — 
The  annual  meeting  of  the  Albany  Medical  College  Alumni  Association 
of  New  England  was  held  at  Springfield,  Mass.,  Tuesday,  October  9, 
1906.  Dr.  A.  E.  Abrams  gave  the  President's  address.  Dr.  James  Vander 
Veer  delivered  an  address  on  "A  Comparison  of  the  Educational  Methods 
between  New  York  State  and  Germany."  The  meeting  was  well  attended 
and  much  enthusiasm  was  shown. 

School  of  Pharmacy. — The  School  of  Pharmacy  opened  October  1st 
very  auspiciously.  Dr.  Tucker,  Dean  of  the  College,  presided  and  ad- 
dresses were  made  by  Dr.  A.  V.  V.  Raymond,  Chancellor  of  the  Univer- 
sity, and  Secretary  Bradley.    The  registration  is  larger  than  last  year. 

Albany  City  Homeopathic  Hospital. — The  corner  stone  of  the  new 
Homeopathic  Hospital  was  laid  September  29th. 

Personals. — Dr.  Leland  D.  Fosbury  (A.  M.  C,  '04)  has  opened  his 
office  at  Endicott,  N.  Y. 

— Dr.  James  W.  White  (A.  M.  C,  '05)  has  sold  his  practice  at  Rural 
Grove,  N.  Y.,  and  is  now  taking  post-graduate  work  at  New  York  city. 

— Dr.  Charles  Sweet  (A.  M.  C,  '05)  has  opened  an  office  at  Pough- 
keepsie,  N.  Y. 

— Dr.  Roscoe  C.  Waterbury  (A.  M.  C,  '05)  has  opened  an  office  at 
Kinderhook,  N.  Y. 

— Dr.  Arthur  H.  Schuyler  (A.  M.  C,  '05)  has  started  practice  at 
Rochester,  N.  Y. 

— Dr.  Clarence  T.  Sicard  (A.  M.  C,  '01)  has  opened  his  office  at  No. 
802  Albany  street,  Schenectady,  N.  Y. 

— Dr.  Eugene  E.  Hinman  (A.  M.  C,  '99),  No.  202  Lark  street,  Albany, 
N.  Y.,  announces  that  after  October  1st  his  practice  is  to  be  limited  to 
diseases  of  the  nose  and  throat. 
1 


In  /Dcmoriam 

Henry  E.  Babcock,  M.  D. 

Dr.  Henry  E.  Babcock,  of  the  class  of  1855,  died  at  his  home  in  New 
London,  N.  Y.,  on  September  20,  1906.  Dr.  Babcock  began  practice  in 
Clarksville,  N.  Y.,  afterward  moving  to  Wayne  county.  After  eight  years 
he  moved  to  New  London,  where  he  spent  the  remainder  of  his  life,  con- 
tinuing in  active  practice  until  1902.  Since  then  he  has  been  in  poor 
health. 


IN  MEMORIAM 


813 


Charles  G.  Bacon,  M.  D. 

Dr.  Charles  G.  Bacon,  of  the  class  of  1874  of  the  Albany  Medical  College, 
died  at  his  home  in  Fulton,  N.  Y.,  August  18,  1906,  aged  ninety-two. 
Dr.  Bacon  attended  lectures  in  the  Albany  Medical  College  in  1841,  and 
in  the  College  of  Physicians  and  Surgeons  in  1848.  In  1858  he  received 
the  degree  of  doctor  of  medicine  from  the  Regents  of  the  University, 
and  again  in  1874  from  the  Albany  Medical  College.  He  always  practiced 
at  Fulton.  He  was  a  member  of  the  Medical  Society  of  the  County  of 
Oswego,  and  in  1854  a  delegate  to  the  American  Medical  Association. 
In  1843  he  was  hospital  brigade  surgeon  for  the  Forty-eighth  Brigade  of 
the  Militia  of  the  State  of  New  York,  with  the  rank  of  major.  In  1887 
Dr.  Bacon  was  president  of  the  New  York  Central  Medical  Society. 


William  A.  Bliss,  M.  D. 

After  an  illness  lasting  for  three  years,  following  twenty-seven  years  of 
devotion  to  professional  work,  Dr.  William  A.  Bliss  died  at  his  residence, 
No.  385  Tenth  street,  Brooklyn,  August  19,  1906,  a  victim  of  cancer.  His 
widow,  Mrs.  Jennie  Jaques  Bliss,  and  a  niece,  Miss  Frances  Bliss  Merri- 
field,  who  is  the  sole  remaining  member  of  his  immediate  family,  survive 
him.  Dr.  Bliss's  brother,  Solon  F.  Bliss,  also  a  physician,  died  ten  years 
since,  after  many  years  of  earnest  work  in  the  East  New  York  section 
of  Brooklyn. 

Dr.  WTilliam  A.  Bliss  was  born  on  the  5th  of  May,  1841,  in  Nassau, 
N.  Y.  His  father,  John  S.  Bliss,  was  a  well-to-do  and  respected  farmer; 
his  mother,  Polly  Hunt  Bliss,  a  sterling  figure  among  the  women  of  the 
community.  In  1847  the  household  removed  to  Sandlake,  N.  Y.,  and 
young  Bliss  received  his  early  education  there,  at  Schramm's  Academy. 
Entering  the  Albany  Medical  College  in  1863,  he  was  graduated  in  1866, 
soon  thereafter  married  Miss  Jennie  Jaques,  of  Albany,  and  shortly  there- 
after took  up  his  life  work  in  Brooklyn. 

Dr.  Bliss  found  himself  confronted  almost  immediately  with  the  duties 
and  cares  of  a  large  practice,  but  he  was  unremitting  in  his  devotion  to 
duty.  He  became  a  member  of  the  Kings  County  Medical  Society,  the 
only  such  organization  with  which  he  affiliated  himself,  and  was  actively 
interested  therein  during  the  entire  time  of  his  residence  in  Brooklyn. 
Although  fitted  by  research  and  careful  reading  for  work  along  special 
lines,  he  confined  himself  to  general  practice,  such  was  the  demand  for 
his  services. 

In  1893,  Dr.  Bliss  gave  up  active  work  and  removed  to  Fishkill-on- 
Hudson,  but  after  residing  there  for  six  years  he  returned  to  Brooklyn, 
but  did  not,  however,  enter  into  active  business  life  again.  His  health 
failed  in  1903,  and  he  suffered  without  intermission  until  the  day  of  his 
death.  His  friends  declare,  however,  that  even  under  the  most  adverse 
conditions  his  courage  was  marvelous,  his  patience  inexhaustible  and  his 
cheerfulness  undaunted.  Flavius  Packer. 


814 


CURRENT  MEDICAL  LITERATURE 


Current  /fceMcal  Xttcraturc 

REVIEWS  AND  NOTICES  OP  BOOKS 

A  Primer  of  Psychology  and  Mental  Diseases.  For  Use  in  Training 
Schools  for  Attendants  and  Nurses  and  in  Medical  Classes,  and 
as  a  Ready  Reference  for  the  Practitioner.  By  C.  B.  Burr,  M.  D., 
Medical  Director  of  Oak  Grove  Hospital  (Flint,  Mich.)  for  Mental 
and  Nervous  Diseases;  Formerly  Medical  Superintendent  of  the 
Eastern  Michigan  Asylum ;  Member  of  the  American  Medico-Psy- 
chological Association;  of  the  American  Medical  Association; 
Foreign  Associate  Member  Societe  Medico- Psychologique  of  Paris, 
etc.  Third  Edition.  Thoroughly  Revised,  with  Illustrations.  Pages 
viii-183,  i2mo.  Bound  in  Extra  Vellum  Cloth,  $1.25  net.  F.  A. 
Davis  Company,  Publishers,  1914-16  Cherry  Street,  Philadelphia. 

Dr.  Burr  s  "  Primer "  has  deservedly  reached  a  third  edition.  The 
Annals  has  commented  favorably  upon  the  book  on  its  first  appearance 
and  now  emphasizes  the  necessity  of  study  of  its  valuable  directions  for 
all  practicing  nurses.  The  lamentable  mismanagement  of  mental  cases 
might  thus  to  some  extent  be  modified. 


The  World's  Anatomists.  Concise  Biographies  of  Anatomic  Masters, 
from  300  B.  C.  to  the  Present  Time,  whose  Names  have  Adorned 
the  Literature  of  the  Medical  Profession.  By  G.  W.  H.  Kemper, 
M.  D.,  Professor  of  the  History  of  Medicine  in  the  Medical  College 
of  Indiana,  Indianapolis,  Ind.  Revised  and  Enlarged  from  the 
Original  Serial  Publication  in  The  Medical  Book  News.  With 
Eleven  Illustrations,  Nine  of  which  are  Portraits.  P.  Blakiston's 
Son  &  Co.,  1012  Walnut  Street,  Philadelphia,  1905. 

This  is  a  very  interesting  little  book;  indeed,  we  may  use  the  author's 
term — fascinating.  Names  familiar  to  every  student  of  medicine  are  here 
explained,  and  the  medical  heroes  of  three  centuries  are  brought  into 
living  contact  with  their  admirers  of  the  present.  If  there  be  any  criticism, 
it  is  that  the  sketches  are  too  concise.  Perhaps  the  author  will  be  en- 
couraged to  prepare  another  enlarged  and  more  elaborate  edition. 


Gynecology.  Volume  IV  of  the  Practical  Medicine  Series  for  the  year 
1006.  By  E.  C.  Dudley  and  C.  von  Bachelle.  Price,  $1.25.  The 
Year  Book  Publishers,  40  Dearborn  Street,  Chicago,  111. 

This  volume  is  one  of  a  series  of  ten  issued  at  about  monthly  intervals, 
and  covering  the  entire  field  of  medicine  and  surgery,  each  volume  being 
complete  for  the  year  prior  to  its  publication  on  the  subject  of  which  it 
treats.    The  price  of  the  series  of  ten  volumes  is  $10.    The  series  is 


CURRENT  MEDICAL  LITERATURE 


published  primarily  for  the  general  practitioner,  at  the  same  time  the 
arrangement  in  several  volumes  enables  those  interested  in  special  sub- 
jects to  buy  only  the  parts  they  desire. 

In  this  book  of  227  pages,  the  subject  of  gynecology  is  presented  in 
the  form  of  abstracts  taken  from  contributions  which  have  appeared 
during  the  past  year.  While  it  does  not  represent  a  review  of  the  entire 
literature,  it  does  give  a  systematically  arranged  and  well  indexed  review 
of  the  contributions  which  the  editors  have  chosen  in  order  to  cover 
the  subject  of  gynecology.  As  such  a  book,  it  can  be  recommended  to 
both  general  practitioners  and  others  interested  in  gynecology. 

j.  h.  s. 


Christianity  and  Sex  Problems.  By  Hugh  Northcote,  M.  A.  Crown 
Octavo,  257  pages.  Bound  in  Extra  Cloth.  Price,  $2.00,  net.  F. 
A.  Davis  Company,  Publishers,  1914-16  Cherry  Street,  Phila- 
delphia, Pa. 

Studies  in  the  Psychology  of  Sex — Erotic  Symbolism,  the  Mechanism  of 
Detumescence,  the  Psychic  State  of  Pregnancy.  By  Havelock 
Ellis.  6%x8%  inches.  Pages  x-285.  Extra  Cloth,  $2.00,  net. 
Sold  only  by  Subscription  to  Physicians,  Lawyers,  and  Scientists. 
F.  A.  Davis  Company,  Publishers,  1914-16  Cherry  Street,  Phila- 
delphia. 

Of  Mr.  Northcote's  book  it  may  be  said  that  he  has  quoted  liberally 
from  Havelock  Ellis'  descriptions,  and  of  these  that  there  seems  to  be  no 
omission  of  any  of  the  lowest  instincts  of  the  human  race.  Such  revolting 
details  are  probably  interesting  to  some  readers,  but  can  only  prove 
suggestive  or  helpful  to  a  very  small  number  of  men  who  have  the  cus- 
todial supervision  of  certain  low  types  of  individuals. 


The  Diseases  of  the  Nose,  Throat  and  Ear.  By  Charles  Prevost  Gray- 
son, A.  M.,  M.  D.,  Lecturer  on  Laryngology  and  Rhinology  in  the 
Medical  Department  of  the  University  of  Pennsylvania;  Physician- 
in-charge  of  the  Department  for  Diseases  of  the  Nose  and  Throat 
in  the  Hospital  of  the  University  of  Pennsylvania;  Laryngologist 
and  Otologist  to  the  Philadelphia  Hospital.  Illustrated  with  129 
Engravings  and  8  Plates  in  Colors  and  Monochrome.  Lea  Brothers 
&  Co.,  Philadelphia  and  New  York.  1 

There  appears  to  be  no  end  to  new  books  on  the  nose  and  throat,  but 
there  is  always  room  for  a  good  book.  The  author  has  very  wisely 
included  the  diseases  of  the  ear,  because  anatomically  and  pathologically, 
its  association  with  the  nose  and  upper  part  of  the  throat  is  very  intimate. 
The  dependence  of  the  large  majority  of  diseases  of  the  ear  upon  some 
disease  of  the  nose  or  naso-pharnyx,  is  now  universally  admitted,  and 
as  the  author  states,  it  is  the  rhinologist  who  holds  the  key  to  the  prophy- 
laxis of  the  ear.    The  different  diseases  of  the  nose,  throat  and  ear  are 


8i6 


CURRENT  MEDICAL  LITERATURE 


very  thoroughly  considered,  and  an  excellent  medical  formulary  is  added 
to  the  book.  One  of  the  best  features  of  this  book  is  the  omission  of  a 
great  number  of  different  methods  of  treating  the  different  diseases,  only 
the  methods  of  treatment  (usually  one)  that  the  author  has  found  to  be 
the  best  being  given.  Taking  it  all  together,  it  is  one  of  the  best  books 
we  have  recently  seen.  c.  f.  t. 


A  Manual  of  Otology.  By  Gorham  Bacon,  A.  B.,  M.  D.,  Professor  of 
Otology  in  the  College  of  Physicians  and  Surgeons,  Columbia  Uni- 
versity, New  York;  Aural  Surgeon,  New  York  Eye  and  Ear  In- 
firmary. With  an  Introductory  Chapter  by  Clarence  John  Blake, 
M.  D.,  Professor  of  Otology  in  Harvard  University.  Fourth  Edi- 
tion, Revised  and  Enlarged.  With  134  Illustrations  and  11  Plates. 
Lea  Brothers  &  Co.,  New  York  and  Philadelphia,  1906. 

This  manual  by  a  well  known  specialist,  is  a  particularly  good  book  for 
students,  because  it  is  concise,  all  unnecessary  detail  being  omitted. 

Mention  should  be  made  of  the  introductory  chapter  by  Dr.  Blake. 
He  mentions  the  danger  of  short  courses  in  otology,  as  in  other  depart- 
ments, which  can  in  a  little  time  afford  only  a  little  knowledge,  and 
enable  the  superficial  student  to  assume  that  he  has  acquired  an  ability 
in  special  practice  which  could  only  be  obtained  through  long  and  serious 
study. 

Dr.  Bacon,  in  the  chapter  devoted  to  the  methods  of  examining  the 
ear,  makes  a  difficult  subject  comparatively  simple,  by  the  extremely  lucid 
explanations  of  the  various  tuning  fork  tests.  He  also  emphasizes  the 
necessity  of  a  thorough  examination  of  the  nose,  naso-pharynx  and 
pharynx,  before  making  the  diagnosis  of  the  ear  condition. 

The  book  is  certainly  one  of  the  best  of  the  smaller  works  on  otology. 

c.  F.  T 

SURGERY 

Edited  by  Albert  Vander  Veer,  M.  D.,  and  Arthur  W.  Elting,  M.  D. 

Gastroenterostomy  or  Resection  in  Ulcer  of  the  Stomach?  (Gastroen- 
terostomie  oder  Resection  hex  Ulcus  callosum  zentriculi?) 

Alexander  Brenner.    Archiv  fur  klinische  Chirurgie,  Band  78,  Heft  3. 

In  1892  the  writer  expressed  the  belief  that  restriction  of  ulcer  of  the 
stomach  was  a  more  desirable  procedure  in  ulcers  of  the  anterior  wall 
or  in  those  in  which  there  was  involvment  of  the  pancreas,  while  gas- 
troenterostomy was  indicated  in  ulcer  of  the  lesser  curvature  and  the 
pylorus  in  which  there  was  no  adhesion  to  the  pancreas. 

The  question  of  the  healing  of  an  ulcer  after  gastroenterostomy  has 
been  much  discussed  and  it  has  been  generally  regarded  that  the  healing 
in  most  instances  took  place  fairly  promptly,  although  there  has  been 
relatively  little  positive  proof.  Some  authors,  however,  have  disputed 
this  and  state  that  there  was  simply  mechanical  relief  of  the  condition 
without  a  positive  healing. 


CURRENT  MEDICAL  LITERATURE 


817 


In  three  instances  in  which  the  writer  had  performed  gastroenter- 
ostomy for  relief  of  an  ulcer  of  the  stomach  he  had  occasion  at  subse- 
quent periods  to  open  the  abdomen  and  to  study  the  conditions  which 
presented. 

In  the  first  case  the  second  operation  was  done  two  years  and  nine 
months  after  the  first,  and  every  vestige  of  the  previous  ulcer  had  dis- 
appeared and  the  patient  has  since  remained  in  perfect  health. 

In  the  second  case  one  year  and  six  months  elapsed  between  the  two 
operations,  and  in  this  instance  also  all  evidence  of  the  ulcer  had  dis- 
appeared. 

In  the  third  case  the  second  operation  was  performed  less  than  a  year 
afier  the  first,  and  yet  a  complete  healing  of  the  ulcer  was  demon- 
strated. 

Many  observers  have  reported  recurrence  of  ulceration  after  resection 
of  the  ulcer  without  gastroenterostomy.  The  writer  has  collected  21 
cases  in  which  he  has  resected  the  ulcer,  with  a  mortality  of  28.6  per  cent. ; 
and  30  cases,  in  which  gastroenterostomy  was  done  for  the  ulcer,  with  a 
mortality  of  15.3  per  cent.  A  comparison  of  these  two  groups  of  cases 
shows  that  a  permanent  cure  resulted  in  66.6  per  cent,  of  the  cases  in 
which  the  ulcer  was  resected,  with  a  mortality  of  28.6  per  cent. ;  while 
in  the  cases  in  which  gastroenterostomy  was  done  there  was  a  permanent 
cure  of  63.68  per  cent.,  with  a  mortality  of  15.3  per  cent.;  all  of  which 
would  seem  to  demonstrate  the  fact  that  gastroenterostomy  is  to  be  pre- 
ferred to  resection. 

At  the  international  congress  in  Brussels  in  1905,  most  of  the  surgeons 
present  expressed  the  view  that  gastroenterostomy  is  the  operation  of 
choice  for  ulcer  of  the  stomach. 


Concerning  Extirpation  of  the  Thymus  in  Asthma  Thymicum.  (Ueber 
Thymusextirpation  bei  Asthma  thymicum.) 

O.  Ehrhardt.    Archiv  fiir  klinische  Chirurgi:%  Band  78,  Heft  ?. 

The  views  in  regard  to  the  relationship  of  the  hyperplasia  of  the  thymus 
to  this  condition  may  be  divided  into  two  groups.  First,  those  who 
regard  the  symptoms  as  due  to  the  mechanical  pressure  of  the  enlarged 
thyymus  upon  the  organs  of  the  anterior  mediastinum;  and,  secondly, 
those  who  regard  the  enlargement  of  the  gland  as  the  expression  of  a 
lymphatic  constitution  and  so  only  indirectly  the  cause  of  the  asthma. 

Surgery  of  the  thymus  is  practically  new  territory,  not  so  much  because 
of  the  difficulties  of  operation  as  because  of  the  difficulty  of  diagnosticat- 
ing an  enlargement  of  this  gland.  The  first  operation  of  the  kind  was 
performed  by  Rehn  and  reported  in  1896.  The  patient  was  a  child  of 
2^2  years  who  for  four  weeks  had  had  pronounced  dyspnoea  with  repeated 
attacks  of  suffocation.  Tracheotomy,  which  was  done  at  first,  gave 
relief  only  when  the  tube  reached  the  bifurcation.  When  the  suprasternal 
space  was  opened  an  enlarged  thymus  was  found,  which  was  drawn 
upward  and  fastened  to  the  fascia  above  the  sternum.  This  gave  relief 
from  the  symptoms  which  was  permanent. 


8i8 


CURRENT  MEDICAL  LITERATURE 


Shortly  after  this  Fritz  Koenig  operated  upon  a  nine  weeks'  old  child 
in  which  he  found  a  markedly  enlarged  thymus,  part  of  which  was 
excised,  and  the  rest  was  fastened  to  the  fascia  above  the  sternum  by 
suture.    This  case  also  made  a  permanent  recovery. 

The/  writer  reports  the  case  of  a  child  two  years  old  who  for  some  time 
before  operation  had  presented  hoarseness  and  difficult  breathing,  which 
increased  in  severity  until  it  presented  attacks  of  suffocation  occurring 
several  times  every  day.  On  physical  examination  the  child  presented  a 
marked  cyanosis.  There  was  a  pronounced  inspiratory  stridor  with  in- 
spiratory depression  in  the  epigastrium  and  suprasternal  notch.  Physical 
examination  was  otherwise  negative.  It  was  impossible  to  demonstrate 
any  enlargement  of  the  thymus. 

The  operation  consisted  in  a  median  incision  just  above  the  manu- 
brium and  when  the  suprasternal  notch  was  freely  opened  a  portion  of 
the  thymus  presented  at  every  inspiration.  The  thymus  was  seized, 
gradually  withdrawn  and  enucleated,  without  much  difficulty.  Examina- 
tion of  the  trachea  after  removal  of  the  thymus  showed  it  to  be  flattened 
in  its  anterior-posterior  diameter.  The  thymus  removed  was  five  centi- 
meters long,  four  centimeters  broad  and  two  centimeters  in  thickness, 
and  was  of  very  firm  consistence.  Microscopically  it  presented  the 
picture  of  normal  thymus  tissue.  The  child  made  a  rapid  recovery  and 
has  remained  well  since. 

Animal  experimentation  has  shown  that  the  removal  of  the  thymus 
does  not  in  any  way  impair  the  nutrition.  The  flattening  of  the  trachea 
which  may  be  associated  with  this  condition  is  of  considerable  import- 
ance and  may  at  times  require  plastic  operation.  The  writer  states  that 
the  gland  can  be  readily  removed  through  the  suprasternal  notch  with 
but  little  danger  of  wounding  the  larger  vessels  aid  with  little  difficulty 
in  controlling  the  hemorrhage.  He  states  that  it  will  rarely  ever  be  pos- 
sible to  make  a  diagnosis  of  enlarged  thymus  before  operation. 

In  the  case  of  Rehn  the  absence  of  relief  after  tracheotomy  with  the 
usual  tracheal  tube,  and  in  the  writer's  case  the  absence  of  relief  after 
intubation,  demonstrated  that  the  obstruction  must  be  shortly  above  the 
bifurcation.  The  only  conditions  which  can  produce  such  an  obstruction, 
practically  speaking,  are  malignant  tumor  or  an  enlarged  thymus.  Medi- 
astinal tumors  in  children  are  extremely  rare;  and  leukemic  or  pseudo- 
leukemic  enlargements  of  the  lymphatic  glands  are  also  extremely  rare 
in  children. 

He  regards  the  operation  as  certainly  indicated  in  cases  where  there 
is  a  strong  suspicion  of  an  enlarged  thymus. 


A  Case  of  the  Severest  General  Infection  Associated  with  Cholangitis; 
Operation;  Recovery.  (Fall  von  schwerster  Allgemeininfektion  hex 
Cholangitis;  Operation;  Recovery.) 

Adolph.  Mittelungen  aus  den  Grenzgebieten  der  Medizin  und  Chirurgie, 
Band  15;  Heft  3  and  4. 

The  following  case  the  writer  regarded  as  worthy  of  especial  mention, 
because  it  illustrates  one  of  the  rare  complications  of  gall  bladder  disease. 


CURRENT  MEDICAL  LITERATURE 


819 


Patient  was  a  woman  of  49  years,  who  had  for  a  number  of  years 
suffered  with  occasional  attacks  of  pain  of  short  duration  in  the  upper 
region  of  the  abdomen,  which  had  been  regarded  as  cramps  of  the 
stomach.  There  had  never  been  any  jaundice.  There  was  no  history  of 
any  other  disease. 

Present  illness  began  with  a  sudden  pain  in  the  region  of  the  liver 
and  upon  physical  examination  there  was  found  to  be  marked  tenderness 
just  below  the  border  of  the  right  ribs.  No  distinct  tumor  mass  could, 
however,  be  felt.  The  disease  ran  a  very  severe  course  from  the  onset, 
characterized  by  frequent  severe  chills,  with  marked  elevation  of  temper- 
ature. At  first  there  were  only  one  or  two  chills  a  day,  but  subsequently 
she  would  have  as  many  as  four  or  more.  The  skin  was  a  dirty  grayish 
yellow  color  and  there  existed  a  diarrhoea.  The  picture  was  one  fairly 
typical  of  septicemia. 

The  patient  was  seen  in  consultation  at  the  end  of  a  week  by  a  promi- 
nent internist,  who  regarded  an  operation  as  not  indicated.  About  two 
weeks  after  the  onset  she  was  seen  by  Prof.  Rehn,  who  made  a  diagnosis 
of  a  suppurative  inflammation  of  the  gall  bladder  or  gall  passages  and 
probably  of  the  liver,  and  advised  an  operation. 

At  the  operation  there  was  no  stone  or  sediment  found  in  the  gall 
bladder.  The  bile  was  of  apparently  normal  character,  as  was  the  gall 
bladder  and  the  bile  passages.  There  were  no  adhesions.  Drainage  of 
the  gall  blader  was  instituted.  The  patient  stood  the  operation  fairly 
well,  but  had  considerable  fever  of  an  irregular  character  for  the  follow- 
ing two  weeks,  after  which  it  gradually  became  reduced  and  she  made  a 
satisfactory  recovery  and  has  remained  permanently  well.  Cultures  from 
the  bile  showed  only  the  colon  bacillus. 

It  would  appear  that  in  addition  to  the  liver  infection  there  must  have 
been  some  other  etiological  element,  but  no  positive  proof  of  this  could 
be  adduced.  On  one  occasion  prior  to  the  operation  the  writer  thought 
that  he  found  some  very  small  gall  stones  in  the  feces,  but  admits  that 
he  may  have  been  mistaken.  It  would  appear,  therefore,  that  this  was  a 
case  of  infectious  cholangitis  without  stone.  It  is  hardly  probable  that 
stones  were  present  and  that  all  of  them  should  escape  spontaneously, 
for  this  occurs  only  very  rarely. 

Riedel  believes  that  an  acute  cholecystitis  without  stone  is  not  of 
especially  infrequent  occurrence,  although  the  cases  are  rarely  ever  seen 
by  surgeons.  Reidel  has  reported  a  case  of  a  boy  of  nine  years  who  pre- 
sented what  appeared  to  be  the  symptoms  of  acute  appendicitis,  but  at 
operation  there  was  found  a  tremendously  distended  gall  bladder,  which 
did  not  present  any  very  definite  evidence  of  disease  other  than  the  pres- 
ence of  large  numbers  of  colon  bacilli  in  the  bile  This  patient  made  a 
satisfactory  recovery  without  drainage  of  the  gall  bladder. 

The  writer  enters  into  a  discussion  as  to  whether  or  not  the  operation 
in  his  case  was  of  any  particular  value,  and  believes  that  it  certainly 
was,  inasmuch  as  it  favored  a  free  drainage  of  the  bile  passages  and  in 
this  way  relieved  in  a  measure  the  cholangitis.  He  has  not  been  able  to 
find  a  case  exactly  like  his  own  in  the  literature,  although  there  are 
numerous  cases  where  jaundice  and  biliary  colic  have  occurred  without 
the  presence  at  the  time  of  operation  of  any  stone 


820 


CURRENT  MEDICAL  LITERATURE 


OPHTHALMOLOGY 

Edited  by  Charles  M.  Culver,  M.  D. 

Concerning  Irritation  Caused  by  the  Use  of  A  tropin. 
Sym.    The  Ophthalmoscope  (London),  I  April,  /905. 

The  continued  use  of  atropin,  as  a  mydriatic,  sometimes  causes  the 
practitioner  much  trouble  by  producing  acute  inflammation  of  the  skin 
and  conjunctiva.  This  is  a  real  idiosyncrasy  and  not  caused  by  a  septic 
condition  of  the  solution  of  atropin ;  the  author  has  not  found  it  advan- 
tageous, in  such  cases,  as  regards  the  dermatitis,  to  change  the  mydriatic. 
A  recent  case  is  quoted,  of  iridocyclitis,  with  a  tendency  to  synechiae,  with 
deposits  on  Descemet's  membrane,  in  which,  consequently,  mydriasis  was 
most  urgently  desired ;  in  which  the  dermatitis  in  question  was  caused 
by  the  use  of  atropin ;  it  became  so  severe  that  the  use  of  this  alkaloid 
needed  to  be  discontinued.  When  a  relapse  occurred,  a  resumption  of 
the  use  of  atropin  resulted  in  a  renewal  of  the  conjunctivitis.  The  alka- 
loid was  then  used  in  oily  solution,  without  causing  the  inflammation  of 
skin  or  conjunctiva.  This  freedom  from  irritation  existed  during  several 
weeks'  use  of  the  oily  solution.  The  solvent  was  pure  olive  oil,  which  was 
boiled  and  atropin  was  added  while  the  oil  was  cooling.  Scrini,  of  Paris, 
praises  this  oleaginous  solution,  but  does  not  report  having  derived 
benefit,  of  the  kind  in  question,  from  its  use.  In  the  actual  inflammation, 
ichthyol  gives  the  best  results. 


Adrenalin  in  the  Treatment  of  Glaucoma.     (Comment  faut-il  employer 
Vadrenaline  pour  guerir  le  giaucome  sans  operation ?) 

Grandclement,  (Lyons).    La  Clinique  Ophthalmologxque,  No.  12,  1904. 

This  author  holds  adrenalin  to  be  capable  of  the  cure  of  glaucoma, 
whether  primary  or  secondary. 

Four  conditions  are  necessary  to  success. 

1.  The  disease  must  be  recent;  not  of  long  enough  standing  to  have 
produced  lesions  of  the  ciliary  body,  iris  or  in  the  angles  of  the  anterior 
chamber. 

2.  The  adrenalin  must  be  instilled  into  the  eye  at  intervals  of  half  an 
hour,  without  any  interruption  at  all,  for  about  three  days,  when  the 
tension  will  have  been  reduced. 

3.  Eserin  must  be  used,  at  the  same  time,  to  combat  two  of  the  pro- 
cesses that  attend  glaucoma ;  the  hypersecretion  of  aqueous  humor,  by  the 
tongested  ciliary  body  and  the  plugging  of  the  angles  of  the  anterior 
chamber  by  the  dilatation  of  the  pupil. 

4.  The  use  of  the  remedy  must  be  discontinued  as  soon  as  the  tension 
has  reached  the  normal,  since  its  overuse  tends  to  produce  atheroma  of 
the  larger  vessels. 


Vol.  xxvii 


DECEMBER,  1906 


No.  12 


ALBANY 
MEDICAL  ANNALS 


®riainal  Communications 

PRESIDENTS'  ADDRESS. 

Delivered  at  the  Annual  Meeting  of  the  Albany  Medical  College  Alumni 
Association  of  New  England,  held  at  Springfield,  Mass.,  October  9,  1906. 

By  ALVA  E.  ABRAMS,  M.  D., 

Hartford,  Conn. 

Friends  and  Members  of  the  Albany  Medical  College  Alumni 
Association  of  New  England: — We  have  convened  to-day  to 
celebrate  our  eighth  anniversary,  to  make  new  friendships  and 
revive  old  ones,  to  compare  our  trials  and  successes  and  con- 
sider the  welfare  of  the  old  "  Homestead  "  we  all  honor,  the 
Albany  Medical  College. 

She  has  always  kept  in  the  front  rank  of  advancing  medical 
science  but  never  before  has  she  been  so  well  equipped  to  offer 
advanced  scientific  teaching  and  splendid  clinical  advantages  to 
her  students  as  to-day.  Where  can  you  find  another  school  in 
the  United  States  that  offers  a  greater  diversity  of  patients 
practically  under  one  roof,  and  such  fine  laboratory  facilities  in 
proportion  to  her  size,  for  those  who  desire  to  pursue  special 
lines  of  study  and  investigation?  It  makes  some  of  us  older 
graduates  feel,  as  we  look  back  on  our  own  student  days,  that 
we  desire  to  be  "  born  again  "  and  pass  along  the  new  and  better 
way.  But  we  have  a  great  duty  yet  to  perform  and  we  are 
false  to  our  Alma  Mater  if  we  do  not  enter  into  her  spirit  of 
progress  and  keep  ourselves  in  touch  with  her  progressive  teach- 
ings. In  the  true  analysis  any  college  is  estimated  by  the 
teachers  she  develops  and  the  students  she  sends  forth.  The 
buildings  and  all  paraphernalia  are  but  instruments  in  the 
artisan's  hand. 


822 


president's  address 


The  laity  in  any  particular  community  will  judge  the  Albany 
Medical  College  by  the  physician  she  sends  to  that  place  and  his 
responsibility  for  that  special  part  of  her  reputation  is  as  great 
and  as  sacred  as  his  honor  unto  father  and  mother.  I  believe 
the  time  will  come  when  every  progressive  medical  school  will 
look  more  carefully  after  the  welfare  and  advancement  of  her 
post-graduates  and  provide  such  attractive  courses  of  post- 
graduate studies  and  clinical  opportunities  that  many  will  accept 
the  chance  to  keep  apace  with  the  rapid  advance  in  our  art. 

To-day  there  seems  to  be  two  great  impediments  in  the  way 
of  this  most  desirable  reform:  first,  the  indifferent  attitude 
of  a  large  number  of  the  Alumni  toward  our  association  meet- 
ings and  the  college  in  general.  We  have  all  sinned  in  this 
respect  and  many  of  us  are  "  no  longer  worthy  to  be  called  sons." 
As  was  well  said  at  the  last  General  Alumni  Meeting  in  Albany 
"  we  have  expected  the  college  to  do  all  for  us,"  and  we  throw 
all  the  burden  on  our  hard  working  professors,  while  we 
passively  wait  with  open  mouths  to  have  the  good  things  dropped 
in  by  other  hands.  I  low  often  have  we  drugged  our  consciences 
with  the  excuse  that  "  we  are  too  busy  to  break  away  for  a 
day  "  and  get  a  spark  of  new  interest  to  cheer  us  on  in  our 
strenuous  existence.  When  the  sons  of  our  Alma  Mater  take 
a  general  interest  in  progressive  medicine  and  are  wise  enough 
to  spend  a  few  weeks  or  months,  now  and  then,  in  post-graduate 
studies,  the  way  will  be  provided  in  our  home  college,  and  many 
a  community  will  be  blessed  with  a  wiser  and  more  enthusiastic 
family  physician. 

During  the  last  ten  years  many  mediocre  physicians  and  sur- 
geons have  lifted  themselves  to  first  places  in  their  respective 
communities  by  devoting  a  liberal  vacation  period  to  special 
work  in  our  medical  centers.  Viewed  from  the  commercial  stand- 
point only,  which  is  the  least  honorable,  it  probably  paid  better 
than  any  other  investments  they  ever  made,  but  the  extra  amount 
of  human  suffering  relieved  cannot  be  estimated  in  dollars, 
while  added  respect  and  honor  from  their  patients  made  life 
seem  worth  living  and  "  living  more  abundantly." 

We  all  get  discouraged.  Everything  ahead  looks  like  slavery 
and  endless  care  and  toil.  We  are  ready  to  desert  our  profes- 
sion. All  other  lives  about  seem  easier  and  more  hopeful  than 
ours.  When  we  get  into  this  "  slough  of  despond "  we  need 
rest  and  a  draught  from  some  new  fountain  of  inspiration.  "Let 


ALVA  E.  ABRAMS 


823 


us  therefore  lay  aside  every  weight  "  and  the  sins  of  omission 
and  indifference  "  which  so  easily  beset  us,"  and  run  with  pa- 
tience and  highest  self-respect  the  race' that  is  set  before  us. 

The  second  great  obstacle  to  adequate  opportunities  for  post- 
graduate studies  is  the  lack  of  money.  We  are  living  in  the 
most  prosperous  period  our  country  has  ever  known.  Money 
flows  freely  into  a  thousand  channels  of  industry  and  amuse- 
ment. We  no  longer  reckon  by  thousands  or  tens  of  thousands 
but  by  millions.  Yet  amid  all  this  flood  of  prosperity  medical 
science  and  investigation  have  never  received  the  honest  por- 
tion to  which  they  are  entitled.  Yet  the  fault  is  not  so  much 
with  the  holders  of  wealth  as  we  commonly  think.  If  half  the 
organized  effort  were  made  to  raise  money  for  the  advance- 
ment of  medical  science  that  is  made  to  acquire  it  for  missionary 
purposes  and  many  another  good  object,  we  should  have  sufficient 
funds  to  bring  to  our  schools  large  numbers  of  the  greatest 
teachers  and  investigators  from  all  parts  of  the  world. 

As  illustrating,  in  a  small  way,  what  can  be  accomplished 
allow  me  to  refer  to  the  Hartford  Medical  Society.  When  I 
first  knew  that  organization  twenty-three  years  ago  it  had  a  hand- 
ful of  good  earnest  workers  who  met,  from  time  to  time,  at  the 
homes  of  the  various  members.  Later  a  hall  was  hired  as  a 
regular  meeting  place  and  a  rule  was  made  that  papers  should 
be  especially  prepared  for  each  meeting.  Little  by  little  we  began 
to  realize  that  to  give  character  to  our  society  and  to  offer  stronger 
inducements  to  the  physicians  all  about  us  to  become  members 
we  needed  a  building  of  our  own  large  enough  to  hold  our 
growing  library  and  accommodate  our  meetings.  Through  the 
influence  of  one  or  two  of  our  active  members,  who  had  the 
welfare  of  the  society  always  at  heart,  we  received  an  endow- 
ment of  $20,000  for  a  home.  Yet  we  had  no  place  to  put  our 
building,  but  enthusiasm  was  growing  and  ere  long  we  had, 
from  our  own  members,  nearly  $10,000  wherewith  to  purchase 
a  suitable  lot,  near  the  center  of  the  city.  With  a  fine  building 
well  equipped  we  still  felt  that  our  ideal  was  not  fully  realized 
and  we  began  reaching  out  for  contributions  and  endowments 
that  would  create  a  sufficient  fund  to  carry  on  some  scientific 
work  and  attract  to  us,  from  time  to  time,  leading  men  from 
various  medical  centers.  To-day  we  have  on  hand,  or  assured, 
about  $105,000.  and  the  end  is  not  yet.  While  not  a  dollar  of 
this  has  so  far  been  expended  directly  for  the  benefit  of  the 


824 


president's  address 


society  we  are  a  more  earnest  and  progressive  body,  for  the 
very  same  reason  that  any  business  man  works  harder  and  with 
better  heart  when  he  sees  success  crowning  his  efforts. 

As  physicians  we  have  been  too  diffident  in  claiming  our  share 
of  the  general  prosperity.  In  many  sections  of  the  country 
the  fees  for  medical  services  are  little  or  no  better  than 
before  the  civil  war,  notwithstanding  the  great  increase  in  wages 
for  all  classes  of  artisans  and  a  very  marked  increase  of  the 
average  amount  of  money,  per  capita,  in  the  United  States  dur- 
ing the  past  ten  years. 

In  an  address  delivered  before  the  State  Medical  Society,  of 
Nebraska,  in  May  of  this  year  (1906)  Dr.  W.  O.  Bridges,  of 
Omaha,  made  some  statements  that  will  bear  repeating  in  this 
connection.    He  says : 

"  Looking  over  the  subject  of  physicians'  fees  in  the  past 
twenty-five  years,  one  is  impressed  with  the  fact  that  the  charges 
made  by  men  in  country  practice  have  not  advanced  one  cent, 
whereas  the  classes  of  people  whom  he  serves  have  doubled, 
trebled  and  even  quadrupled  their  incomes.  Twenty-five  years 
ago  the  outlay  for  the  physician's  medical  education  in  time  re- 
quired and  money  expended  was  less  than  one-half  the  present 
cost  and  in  consequence  thereof  the  value  of  service  which  he 
gives  to-day  as  compared  with  the  former  period  can  not  even 
be  measured  in  dollars  and  cents.  The  charge  of  fifty  cents 
for  an  office  prescription  may  be  all  the  prescription  is  worth 
many  times,  for,  if  it  is  the  prescription  which  the  fee  is  made 
for,  the  patient  is  not  getting  more  than  his  money's  worth. 
Too  often  is  this  impression  given  to  patients  or  too  seldom 
are  they  led  to  understand  that  the  prescription  is  only  an  end 
result  of  an  examination  which  requires  technical  knowledge 
and  experienced  judgment.  A  fifty  cent  fee  is  too  apt  to  mean 
a  fifty  cent  service.  This  is  no  reflection  on  the  doctor,  what- 
ever, for  human  nature  is  the  same  everywhere,  and  so  long 
as  it  is  the  custom  for  our  services  to  be  measured  in  money 
value  the  reverse  in  most  instances  will  apply,  the  value  in 
money  determines  the  service.  To  state  an  opposite  hypothesis 
may  make  this  statement  seem  less  critical.  Suppose  the  fee 
charged  for  office  consultation  were  arbitrarily  fixed  at  five  dol- 
lars, is  there  a  single  physician  in  this  state  who  would  be  content 
simply  to  ask  a  few  questions,  look  at  the  tongue,  determine 
the  absence  of  fever,  by  the  hand  contact,  turn  around  and 


ALVA  E.  ABRAMS 


825 


write  a  prescription?  What  applies  to  a  fifty  cent  office  fee 
applies  also  to  a  dollar  visit  in  town,  a  mileage  of  fifty  cents 
without  a  visit  fee  in  the  country  and  a  twenty-four  to  forty- 
eight  hour  obstetric  fee  of  ten  dollars. 

"  The  low-fee  proposition  has  two  principal  bad  results  for 
the  physician.  By  the  undervaluation  of  his  own  service,  his 
confidence  in  himself  in  time  suffers,  his  wrork  becomes  super- 
ficial and  he  ceases  to  develop,  and,  failing  to  earn  a  competency 
during  the  active  years  of  his  professional  life,  he  too  frequently 
goes  into  his  old  age  without  the  necessities  of  life  or  is  de- 
pendent on  relatives  for  support.  On  the  other  hand,  fees  pro- 
portionate to  good  service  mean  much  to  the  doctor.  The  stimu- 
lus to  be  thorough  and  painstaking,  to  think  and  to  study  over 
his  cases,  to  relieve  him  of  the  necessity  of  outside  financial 
interests,  means  much  for  his  professional  advancement,  for  the 
increased  revenue  and  his  inclination  lead  him  to  seek  the  change 
and  advantages  offered  by  the  post-graduate  schools  and  by  the 
hospitals  of  nearby  cities.  He  also  feels  better  able  to  afford 
the  time  and  pleasure  of  the  county,  state  and  national  societies 
more  frequently. 

"There  is  no  community  which  would  not  be  greatly  benefited 
by  an  increased  income  to  all  the  members  of  the  profession  in 
their  midst.  Suppose,  for  example,  that  each  physician  in  a 
town  having  six  physicians  should  devote  from  three  to  six 
months  every  *six  years  to  post-graduate  hospital  work,  what  effect 
would  this  have  on  the  value  of  his  service  and  who  else  would 
profit  by  it?  Does  a  physician  ever  go  to  a  county,  state  or 
other  medical  society  meeting  without  receiving  some  new  sug- 
gestion or  having  awakened  some  new  thought?  If  he  goes  to 
Chicago,  New  York,  Philadelphia,  or  Baltimore  for  a  month  in 
contact  with  other  medical  men.  does  he  not  return  with  renewed 
determination  to  get  out  of  a  rut  and  stay  out?  If  he  can  figure 
that  his  professional  income  will  admit  of  his  doing  this,  and 
that  by  so  doing  he  will  gain  vantage  ground,  and  by  the  very 
move  still  further  increase  his  income,  is  he  not  standing  in 
his  own  light  not  to  do  it?  Farther  than  this,  does  not  his  duty 
to  his  patrons  and  his  influence  in  the  community  require  him 
to  do  it?  And  if  so,  should  they  not  pay  for  it  in  fees  which 
will  permit  of  a  little  more  than  a  comfortable  living?  When 
I  have  talked  with  some  of  my  professional  friends  about  this 
subject,  the  reply  has  been  '  The  fees  in  our  community  have 


826 


president's  address 


been  fixed  so  long  that  our  patrons  would  rebel  at  any  increase, 
and,  furthermore,  there  would  be  lack  of  uniformity  in  com- 
peting towns  and  we  might  sacrifice  our  business.'  To  the  first 
suggestion  I  would  offer  a  protest.  From  what  I  have  written 
above  as  to  the  character  of  the  service,  it  is  assumed  that  the 
farmer  or  the  tradesman  is  willing  to  pay  for  what  he  buys, 
if  he  is  made  to  see  that  what  he  buys  is  worth  the  money,  he 
pays.  That  he  is  not  averse  to  doing  so  can  be  demonstrated 
time  and  time  again,  when  he  is  seen  to  pay  railroad  fare  in 
addition  to  a  good-sized  consultation  fee  to  some  city  doctor, 
who  may  be  no  better  or  perhaps  not  so  good  as  his  own 
physician." 

Every  word  I  quote  from  the  Doctor's  address  is  true  as 
gospel,  and  yet  from  my  own  observation  and  inquiry  during  the 
past  summer  over  a  portion  of  the  western  states  and  Canada  I 
believe  our  western  physician  especially  in  the  country  towns,  gets 
better  fees  and  collections  are  easier,  than  the  average  county 
practitioner  in  the  east.  For  example,  a  physician  practicing  in  a 
small  town  in  Alberta,  Canada,  several  hundred  miles  from  any 
city,  told  me  that  he  collected  twenty-five  dollars  each  for  nearly 
all  his  obstetric  cases  which  is  considerably  more  than  is  usually 
paid  here  in  the  east,  in  village  or  country  practice,  or  even  for 
a  great  share  of  cases  in  the  medium  sized  cities,  yet  this  young 
man  did  not,  in  many  instances,  get  anything  like  just  remuner- 
ation for  his  time,  hard  work  and  anxiety  involved.  But  as 
Doctor  Bridges  has  said,  if  we  expect  proper  fees  we  must  give 
adequate  return  for  money  expended. 

A  lady  recently  came  to  my  office  who  had  spent  the  summer 
in  one  of  our  Northern  States.  She  was  suffering  from  ovarian 
disease  and  when  I  asked  why  she  had  not  received  any  treat- 
ment during  her  summer  outing  she  replied  that  she  had  called 
on  six  different  physicians  during  that  time  and  not  one  of  them 
had  an  office,  or  a  pair  of  hands,  that  looked  clean  enough  to 
justify  her  in  allowing  a  vaginal  examination  to  be  made.  An- 
other patient,  while  rusticating  in  a  town  in  the  White  Moun- 
tains, was  seized  with  a  severe  attack  of  biliary  colic.  The 
physician  who  was  called  proceeded  to  administer  a  hypodermic 
injection  made  from  non-sterile  water,  without  even  washing 
his  hands  or  in  any  way  cleansing  the  patient's  skin.  To  all 
of  this  she  very  wisely  and  firmly  took  exception,  and  refused  to 
have  treatment.    What  reasonable  excuse  can  be  offered  for  such 


ALVA  E.  ABRAMS 


827 


mal-practice  in  this  enlightened  twentieth  century?  It  would 
be  interesting  to  know  how  many  obstetric  cases  in  the  care 
of  this  man  died  from  so-called  "  taking  cold  "  a  few  days  after 
delivery ;  yet  these  doctors  were  all  regular  graduates  in  medi- 
cine but  every  one  casting  discredit  on  the  college  from  which 
he  graduated  and  on  the  profession  in  general,  not  because  his 
teachers  had  neglected  their  duty,  but  because  he  had  grown 
indifferent  and  proven  a  traitor  to  his  Alma  Mater.  If  such 
men  get  small  fees,  or  none  at  all,  who  shall  say  that  they  are 
not  paid  all  their  services  are  worth? 

Every  successful  business  man  puts  a  certain  portion  of  his 
annual  profits  back  into  his  business  in  the  way  of  better  equip- 
ment and  enlarged  facilities,  but  we  as  medical  men  seem  too 
often  to  overlook  this  fundamental  principle  of  success,  and  ex- 
pect the  business  ends  of  our  affairs  to  run  themselves.  We 
have  sometimes,  I  fear,  allowed  our  hard  earned  dollars  to  slip 
away  in  poor  investments,  when  had  they  been  invested  in  up-to- 
date  appliances  and  methods  in  our  practice  the  returns  would 
show  a  larger  per  cent  or  profit  than  any  gold  mine  we  ever 
purchased  stock  in.  I  honestly  believe  if  we,  every  sabbatical 
year,  threw  away  all  of  our  out-of-date  instruments  and  books 
and  after  six  months  of  serious  post-graduate  study,  took  a  fresh 
start  among  our  patients  in  an  attractive  office  we  should  have 
larger  incomes  and  greatly  increased  confidence  from  the  in- 
telligent patrons  of  our  community.  We  cannot  expect  our 
patients  to  pay  their  bills  cheerfully,  unless  they  feel  that  it  is 
"  for  value  received." 

Let  us  live  nearer  to  the  measure  of  our  opportunities,  demand 
fair  pay  for  good  service  and  endeavor  to  show  to  the  public  in 
general  the  great  need  of  endowments  all  along  the  lines  of 
medical  teaching  and  investigation.  We  shall  not  appeal  in  vain 
and  in  the  latter  days  of  our  lives  we  shall  hear  many  voices 
saying,  "  Well  done,  good  and  faithful  secant." 


828      HYPEREMIA  IN  THE  TREATMENT  OF  ACUTE  INFECTIONS 

HYPEREMIA  IN  THE  TREATMENT  OF  ACUTE  IN- 
FECTIONS. 
By  ARTHUR  W.  ELTING,  M.  D., 

Surgeon  to  the  Albany  Hospital,  St.  Peter's  Hospital  and  the  Child's  Hospital. 
Albany,  N.  Y. 

As  a  result  of  modern  study  and  investigation  the  views  held 
regarding  the  malignity  of  many  of  nature's  processes  have  been 
greatly  modified,  and  in  no  phase  of  disease  is  this  more  strik- 
ingly exemplified  than  in  the  processes  of  inflammation.  Once 
regarded  as  a  most  unfavorable  process,  we  have  now  come  to 
look  upon  it  as  nature's  most  powerful  agent  to  protect  the  tissues 
from  the  ravages  of  bacteria  and  their  toxins.  Were  it  not  for 
the  phenomena  of  inflammation  the  most  trivial  of  infections 
would  speedily  prove  fatal  and  animal  life  would  in  a  short  time 
become  extinct.  Of  all  the  phenomena  associated  with  inflam- 
mation, perhaps  the  most  constant  and  striking  is  hyperemia, 
which  may  be  said  to  be  nature's  greatest  therapeutic  agent. 
The  recognition  of  hyperemia  as  an  important  factor  in  the 
cure  of  infections  is  not  of  recent  date,  for  the  ancients  in  medi- 
cine were  well  aware  of  its  value  and  in  more  or  less  crude 
manner  employed  it.  The  credit  for  the  development  of  hyper- 
emia as  a  logical  method  of  treatment  of  infections  belongs  to 
Professor  Bier  of  Bonn,  who  for  the  past  fifteen  years  has  made 
constant  use  of  the  method  in  his  clinic,  and  who  has  developed 
and  refined  the  mode  of  its  employment,  until  to-day  it  is  within 
the  reach  of  every  intelligent  physician. 

Hyperemia  simply  seeks  to  accentuate  nature's  methods  of 
combating  noxious  substances  which  may  have  gained  entrance 
into  the  organism.  Antiphlogistic  methods  of  treatment  of  acute 
inflammations  are  in  general  to  be  condemned,  because  they 
actively  counteract  nature's  beneficent  efforts  in  behalf  of  the 
diseased  tissue.  Two  varieties  of  hyperemia  must  be  distin- 
guished, the  active  and  the  passive.  In  a  general  way  the  former 
may  be  said  to  be  arterial  and  the  latter  venous,  although  to 
this  rule  there  are  exceptions,  as  in  chronic  passive  congestion 
of  the  lungs  resulting  from  heart  disease,  in  which  instance  the 
passive  hyperemia  is  arterial  in  character.  Between  the  blood 
of  active  hyperemia  and  that  of  passive  hyperemia  there  are 
important  physical  and  chemical  differences ;  the  former  con- 
taining much  free  oxygen  and  but  little  carbonic  acid  and  alkali, 


ARTHUR  VV.  ELTING 


829 


while  the  latter  presents  exactly  the  opposite  character.  Further- 
more, the  fluid  and  formed  elements  are  kept  in  active  motion 
in  the  blood  stream  in  active  hyperemia,  while  in  passive  hyper- 
emia they  are  both  allowed  to  escape  more  or  less  into  the  tissues. 

Active  hyperemia  can  be  produced  in  a  great  variety  of  ways — 
mechanically,  chemically  and  physically.  Much  of  the  benefit 
derived  from  massage  and  manipulation  is  due  to  the  hyperemia 
induced.  The  same  may  be  said  to  be  true  to  even  a  greater 
degree  of  chemicals  as  applied  in  the  form  of  blisters,  etc.  The 
most  universally  employed  of  all  measures  to  induce  active 
hyperemia  is  warmth,  the  effect  of  which  is  to  increase  the 
rapidity  of  the  circulation  and  the  amount  of  blood  brought  to 
the  part.  Bier  has  shown  conclusively  that  of  all  forms  of  heat, 
hot  air  is  the  most  efficacious  in  the  production  of  hyperemia, 
and  to  Bier  belongs  the  credit  for  the  invention  of  the  modern 
hot  air  method  of  treatment.  It  has  been  conclusively  proven 
that  the  exposure  of  a  portion  of  the  surface  of  the  body  to  hot 
air  produces  an  hyperemia  of  the  deep  as  well  as  the  superficial 
tissues. 

The  methods  for  the  production  of  passive  hyperemia  are  by 
no  means  as  numerous  as  those  employed  for  the  production  of 
active  hyperemia.  One  of  the  oldest,  if  not  the  oldest,  method 
of  producing  passive  hyperemia  is  the  application  of  cold.  The 
old  idea  that  cold  possessed  an  antiphlogistic  action  must  be 
abandoned,  for  there  is  no  longer  any  doubt  that  the  ice  bag  is 
a  very  effective  means  of  inducing  passive  hyperemia,  and  this 
hyperemia  extends  deeply  into  the  tissues.  Ambroise  Pare 
appears  to  have  employed  passive  hyperemia  in  the  treatment  of 
ununited  fractures  and  in  cases  in  which  the  production  of  callus 
was  unsatisfactory.  His  ideas  were  apparently  forgotten  until 
Nicoladoni  revived  them  in  1875  and  strongly  advocated  passive 
hyperemia  as  a  valuable  method  of  treatment  for  ununited  frac- 
tures. Since  that  time  numerous  observers  have  confirmed  the 
correctness  of  his  conclusions.  The  method  employed  by  Nicola- 
doni for  the  production  of  passive  hyperemia  was  practically  the 
method  employed  to-day,  namely:  constriction  by  means  of  an 
elastic  band.  Hyperemia  of  a  passive  character  can  also  be  pro- 
duced by  means  of  a  variety  of  suction  apparatuses.  One  variety 
employed  for  small  local  infections,  such  as  boils,  resembles  a 
small  glass  breast  pump ;  a  small  bell-shaped  glass,  to  the  apex 
of  which  a  rubber  tube  is  attached,  being  applied  immediately 


830      HYPEREMIA  IN  THE  TREATMENT  OF  ACUTE  INFECTIONS 

over  the  area  where  hyperemia  is  desired  and  the  air  exhausted 
by  a  rubber  suction  pump,  after  which  the  rubber  tube  is  clamped, 
the  suction  pump  disconnected,  and  the  glass  left  in  place  as  long 
as  desired.  Similar  apparatus  in  larger  size  has  been  devised 
for  inducing  hyperemia  of  joints.  The  joint  is  enclosed  in  an 
air-tight  glass  compartment  and  the  air  withdrawn  by  means  of 
the  suction  pump  until  more  or  less  of  a  vacuum  is  produced. 
In  this  way  varying  degrees  of  passive  hyperemia  can  be  secured. 

All  investigators  are  agreed  that  passive  hyperemia  increases 
the  quantity  of  lymph  in  the  part  as  well  as  the  rapidity  of  its 
flow.  In  passive  hyperemia,  however,  which  is  produced  by  an 
elastic  band,  this  flow  of  lymph  is  naturally  interfered  with, 
because  the  delicate  walls  of  the  lymph  vessels  are  even  more 
readily  constricted  by  the  pressure  than  are  the  walls  of  the  veins. 
The  oedema  associated  with  passive  hyperemia  artificially  induced 
is  in  large  part  due  to  the  lymph  stasis. 

One  of  the  most  striking  effects  of  both  active  and  passive 
hyperemia  is  the  lessening  of  pain.  This  phenomenon  is  prob- 
ably due  to  a  lessening  of  the  sensitiveness  of  the  nerve  endings 
which  Ritter  believes  is  the  result  of  the  infiltration  of  the  tissues 
with  serum  in  much  the  same  way  that  artificial  infiltration  by 
Schleich's  method  produces  anaesthesia.  The  view  that  pain 
associated  with  inflammation  is  due  to  hyperemia  must  be  aban- 
doned, the  probable  cause  of  this  pain  being  some  disturbance 
of  the  nerve  endings  by  the  noxious  substances  in  the  tissues. 
The  soothing  action  of  heat  or  counter-irritants  is  undoubtedly 
due  to  the  hyperemia  induced.  This  pain-lessening  property  of 
hyperemia  is  of  importance  not  only  from  the  subjective  stand- 
point of  the  patient,  but  also  from  the  fact  that  it  allows  more 
vigorous  active  and  passive  motion  of  inflamed  tendons  and 
joints,  and  thereby  materially  lessens  the  likelihood  of  contrac- 
tures and  faulty  positions. 

Another  most  important  property  of  hyperemia  is  its  bacteri- 
cidal action.  This  has  been  clearly  demonstrated  experimentally 
by  Notzel,  who  inoculated  portions  of  the  bodies  of  rabbits 
rendered  passively  hyperemic  with  lethal  doses  of  bacteria,  and 
found  that  in  fifty-one  of  sixty-seven  such  experiments  the 
animals  recovered,  while  all  the  control  animals  died. 

Laqueur  has  demonstrated  that  the  serum  from  tissues  pas- 
sively hyperemic  possesses  a  bactericidal  power  distinctly  greater 
than  that  of  serum  from  a  non-hyperemic  part  of  the  same  indi- 


ARTHUR  W.  ELTIXG 


831 


vidual.  Wessely  has  also  shown  that  the  anti-bodies  are  pro- 
duced more  actively  in  passively  hyperemic  tissues  than  in  normal 
tissues.  Buchner  and  others  believe  that  a  large  part  of  this 
bactericidal  property  is  due  to  an  increase  of  the  leucocytes  in 
the  hyperemic  area,  and  that  to  these  leucocytes  rather  than  to 
the  blood  serum  the  destruction  of  bacteria  and  toxines  is  due. 
Hamburger  is  of  the  opinion  that  the  increased  content  of  car- 
bonic acid  in  the  passively  hyperemic  tissue  is  largely  responsible 
for  the  bactericidal  action.  He  has  demonstrated  that  the  lymph 
in  passively  hyperemic  tissue  is  also  distinctly  more  bactericidal 
than  the  lymph  from  other  parts  of  the  same  body,  and  since 
the  bacteria  occupy  chiefly  the  lymph  spaces  the  therapeutic  effect 
of  passive  hyperemia  would  be  the  natural  sequence. 

The  absorptive  property  of  active  hyperemia  can  be  readily 
enough  demonstrated  by  exposing  an  oedematous  leg  to  hot  air, 
when  after  a  short  time  a  more  or  less  marked  diminution  of  the 
oedema  will  be  noted.  Absorption  of  fluids  seems  to  occur 
chiefly  through  the  blood  capillaries  and  not  through  the  lymph 
vessels,  as  was  once  supposed.  Absorption  of  formed  particles, 
on  the  other  hand,  occurs  almost  exclusively  through  the  lymph 
channels.  Klapp  has  shown  that  in  passive  hyperemia  the 
absorption  is  delayed  while  the  elastic  band  is  in  place,  but  is 
increased  after  the  band  is  removed,  and  so  much  is  the  rapidity 
of  absorption  increased  that  the  sum  total  of  the  effect  of  passive 
hyperemia  can  be  said  to  be  a  decided  increase  of  absorption. 

The  solvent  property,  especially  of  active  hyperemia,  is  another 
of  its  well  recognized  features.  As  a  result  of  this  action,  blood 
clot,  joint  accumulations,  fibrin,  etc.,  are  more  or  less  dissolved 
and  rendered  capable  of  being  absorbed.  In  the  course  of  acute 
inflammatory  processes,  so-called  autolysis  or  autodigestion  is 
observed  and  is  usually  regarded  as  the  result  of  the  action  of 
ferment  supposed  to  be  derived  mainly  from  the  leucocytes.  It 
is  to  be  presumed,  however,  that  the  inflammatory  hyperemia  is 
the  most  important  factor  in  this  autolysis.  It  is  a  matter  of 
frequent  observation  that  scars  become  softened  and  elastic 
under  the  influence  of  hyperemia.  The  exact  cause  or  causes  of 
this  solvent  property  of  hyperemia  have  not  as  yet  been  definitely 
determined,  for  hyperemia  is  most  certainly  a  complex  associa- 
tion of  physical  and  chemical  phenomena. 

It  has  long  been  recognized  that  hyperemia  possesses  a  pro- 
nounced nutritive  action,  and  Paget  many  years  ago  emphasized 


832      HYPEREMIA  IN  THE  TREATMENT  OF  ACUTE  INFECTIONS 

the  important  relationship  of  the  hyperemia  resulting  from  a 
venous  thrombosis  to  an  increase  in  the  volume  of  the  involved 
area.  Many  observers  have  claimed  that  this  increase  in  size 
was  due  to  an  hypertrophy  of  the  muscles,  but  it  seems  rather 
more  probable  that  this  apparent  hypertrophy  may  be  simply  a 
forerunner  of  a  subsequent  muscular  degeneration.  It  is,  how- 
ever, definitely  proven  that  a  passive  hyperemia  promotes  the 
activity  of  growth  of  the  skin,  hair  and  nails.  There  is  no 
evidence  that  hyperemia  causes  any  hyperplasia  of  secreting 
glandular  epithelium,  but  on  the  other  hand  it  would  appear,  in 
some  instances  at  least,  to  cause  an  atrophy  of  the  cells.  For 
many  years  surgeons  have  recognized  the  fact  that  prolonged 
hyperemia  during  the  period  of  growth  had  a  decided  tendency 
to  cause  an  increase  in  the  dimensions  of  the  bones  of  the  hyper- 
emic  part  decidedly  greater  than  would  occur  in  a  normal  grow- 
ing part.  The  clubbed  fingers  of  cardiac  and  pulmonary  disease 
are  in  all  probability  the  result  of  a  long  continued  passive 
hyperemia.  While  the  evidences  of  the  hypertrophic  influence  of 
passive  hyperemia  are  most  abundant,  those  demonstrating  a 
similar  influence  of  active  hyperemia  are  relatively  few.  Roux 
has  expressed  the  belief  that  only  those  tissues  or  organs  with  a 
passive  function,  and  never  those  with  an  active  function,  are 
capable  of  hypertrophy  as  a  result  of  increased  nourishment. 
That  hyperemia  promotes  regeneration  of  tissue  is  generally 
recognized,  and  no  better  illustration  of  this  function  can  be 
adduced  than  its  effect  upon  ununited  fractures,  in  which  class 
of  cases  it  has  come  to  be  a  well  recognized  mode  of  treatment. 

After  a  careful  study  of  the  relative  value  of  active  and  pas- 
sive hyperemia  in  the  treatment  of  infections,  Bier  has  con- 
cluded that  passive  hyperemia  more  nearly  resembles  nature's 
method  of  treatment,  and  from  practical  experience  he  has 
demonstrated  it  to  be  more  efficacious  than  active  hyperemia. 
In  general  it  may  be  said  that  passive  hyperemia  is  indicated  in 
acute  or  bacterial  infections,  while  active  hyperemia  is  indicated 
in  chronic,  non-bacterial  diseases.  Bier  believes  the  most  impor- 
tant feature  of  passive  hyperemia  is  the  slowing  of  the  circula- 
tion and  the  widening  of  the  stream,  which  allows  a  more  inti- 
mate and  prolonged  contact  of  the  constituents  of  the  blood  with 
the  diseased  tissues. 

For  the  past  two  years  the  writer  has  made  constant  use  of 


ARTHUR  W.  ELTING 


833 


the  method  of  passive  hyperemia  in  the  treatment  of  all  forms  of 
acute  infections. 

This  treatment  has  been  made  a  routine  measure  in  his  service 
at  the  Albany  Hospital,  the  St.  Peter's  Hospital,  as  well  as  in 
private  practice,  and  the  results  have  been  in  every  respect  most 
satisfactory.  To  induce  passive  hyperemia  one  applies  proximal 
to  the  part  to  be  rendered  hyperemic  a  few  turns  of  an  elastic 
band  about  three  inches  in  width,  preferably  a  very  thin  Esmarch. 
To  prevent  discomfort  the  rubber  bandage  is  usually  applied 
over  one  or  two  turns  of  some  soft  bandage.  According  to  the 
tightness  of  the  rubber  band  the  degree  of  hyperemia  will  differ. 
To  secure  a  satisfactory  passive  hyperemia  the  band  should  not 
be  applied  tightly  enough  to  cause  discomfort.  At  first  the  sub- 
cutaneous veins  become  swollen,  the  skin  somewhat  blue,  and 
gradually  an  oedema  develops.  The  pulse  is  full  and  strong — 
somewhat  stronger  if  anything  than  before  the  band  was  applied. 
The  surface  temperature  is  also  gradually  increased;  in  short 
the  local  evidences  of  inflammation  should  appear  to  be  increased 
in  the  hyperemic  area.  Great  care  should  be  taken  to  see  that 
the  hyperemic  part  is  always  warm.  A  cold  hyperemia  means 
that  the  band  is  too  tight.  Furthermore,  there  should  never  be 
any  pain  or  paraesthesia  in  a  part  properly  hyperemic,  and  to  this 
point  especial  attention  should  be  given.  Whenever  either  pain 
or  paraesthesia  are  complained  of  it  is  positive  proof  that  the 
band  has  been  applied  too  tightly. 

In  the  treatment  of  acute  infections,  passive  hyperemia  is 
employed  as  a  rule  from  twenty  to  twenty-two  out  of  the  twenty- 
four  hours,  and  during  the  remaining  two  to  four  hours  the  part 
is  kept  elevated  to  lessen  the  oedema  resulting  from  the  hyper- 
emia. It  is  usually  best  to  apply  the  elastic  band  for  from  eight 
to  ten  hours  at  a  time,  and  after  an  interval  of  one  or  two  hours 
it  is  reapplied.  Only  in  rare  instances  is  the  hyperemia  applied 
for  a  shorter  period  in  the  twenty-four  hours,  although  in  locali- 
ties where  the  pressure  of  the  band  may  be  uncomfortable  or 
cause  irritation,  it  may  be  necessary  to  shorten  the  period  of  its 
application.  As  the  inflammation  lessens  the  period  of  applica- 
tion of  the  elastic  band  should  be  decreased,  but  care  should  be 
taken  not  to  discontinue  its  use  until  recovery  is  well  established. 
As  a  rule  the  lymphangitis  and  lymphadenitis  on  the  proximal 
side  of  the  elastic  band  are  favorably  influenced,  because  as  the 
infection  is  benefited  by  the  hyperemia  fewer  bacteria  and  less 


834     HYPEREMIA  IN  THE  TREATMENT  OF  ACUTE  INFECTIONS 

toxins  are  absorbed.  The  elastic  band  should  not  be  applied  too 
near  the  focus  of  infection  and  in  severe  infections  the  patient 
should  always  be  kept  in  bed.  The  part  should  be  inspected  at 
intervals  after  the  application  of  the  band  to  determine  whether 
the  hyperemia  is  of  the  proper  degree,  and  in  this  resides  the 
chief  secret  of  its  successful  employment;  for  if  the  band  is 
applied  too  loosely  no  benefit  will  result,  while  if  it  is  applied  too 
tightly  distinct  harm  may  be  done.  The  entire  treatment  should 
be  under  the  observation  of  one  more  or  less  skilled  in  the  method 
and  should  not  be  left  to  chance  attendants.  In  acute  inflam- 
mations of  joint  or  tendon  sheaths  active  and  passive  motion 
should  be  applied  as  soon  as  it  can  be  tolerated  in  order  to  insure 
as  much  of  a  restoration  of  function  as  possible. 

Whenever  a  focus  of  pus  is  evident  a  small  incision  should  be 
made.  With  the  employment  of  hyperemia  large  incisions  are 
as  a  rule  unnecessary,  and  this  is  of  especial  advantage  in  affec- 
tions of  tendon  sheaths,  in  which  a  much  better  function  is  apt 
to  follow  several  small  incisions  than  extensive  exposure  of  the 
tendon.  The  wounds  are  rarely  drained  and  never  packed  with 
gauze,  for  such  foreign  bodies  introduced  into  a  wound  can  only 
contribute  to  the  extension  of  the  necrosis.  The  wound  is  simply 
covered  either  with  sterile  gauze  or  hot  bichloride  of  mercury 
packs  and  irrigated  once  or  twice  daily  as  conditions  may  demand. 

Suppurative  processes  react  differently  under  the  influence  of 
hyperemia.  At  times  the  suppuration  rapidly  ceases,  although 
as  a  rule  it  is  at  first  increased.  The  character  of  the  drainage 
is  usually  rapidly  modified,  the  purulent  giving  place  to  a  dis- 
tinctly serous  discharge.  The  extension  of  the  necrosis  of  tissue 
is  decidedly  lessened  and  a  separation  of  the  necrotic  tissue  is 
hastened. 

In  many  instances  the  temperature  rapidly  falls  after  the 
application  of  hyperemia  and  remains  normal  thereafter.  Coin- 
cident with  a  fall  of  temperature  there  is  a  subsidence  of  other 
symptoms.  At  times  the  temperature  remains  normal  only  dur- 
ing the  period  of  application  of  the  band  and  again  becomes 
elevated  when  the  band  is  removed.  This  is  probably  due  to  an 
increased  absorption  of  toxine  after  the  removal  of  the  band. 

Perhaps  the  most  striking  results  of  the  employment  of  pas- 
sive hyperemia  are  seen  in  acute  inflammation  of  the  tendon 
sheaths.  Bier  states  that  prior  to  the  introduction  of  hyperemia 
in  the  treatment  of  this  condition,  he  had  never  seen  a  suppura- 


ARTHUR  VV.  ELTING 


335 


tive  inflammation  of  a  tendon  sheath  recover  without  necrosis 
and  loss  of  tendon,  but  that  with  the  hyperemic  treatment  he  now 
rarely  ever  sees  such  a  necrosis. 

In  acute  osteomyelitis  passive  hyperemia  has  been  found  to  be 
a  very  effectual  method  of  treatment.  In  half  of  this  class  of 
cases  in  which  it  has  been  employed  by  Bier  there  has  not  been 
any  necrosis  of  bone,  and  in  the  cases  in  which  necrosis  has 
occurred  it  has  been  of  strikingly  slight  extent. 

In  the  treatment  of  acute  and  subacute  inflammations  of  joints, 
passive  hyperemia  is  of  the  greatest  service  and  especially  in  the 
gonorrhoeal  form  of  infection.  Not  only  is  the  inflammation 
rapidly  reduced,  but  the  ability  to  employ  active  and  passive 
motion  early  prevents  in  many  instances  serious  impairment  of 
motion  or  ankylosis. 

Bier  has  also  employed  passive  hyperemia  extensively  for  the 
treatment  of  acute  inflammations  and  acute  suppurations  about 
the  head  and  face.  This  is  accomplished  by  the  application  of 
an  elastic  band  around  the  neck  just  below  the  larynx.  The 
effect  of  the  application  of  hyperemia  in  the  treatment  of  these 
conditions  is  practically  the  same  as  observed  elsewhere  in  the 
body.  Bier  reports  most  favorable  results  from  this  method  of 
treatment  of  acute  suppurative  inflammations  of  the  middle  ear 
with  their  complications,  acute  inflammations  of  the  eyes,  acute 
parotitis,  lymphadenitis,  and  all  forms  of  acute  suppurative 
processes. 

In  conclusion  it  may  be  said  that  passive  hyperemia  as  a 
method  of  treatment  of  acute  infections  is  no  longer  in  the 
experimental  stage;  that  it  is  a  logical  and  rational  procedure, 
and  that  the  results  obtained  from  its  correct  employment 
demonstrate  conclusively  that  it  is  the  most  effective  method  yet 
proposed  for  the  management  of  this  class  of  cases. 


4 


836  BIER-KLAPP  METHOD  OF  PASSIVE  HYPEREMIA 

REPORT  OF  CASES  TREATED  BY  A  MODIFIED  BIER- 
KLXPP  METHOD  OF  PASSIVE  HYPEREMIA. 

Read  before  the  Medical  Society  of  the  County  of  Albany,  November  7,  igo6. 

By  JAMES  N.  VANDER  VEER,  M.  D. 
Mr.  President  and  Gentlemen: 

I  wish  to  present  this  evening,  before  the  members  of  the 
Society,  a  report  of  cases  treated  by  the  so-called  Bier-Klapp 
method.  This  method  is  in  reality  an  improved  form  of  cupping, 
utilizing  our  present-day  knowledge  of  bacteriology  and  path- 
ology as  its  basis. 

The  method,  of  itself,  is  quite  simple,  requiring  an  incision 
to  be  made  in  the  majority  of  cases,  and  following  this,  the  appli- 
cation of  a  cupping  apparatus.  The  cups  utilized  by  Professor 
Bier  and  his  assistant,  Dr.  Rudolf  Klapp,  are  of  various  sizes 
and  designs. 

In  order  to  give  systematic  arrangement  to  the  paper,  I  pre- 
sent it  under  four  heads,  as  follows: 

(1)  Those  conditions  in  which  the  method  of  treatment  is 
especially  indicated, 

(2)  Outline  of  treatment, 

(3)  Reports  of  cases, 

(4)  Display  of  the  apparatus  used. 

Under  the  first  heading,  I  would  especially  call  your  attention 
to  a  condition  which  the  general  practitioner  is  almost  daily 
called  upon  to  treat — a  furuncle — simple  at  first  and  more  com- 
plicated as  progressive  stages  are  reached. 

If  we  refer  to  volume  1,  1905  edition  of  the  International 
Text-book  of  Surgery,  we  are  enabled  to  gain  quickly  a  knowl- 
edge of  the  formation  of  a  furuncle.  One  of  the  paragraphs 
reads  as  follows : 

"A  boil  or  furuncle  is  caused  by  an  invasion  of  bacteria  either 
through  the  hair  follicle  or  sudoriparous  glands  to  a  deeper  por- 
tion of  the  skin  or  to  the  subcutaneous  cellular  tissue.  The 
active  growth  of  the  organism  is  sufficiently  extensive  in  this 
case  to  produce  a  coagulation-necrosis  of  appreciable  size,  which 
subsequently  forms  the  '  core '  of  the  boil.  The  part  most  fre- 
quently destroyed  is  the  hair  follicle  with  its  accompanying  seba- 
ceous gland.  The  first  appearance  of  a  boil  is  the  appearance 
of  a  minute  pustule  situated  at  the  opening  of  a  hair  follicle. 


To  Illustrate  Dr.  James  N.  Vander  Veer's  Article  on  "  Report  of  Cases 
Treated  by  a  Modified  Bier-Klapp  Method  of  Passive  Hyperemia." 


Albany  Medical  Annals,  December,  1006. 


No.  1  10—  For  Furuncle  of  Great  Prominence 


No.  120 — For  Furuncle  of  Broad  Base 


No.  126 — For  Furuncle  where  Curved  Rim  is  necessary. 
(Most  useful). 


«r  ■«  ■■■  

No.  126^ — For  Carbuncle  with  Multiple  Openings 


No.  127 — For  Bubos. 


By  courtesy  of  The  Kny-Scheerer  Co.,  New  York. 


To  Illustrate  Dr.  James  N.  Vander  Veer's  Article  on  "  Report  of  Cases 
Treated  by  a  Modified  Bier-Klapp  Method  of  Passive  Hyperemia." 


Albany  Medical  Annals,  December,  1906. 


No.  132 — For  Large  Abscess. 


No.  138 — For  Infection  of  Finger'. 
(Most  useful). 


No.  147 — Suction  Pump  (Medium  size). 


By  courtesy  of  The  h'ny-Sclnerer  Co.,  Xeu<  York. 


JAMES  N.  VANDER  VEER 


837 


Its  presence  is  first  noticed  on  account  of  an  itching  sensation 
which  it  causes.  This  is  soon  followed  by  an  infiltration  of  the 
skin  which  finally  extends  to  subcutaneous  cellular  tissue.  A 
crust  forms  on  the  site  of  the  papule,  and  on  removing  this 
a  small  quantity  of  pus  escapes.  On  introducing  a  fine  probe, 
it  is  found  to  enter  to  a  small  depth.  This  boil  continues  to 
enlarge  for  a  day  or  two.  and  the  opening  is  now  sharply  defined 
and  circular,  and  is  sufficiently  large  to  enable  the  pus  to  escape 
freely.  Finally,  pressure  extrudes  a  small  slough  and  the 
inflammation  begins  to  subside,  the  opening  contracts  and  the 
minute  abscess  eventually  heals  by  granulation." 

And  further.  "  a  carbuncle  is  a  suppurative  and  gangrenous 
inflammation  of  the  skin  and  the  subcutaneous  cellular  tissue, 
and  spreads  gradually  downward  and  laterally  into  the  sub- 
cutaneous tissue." 

The  formation  of  the  abscess  is  the  carrying  of  this  process 
but  one  step  further,  as  we  see  by  referring  to  Nancrede's 
Principles  of  Surgery.  1905 : 

"  In  an  abscess,  the  virulent  infection  ends  in  the  death  of  the 
cells  of  the  focus  and  their  conversion  into  pus,  and  the  intense 
surrounding  hyperemia  results  in  such  an  outpouring  of  exudates 
that  the  still-living  tissues  have  their  nutriment  mechanically 
diminished,  producing  a  lowering  of  vitality,  which  renders  them 
an  easy  prey  to  the  multiplying  germs. 

"  The  pressure  under  which  pus  exists  forces  into  the  sur- 
rounding tissues  toxic  substances  destructive  to  the  cell,  or  so 
lowering  their  vitality  that  fresh  soil  for  new  crops  of  micro- 
organisms is  prepared. 

"  Clearly,  then,  evacuation  of  the  pus  will  remove  only  a  por- 
tion of  the  germs  and  their  toxic  products,  but  the  relief  from 
pressure  also  effected  will  prevent  the  dissemination  of  bacterial 
poisons,  and  will  relieve  the  strangulations  of  the  tissues,  which 
prevents  proper  nutrition,  thus  enabling  them  to  cope  with  the 
germs  left  behind. 

"Thus,  although  the  germs  in  the  still  living  tissues;  i.  e., 
the  chief  morbid  condition,  cannot  directly  be  attacked,  the 
evacuation  of  the  germs  contained  in  the  pus  and  the  relief  of 
tension  will  remove  many  of  their  worst  effects  and  enable  the 
tissues  to  not  only  protect  themselves  against  further  invasion 
but  also  to  destroy  those  germs  already  present." 


838  BIER-KLAPP  METHOD  OF  PASSIVE  HYPEREMIA 

Again,  and  secondly,  the  practitioner  is  often  consulted  con- 
cerning the  small  granulating  surface  of  an  abrasion,  and  asked 
if  it  is  not  possible  to  hurry  the  process.  If  he  adopts  the  usual 
line  of  treatment  there  will  be  recourse  to  salves,  powders  and 
balsams,  whereas  by  aiding  the  pathological  process  of  repair  in 
such  cases  (in  other  words,  increasing  the  blood  flow  to  the 
part)  nutriment  in  abundance  can  be  furnished  to  the  impaired 
surface. 

In  a  third  class  of  cases,  we  are  asked  to  prescribe  for  an 
acute  infection  before  it  has  reached  the  stage  of  abscess,  and 
yet  where  we  note  a  violent  systemic  reaction.  Did  we  yield  to 
our  teaching  of  earlier  days,  our  patient  would  be  subjected  to 
the  poultice,  ice  or  ichthyol  treatment  with  supporting  stimula- 
tion. In  this  class  of  cases  I  beg  you  to  note  the  strong  ally 
furnished  to  the  affected  part  in  helping  the  blood  to  do  an 
increased  amount  of  work,  that  help  which  nature  is  trying  to 
furnish,  but  as  in  the  antitoxin  treatment,  cannot  furnish  quickly 
enough. 

Again,  in  the  International  Text-book  of  Surgery,  we  note 
under  "  Local  Infection  "  : 

"  The  organisms  which  are  most  commonly  found  in  these 
conditions  are  known  as  the  pyogenic  organisms.  They  produce 
chemical  changes  in  the  tissue  by  the  formation  of  a  toxic  sub- 
stance or  poison.  The  substances  exert  a  peptonizing  action 
upon  the  cells  of  the  part  and  cause  a  coagulation-necrosis  or 
death  of  the  tissues  in  the  immediate  neighborhood  for  a  group 
of  microbes,  and  bring  about  in  the  surrounding  tissues  a  reaction 
which  softens  them  and  changes  them  into  pus.  In  this  way  the 
affected  area  is  separated  from  the  rest  of  the  body,  and  when 
pus  escapes  the  products  of  disease  are  discharged  with  it. 
Under  less  favorable  conditions  the  reaction  is  less  effective, 
the  organisms  continue  to  spread  in  the  surrounding  parts,  and 
although  suppuration  may  take  place,  the  walls  of  the  suppurat- 
ing cavity  contain  bacteria  which  are  still  in  active  growth  and 
are  invading  new  regions." 

A  fourth  class  of  cases  where  this  method  is  of  great  advantage 
is  in  the  after-treatment  of  surgical  operations,  especially  in 
infected  fields  or  where  the  field  of  operation  becomes  infected. 
Here  do  we  find  our  old  plan  of  packing  a  drainage  tube  or  per- 
haps of  ever  using  a  drainage  tube  at  all  superseded,  for  from 
clinical  experience  we  know  that  gauze  eventually  becomes  a 


JAMES  N.  VANDER  VEER 


839 


hindrance  rather  than  a  help  in  a  richly  suppurating  wound, 
and  a  drainage  tube  may  give  a  postoperative  hernia. 

Under  this  subject  of  secondary  infection,  I  would  call  your 
attention  to  the  fact  that  the  aim  of  the  surgeon  is  to  eliminate 
these  pus-organisms  as  quickly  as  possible,  because  of  the 
devitalized  condition  of  the  tissues  after  the  existing  surgical 
condition.  How  simple  a  matter  now  to  pump  out  the  detritus 
and  thus  aid  nature  in  strengthening  the  part,  rather  than  to 
depend  on  nature  to  do  it  all. 

And  now  for  the  application  of  the  treatment. 

As  originally  suggested  by  Professor  Bier  and  his  assistant. 
Dr.  Rudolf  Klapp,  in  the  Surgical  Clinic  of  the  University  of 
Bonn,  each  treatment  lasts  for  forty  minutes,  is  utilized  once  a 
day  and  the  application  is  as  follows : 

A  small  linear  incision  is  made  through  the  apex  of  the 
inflamed  area  and  a  cup  is  applied  for  five  minutes,  with  a  suc- 
tion just  strong  enough  to  avoid  the  painful  degree.  To  facili- 
tate suction,  some  sterile  vaseline  or  ointment  (preferably  zinc 
oxide)  is  applied  to  the  area  just  around  and  beneath  the  rim 
of  the  cup.  At  this  first  suction  following  the  incision  a  large 
amount  of  pus  and  sero-sanguineo-purulent  material  is  with- 
drawn. The  cup  is  then  removed  for  three  minutes,  and  again 
reapplied  for  five  minutes,  thus  alternating  throughout  the  forty 
minutes.  The  wound  and  the  area  are  then  dressed  with  a 
simple  ointment  and  sterile  dressings,  and  the  patient  sent  home 
to  return  the  next  day. 

It  will  be  noted  that  this  method  of  procedure  has  caused  the 
following  phenomena : 

(1)  Continuous  drainage  is  established  for  the  area,  and  there 
has  been  no  curetting  or  probing  or  disturbance  of  the  protec- 
tive wall  of  leucocytes  in  process  of  forming. 

(2)  The  physiological  and  pathological  phenomena  are: 

(a)  The  current  in  the  arteries,  arterioles  and  capil- 

laries is  first  quickened. 

(b)  Then  comes  a  slight  retardation  of  the  current, 

with  an  increase  in  intravascular  pressure,  dis- 
tension and  thinning  of  the  vessel  wall. 
{c)  An  extravasation  of  blood  serum,  with  possibly 
a  dialysis  between  the  serum  in  the  vessel  and 
that  outside  of  the  vessel,  thus  hastening  the 
process  of  liquefaction  of  the  necrotic  elements. 


840  PIER-KLAPP  METHOD  OF  PASSIVE  HYPEREMIA 

(d)  An  exudation  of  white  and  red  corpuscles,  espe- 
cially of  the  former,  in  great  abundance,  thus 
hastening  nature's  efforts  to  deposit  a  protective 
army  at  the  point  most  needed. 
Occasionally  the  Bier-Stauungs  method  of  light  constriction 
is  also  utilized  to  good  advantage,  especially  where  an  extremity 
is  involved. 

In  the  treatment  of  the  cases  reported  in  this  article  there  has 
been  a  slight  modification,  and  the  procedure  has  been,  in  general, 
after  this  manner  : — 

So  soon  as  the  inflamed  region  was  made  out,  an  incision  about 
one-quarter  to  one-half  an  inch  in  length  was  made  through 
the  most  prominent  portion,  down  to  and  through  the  deep  fascia, 
into  the  infected  area.  The  proper  sized  cup  was  then  applied, 
using  zinc  oxide  ointment  as  a  cohesive,  for  a  period  of  five 
minutes  only,  followed  by  a  hot  pack  of  bichloride  of  mercury 
(1-10,000).  The  hot  pack  was  changed  every  hour,  and  for  five 
minutes  between  each  change  the  cup  was  used  for  the  first  three 
hours  and  then  three  times  daily.  There  was  also  utilized  a  tonic 
treatment  as  deemed  appropriate. 

No  packing  or  probing  of  the  wound  was  indulged  in,  and  sav? 
as  a  necrotic  bit  of  tissue  required  removal,  no  manipulation  of 
the  interior  of  the  wound  was  attempted.  Irrigations  were  also 
dispensed  with,  for  fear  of  destroying  the  protective  membrane, 
and  contrary  to  reason,  the  incised  wound  did  not  close  up 
entirely,  while  healing  took  place  rapidly  and  by  granulation. 

After  the  incising  of  the  inflamed  area,  and  the  first  applica- 
tion of  the  cup,  the  patients,  one  and  all,  remarked  at  the 
peculiarly  agreeable  sensation  felt  here,  and  were  eager  to  make 
the  application  themselves  more  frequently.  In  each  case  where 
the  lesion  was  accessible  the  patient  was  taught  how  to  apply  the 
cup,  as  he  (or  she)  was  the  only  one  to  judge  when  the  painful 
point  was  reached. 

Each  cup  was  sterilized  by  boiling  immediately  before  and 
after  using,  thus  preventing  any  mixing  of  infections  in  the 
different  cases. 

Temperature,  high  pulse,  nausea  and  headache,  and  in  one 
case,  the  vomiting,  were  rapidly  alleviated,  following  the  incision 
and  the  first  cup  application,  even  though  no  pus  was  obtained 
until  later. 

In  a  case  where  pus  was  demonstrable  macroscopically  from 


JAMES  N.  VANDER  VEER 


841 


the  first,  the  discharge  usually  ended  after  forty-eight  to 
sixty  hours,  but  organisms  were  obtainable,  by  culture,  even  to 
the  last,  usually  changing  from  the  mixed  type  at  first,  to  a 
single  type  in  the  end,  and  this  of  the  staphylococcus  group. 

I  judge  that  the  mode  of  growth  of  this  group  tends  to  crowd 
out  and  destroy  the  other  organisms,  for  the  staphylococcus 
group  causes  a  localized  inflammation  and  one  within  a  well- 
defined  area,  when  nature  has  asserted  herself  strongly. 

I  now  present  to  you  the  reports  of  ten  cases,  divided  as 
follows : 

Two  cases  of  infected  finger ; 

Two  cases  of  typical  furuncle,  one  of  the  axillary  region, 
and  one  of  the  breast; 

Two  cases  of  furuncle  of  the  neck,  each  very  extensive  in 
character ; 

Four  cases  of  acute  perforated  and  gangrenous  appendices, 
two  of  which  were  sewed  up  tight  at  the  time  of  the  usual 
operation,  and  subsequently  developed  phlegmons,  and  two  of 
which  where  the  abdomen  was  simply  opened  and  a  glass  drain- 
age tube  introduced,  and  no  attempt  made  to  remove  the 
appendix. 

Of  these  ten  cases,  nine  recovered  completely,  and  one,  Dr.  W., 
died  forty-eight  hours  after  seeing  him,  from  a  previously  exist- 
ing cirrhotic  liver,  a  parenchymatous  nephritis,  with  over  5% 
albumen,  and  chronic  alcoholism. 

All  ten  were  markedly  benefited  following  the  cup  appli- 
cation, and  in  nine,  the  convalescent  period  was  reduced  by  over 
half  the  time. 

Case  No.  i. 

Miss  C.  nurse,  aged  28,  gives  a  history  of  having  scratched  her  right 
forefinger  on  a  pin,  some  five  days  ago,  while  pinning  up  the  bandage 
of  an  infected  case.  Has  attempted  to  treat  the  resultant  condition  her- 
self, by  means  of  hot-packs  at  night  and  constant  bichloride  baths  by 
day;  but  because  of  the  pain  running  through  her  right  arm  and  shoulder, 
has  been  obliged  to  seek  surgical  interference. 

Examination  shows  the  right  forefinger  enlarged,  between  the  second 
and  the  third  phalanges,  to  twice  the  size  of  the  left  one.  There  is  a 
hard  induration  on  the  palmar  and  outer  aspect  about  the  size  of  a  copper- 
penny.  No  fluctuation  is  present.  A  well-marked  lymphangitis,  with 
soreness,  extends  up  the  forearm  almost  to  the  elbow.  There  is  a  stiff- 
ness of  the  wrist  and  elbow,  and  the  axillary  region  is  sore,  but  no  glands 
are  palpable.  Temperature,  ioo° ;  pulse,  90,  full  and  bounding;  some 
headache;  loss  of  appetite  and  sleeplessness. 


842 


BIER-KLAPP  METHOD  OF  PASSIVE  HYPEREMIA 


A  slight  incision  was  made  over  the  radial  aspect  of  the  finger,  where 
the  area  seemed  to  be  most  indurated,  and  the  finger-cup  was  applied 
in  the  usual  manner,  with  the  extraction  of  no  pus,  but  some  blood  serum. 
There  was  also  applied  the  bandage  lightly  around  the  arm  for  periods 
of  four  hours  at  a  time.  The  cupping  was  continued  with  hot-packs 
for  thirty-six  hours,  when  the  nurse  returned  to  duty,  having  a  normal 
temperature  and  pulse,  no  headache  and  a  slight  soreness  in  the  finger. 
The  other  symptoms  of  infection  had  also  disappeared.  Cup  was  then 
applied  for  the  next  thirty-six  hours,  three  times  daily,  and  the  wound 
healed  with  a  scar  the  size  of  a  pinhead  only.  This  is  a  case  which  was 
not  treated  from  the  very  beginning,  and  probably  would  have  gone  on 
to  a  severe  consequence. 

Case  No.  2. 

E.  J.,  aged  24,  has  carried  two  false  arms  for  a  number  of  years,  having 
received  a  crush  of  the  right  arm  necessitating  an  amputation  at  the  elbow, 
and  of  the  left  hand,  so  that  only  the  thumb  and  the  forefinger  are  left. 

Patient  experiences  about  three  times  a  year  an  irritation  of  the  parts 
concerned,  due  to  the  rubbing  of  the  false  hand ;  and  following  this  irrita- 
tion, if  neglected,  there  always  appears  a  severe  infection  involving  the. 
arm  and  giving  other  systemic  symptoms. 

The  patient  has  been  treated  for  the  last  ten  days  with  hot-packs,  fol- 
lowing one  of  the  periodical  attacks  of  infection.  The  focus  lies  to  the 
ulnar  side  and  at  the  base  of  the  thumb-nail ;  it  has  been  opened  twice. 
A  suggestion  having  been  made  that  the  Bier  apparatus  be  used,  no  new 
opening  was  made,  but  the  apparatus  was  applied,  and  after  a  use  of  four 
days,  coupled  with  cold  to  the  axilla  and  heat  to  the  forearm,  great  relief 
was  obtained.  Here  also  a  bandage  was  used  on  the  forearm.  The  patient 
made  an  excellent  recovery  in  five  days'  time,  and  resumed  his  normal 
occupation. 

Case  No.  3. 

Dr.  W.  T.  has  experienced  for  some  two  years  past  a  crop  of  furuncles. 
They  seem  to  attack  especially  his  right  axilla,  but  one  very  persistent  one 
was  situated  over  the  left  infra-maxillary  region.  Patient  presents  an  in- 
durated surface  of  a  size  slightly  smaller  than  the  palm  of  one's  hand, 
and  with  a  raised  area  the  size  of  a  hickory  nut  in  its  very  center.  This 
infiltrated  area  is  situated  on  the  inner  and  axillary  aspect  of  the  right 
arm  and  is  exceedingly  painful  to  touch,  as  well  as  giving  exceeding  tor- 
ture on  movement  of  the  shoulder.  The  glands  in  the  axilla  are  dis- 
tinctly palpable  and  very  tender.  No  other  enlarged  glands  are  ascer- 
tained upon  physical  examination. 

The  Bier  treatment  was  suggested  and  acceded  to,  and  a  slight  incision 
one-half  inch  long  and  a  half-inch  deep,  under  ethyl  chloride,  was  made 
over  the  prominent  portion  of  the  area.  No  pus  was  obtained,  but  the 
center  of  induration  was  decidedly  necrotic,  and  small  shreds  could  be 
removed  by  means  of  the  thumb-forceps.  No  packing  or  irrigation  or 
this  area  was  allowed,  the  suggestion  being  made  that  hot-packs  be  ap- 
plied as  often  as  possible  and  the  suction  apparatus  be  used  between  each 
application.    There  was  instant  relief  following  the  first  application  of 


JAMES  N.  VANDER  VEER 


843 


the  cup,  but  quite  some  pain  was  experienced  by  reason  of  using  a  cup 
whose  rim  area  was  too  small.  After  thirty-six  hours,  the  hot-packs 
were  discontinued,  as  well  as  the  cupping,  and  the  wound  closed  within 
the  next  twenty-four  hours. 

The  remark  was  made  concerning  this  case,  by  the  patient,  that  he  had 
never  seen  enlarged  glands  disappear  so  quickly,  as  well  as  the  accompany- 
ing soreness,  as  they  did  here  about  the  twelfth  hour  after  the  applica- 
tion of  the  Bier  cup. 

Case  No.  4. 

Mrs.  McC.  Diagnosis :  Abscess  of  left  breast. 

Patient  gave  history  of  having  her  right  breast  removed  some  eight 
weeks  previous,  in  a  neighboring  hospital,  for  carcinoma,  and  says  that 
the  present  condition  developed  about  one  week  after,  and  it  is  now 
about  one  week  since  her  departure  from  the  hospital. 

The  abscess  tended  to  point  just  beneath  and  internal  to  the  left  nipple, 
and  was  about  the  size  of  a  hen's  egg,  very  hard  and  tense  in  consistency. 
It  was  very  painful  to  touch,  but  there  was  no  enlargement  of  the  axil- 
lary region,  though  this  region  was  tender.  The  right  breast  scar  was 
entirely  healed,  and  gave  evidence  of  having  done  so  by  first  intention. 

A  small  incision  one-half  an  inch  in  length  was  made  down  to  and 
through  the  deep  fascia  and  directly  into  the  abscess  cavity,  when  about 
two  ounces  of  pus  were  evacuated.  The  Bier  cup  was  applied,  together 
with  hot-packs,  for  forty-eight  hours,  followed  with  a  cold  bichloride  pack, 
and  the  application  of  the  cup  three  times  a  day.  At  the  end  of  the 
fourth  day  the  patient  left  the  hospital  and  went  to  her  home,  where 
the  cup  was  abandoned  and  the  wound  simply  dressed  with  a  cold 
bichloride  pack. 

In  this  case  there  was  a  slight  slough  in  the  very  center  of  the  incision, 
which  was  removed  by  means  of  the  thumb-forceps;  and  it  would  seem 
as  if  the  cup  had  hastened  the  separation  of  it;  for,  following  its 
removal,  the  pus  ceased  to  be  produced  and  a  clean  and  healthy  granular 
surface  was  presented. 

Of  all  patients,  this  was  the  most  nervous  when  the  cup  was  being 
applied,  and  yet,  after  the  first  application,  she  welcomed  it  most 
cordially. 

The  scar  remaining  in  her  case  was  very  small  in  size,  and  the  relief 
afforded  in  not  packing  the  cavity  or  irrigating  it  as  frequently  as  would 
have  been  done  under  the  old  lines  of  treatment  was  appreciated  by  her. 

Case  No.  5. 

Mr.  L.  T.,  a  superintendent  of  construction,  presented  himself  with  a 
large  furuncle  on  the  back  of  his  neck.  His  past  is  negative,  save  that 
he  has  had  one  furuncle  near  the  same  spot  some  years  ago,  which  was 
lanced,  packed  and  irrigated  in  the  usual  manner. 

About  four  weeks  ago  (June  10th)  he  noticed  a  little  pimple  on  the 
back  of  his  neck.  This  he  picked  with  a  pin,  after  which  it  grew 
steadily  worse.  Since  then  he  has  been  poulticing  his  neck.  He  experi- 
enced severe  pains  when  he  lay  down  at  night,  but  very  little  when  he 
sat  up.      On  Monday  evening,  June  18th,  furnucle  was  lanced  while 


844 


BIER-KLAPP  METHOD  OF  PASSIVE  HYPEREMIA 


patient  was  on  a  trip  through  Canada.  Considerable  pus  was  evacuated 
and  the  pain  abated  somewhat.  Two  days  later,  however,  the  pain 
recommenced,  and  he  was  compelled  to  seek  further  surgical  advice. 

The  patient  presented  on  the  back  of  his  neck  an  indurated  area  of 
some  three  and  one-half  inches  in  diameter,  very  painful  to  touch,  and 
in  the  center  were  two  parallel  incisions  about  one  and  one-half  inches 
long.  These  led  down  to  an  inside  sloughing  mass  which  discharged  a 
sero-purulent  material.  The  probe  sank  into  the  mass  for  a  distance  of 
about  one  and  one-half  inches.  There  was  no  enlargement  of  the 
glands.    The  patient's  temperature  was  ioi°;  his  pulse,  80. 

Cups  were  applied  in  this  case  for  twenty  minutes  at  a  time,  every 
three  hours,  in  the  routine  of  five  minutes  on  and  three  minutes  off. 
Zinc  ointment  was  well  rubbed  into  the  area  surrounding  the  incision, 
so  far  as  the  patient  could  bear  the  application,  and  a  flaxseed  poultice 
was  applied  till  the  following  morning,  followed  by  hot  bichloride  packs 
(1-10,000).  It  became  necessary  to  lessen  the  application  of  the  cups, 
by  reason  of  the  gangrenous  appearance  of  the  edges  of  the  wound, 
and  they  were  applied  only  once  a  day.  The  patient  was  given  a 
cathartic  (and  put  upon  a  tonic  containing  iron)  and  the  temperature 
immediately  dropped,  following  a  good  evacuation  of  the  bowels.  There 
was  no  restriction  as  to  diet,  and  upon  the  fourth  day  a  slough  was 
removed  through  one  of  the  incisions,  leaving  a  hole  the  size  of  a  horse 
chestnut.  This  seemed  to  be  a  complication  in  the  case  contrary  to 
desires.    An  irrigation  of  diluted  nitric  acid  twice  daily  was  ordered. 

The  patient  was  discharged  from  the  hospital  on  the  29th,  but  for 
the  last  four  days  had  been  attending  to  his  business  downtown,  simply 
going  back  to  the  hospital  for  the  Bier  treatment  and  the  dressing  of 
the  wound.  At  the  end  of  the  second  week,  or  on  August  6th,  the  very 
last  of  the  wound  had  closed,  leaving  a  parallel  scar  about  one-quarter 
inch  in  length,  but  with  no  deformity  or  contraction  of  the  tissue  beneath 
as  yet. 

The  patient  has  been  seen  frequently  since  that  time,  and  remarks  at 
the  ease  and  simplicity  utilized  in  this  manner  of  treatment  as  compared 
with  previous  experiences  with  abscesses. 

Case  No.  6. 

Dr.  W.  A.,  aged  65,  has  suffered  for  six  weeks  with  a  furuncle  on  the 
back  of  his  neck,  and  when  I  saw  him  the  furuncle  extended  from  one 
pinna  of  the  ear  to  the  opposite  side,  and  in  vertical  aspect  was  four 
inches  or  more  in  size.  The  area  in  the  center  was  slightly  honey- 
combed, and  led  one  to  suspect  a  condition  of  actinomycosis.  It  was 
very  painful  to  touch.  The  glands  in  the  axilla  were  very  tender,  as 
well  as  those  in  the  infra-clavicular  region.  On  both  sides,  behind  and 
beneath  the  ear,  was  a  protruding  area  the  size  of  a  pigeon's  egg,  which 
fluctuated  upon  handling.  In  the  center  of  the  wound,  about  this  honey- 
combed area,  there  was  a  bogginess  differing  decidedly  from  the  hard 
indurated  feeling  of  the  remainder  of  the  mass,  and  which,  upon  pressure, 
yielded  a  thick  pus  from  the  openings. 

The  patient's  past  history  was  one  of  chronic  alcoholism,  together  with 
many  severe  accidents  experienced  during  the  last  few  years,  and  he 


JAMES  N.  VANDER  VEER 


845 


showed  an  extreme  condition  of  nephritis,  there  having  been  about  five 
per  cent  of  albumen  in  a  specimen  voided  at  entrance.  He  was  slightly 
delirious,  but  could  be  recalled  to  himself,  and  had  a  temperature  of 
1020,  with  a  pulse  of  120. 

It  was  realized  that  this  was  a  severe  case,  and  it  was  suggested  that 
the  Bier  treatment  be  tried,  together  with  hot-packs,  to  which  the  patient 
acceded,  and  under  ethyl  chloride  an  incision  one  and  one-half  inches 
long  and  three-quarters  of  an  inch  deep  was  made  in  the  abscess  under 
the  left  ear,  which  yielded  about  an  ounce  of  pus,  and  a  similar  vertical 
incision  was  also  made  in  the  center  of  the  neck,  but  this  did  not  yield 
much  pus,  although  the  scalpel  passed  through  the  deeply  infiltrated  and 
sloughing  area.  For  the  next  twenty-four  hours  the  process  of  cupping 
was  adhered  to,  and  was  abandoned  because  of  the  delirium  of  the 
patient  and  his  point-blank  refusal  to  have  anything  done.  During  this 
time,  however,  the  hot-packs  yielded  fair  results.  Under  coercion  the 
cups  were  again  allowed  to  be  applied,  and  from  the  abscess  on  the  left 
at  least  two  ounces  were  obtained,  while  from  the  abscess  in  the  center 
of  the  neck  shreds  of  tissue,  as  well  as  a  sanguino-purulent  material,  were 
withdrawn.  In  the  meanwhile  the  patient  was  given  a  supporting  treat- 
ment consisting  in  the  main  of  whiskey  in  very  small  doses,  together 
with  quinine,  but  he  gradually  passed  into  a  state  of  delirium  with 
excitement,  and  died  some  four  days  after  entrance  to  the  hospital.  This 
is  the  first  case  where  the  success  has  not  been  as  great  as  could  have 
been  hoped  for,  and  yet  the  adverse  conditions  of  the  patient  in  a  large 
measure  seemed  to  gainsay  any  hope  for  his  ultimate  recovery. 

Case  No.  7. 

W.  L.,  bookkeeper,  taken  ill  some  two  weeks  ago  with  a  pain  which 
settled  in  the  right  lower  quadrant,  had  the  typical  symptoms  of  appen- 
dicitis, and  his  physician  ordered  an  ice-pack  applied.  On  the  third  day 
there  was  an  exacerbation,  and  the  patient  kept  to  his  bed  until  the  tenth 
day,  when  he  took  a  short  walk,  and  on  the  next  day  began  to  have 
such  severe  pain  that  the  physician  was  again  called,  when  a  diagnosis 
of  perforated  appendix  was  made.  The  usual  operation  was  performed, 
and  a  condition  of  gangrenous  appendicitis  was  proven  and  the  concre- 
tion which  had  caused  the  trouble  was  found.  But  the  location  of  the 
appendix  precluded  its  removal  entirely,  and  the  wound  was  closed  with 
silkwormgut  sutures,  there  being  one  glass  tube  and  one  vaginal  tampon 
left  in  as  drainage.  Patient  did  well  for  three  days,  when  he  developed 
some  pain  in  the  right  side,  mostly  gaseous  in  character.  Manipulation 
of  tube  to  facilitate  drainage,  the  same  as  usual  in  such  cases,  was  tried, 
with  no  result.  On  the  fourth  day  the  right  side  above  the  wound  was 
very  sensitive  to  the  touch,  and  on  the  sixth  day  the  wound  began  to 
discharge  a  very  foul-smelling  pus,  following  up  the  loosening  of  three 
of  the  silkwormgut  stitches.  After  this  the  hot  bichloride  packs  were 
utilized,  and  the  wound  was  irrigated  with  boracic  acid  and  various 
other  solutions,  but  seemed  disinclined  to  fill  in,  as  a  small  fistula  was 
persistent.  On  the  eighteenth  day  the  Bier  apparatus  was  applied,  using 
it  twice  daily,  and  on  the  28th  day  the  patient  was  discharged  from  the 
hospital  with  no  evidences  of  latent  condition  remaining. 


846 


BIER-KLAPP  METHOD  OF  PASSIVE  HYPEREMIA 


During  this  time  a  comparison  was  furnished  very  nicely  by  a  brother 
practitioner,  who  treated  his  patient  under  exactly  the  same  conditions, 
by  means  of  irrigations  and  hot-packs,  and  which  patient  remained  in 
the  hospital  some  two  weeks  after  the  discharge  of  W.  L.  A  close 
comparison  of  the  cases  showed  that  they  were  as  nearly  similar  as  could 
be  obtained  in  surgical  lines. 

Case  No.  8. 

Mr.  C.  J.,  an  examiner,  has  been  perfectly  well  until  three  days  ago, 
when  he  was  taken  with  severe  pains  in  his  abdomen,  and  these  finally 
localized  in  thirty-six  hours,  when  a  diagnosis  of  appendicitis  was  made 
by  his  attending  physician,  and  an  operation  was  acceded  to.  Blood 
count  showed  an  increasing  leucocytosis,  even  following  the  removal  of 
a  completely  gangrenous  appendix,  and  where  no  adhesions  existed. 
Drainage  was  instituted  and  the  wound  was  closed  with  silkwormgut 
sutures,  which  had  to  be  removed  at  the  end  of  the  third  day.  Drainage 
continued  to  be  enormous  until  the  sixteenth  day,  when  the  Bier  apparatus 
was  suggested,  and  was  utilized  four  times  daily  at  first,  with  a  result 
of  sanguino-purulent  material  of  fecal  odor,  followed  later  by  decreasing 
amounts.  This  patient  was  finally  treated  twice  daily  in  this  manner  for 
two  weeks  before  dismissal,  and  seemed  to  be  an  especially  hard  one  to 
handle.  However,  at  the  end  of  the  month  in  the  hospital  he  was 
discharged,  with  no  fecal  fistula  or  sinus  remaining. 

Case  No.  9. 

Mrs.  H.,  a  very  fleshy  woman,  was  seen  Sunday  morning,  taken  imme- 
diately to  the  hospital,  where  she  was  operated  upon,  and  a  gangrenous 
appendix  removed,  together  with  drainage  of  the  abscess.  The  wound 
was  closed  in  with  silkwormgut  sutures,  and  the  patient  did  well  up  to 
some  ten  days  afterwards,  when  a  slight  induration  and  prickly  sensation 
developed  in  the  upper  angle.  Upon  opening  this  about  two  ounces  of 
pus  were  released,  and  the  temperature,  pulse  and  headache  accompanying 
the  condition  immediately  disappeared.  Hot-packs  were  then  applied  and 
the  wound  continued  to  drain  for  about  a  week,  when  the  Bier  treatment 
was  applied,  the  discharge  increasing  for  some  twenty-four  hours,  then 
gradually  disappearing  in  the  course  of  the  next  forty-eight  hours.  The 
condition  was  apparently  relieved,  the  wound  healing  by  granulation,  and 
with  no  other  untoward  symptoms. 

The  patient  did  not  complain  of  the  treatment  in  this  instance,  as  was 
to  be  expected,  for  at  the  first  cupping  the  instrument  was  applied  some- 
what more  strongly  than  necessary,  producing  a  discoloration  of  the  skin. 
However,  she  learned  to  apply  it,  and  did  so  herself  the  second  time  and 
several  times  following. 

The  result  in  her  case  was  very  gratifying,  as  her  infection  was  one 
of  the  superficial  layers,  and  not  deep  down  into  the  abdominal  cavity, 
as  was  first  thought.  However,  no  probing  of  the  wound  was  allowed,, 
and  there  was  no  necrotic  tissue  in  this  instance  to  be  removed. 

Case  No.  10. 

Mrs.  B.  presented  herself,  complaining  of  severe  and  sudden  pains  in- 
the  right  lower   quadrant  of  the  abdomen.     Diagnosis   of   a  twisted 


JAMES  N.  VANDER  VEER 


847 


pedicle  of  an  ovarian  cyst  was  made.  She  had  had  trouble,  however, 
for  the  last  few  years  with  mild  attacks  similar  to  the  present,  and  a 
tentative  diagnosis  of  chronic  appendicitis  was  also  entertained. 

The  usual  median  laparotomy  was  performed.  An  appendix  deeply 
imbedded  in  adhesions,  and  with  some  pus,  was  found,  as  well  as  an 
ovarian  cyst  the  size  of  an  orange,  and  partly  strangulated.  It  seemed 
wisest  to  make  a  counter-incision  in  the  right  iliac  region,  through  which 
a  drainage  tube  was  passed  down  into  the  cavity  formerly  occupied  by 
the  appendix,  and  the  median  incision  was  then  closed  by  the  layer 
method.  The  median  incision  healed  kindly,  and  there  was  considerable 
drainage  for  a  week  through  the  counter-opening,  the  drainage  tube 
having  been  removed  at  the  end  of  this  time,  and  gauze  substituted.  This 
opening  apparently  refused  to  heal,  once  the  edges  being  scraped  and  a 
few  silkwormgut  sutures  introduced  in  order  to  approximate  them. 
However,  another  week  of  hot-packs  and  irrigations  followed,  with  still 
no  appreciable  effect  upon  the  surfaces.  Following  the  removal  of  the 
silkwormgut  sutures,  balsam  of  Peru  was  also  attempted,  and  the  Bier 
cup  was  then  applied.  During  the  period  of  the  first  few  applications 
of  the  cup  considerable  serum  and  sero-purulent  material  was  obtained, 
but  after  a  week's  application,  three  times  daily,  for  ten  minutes  at  a 
time,  and  not  very  strongly,  the  wound  closed  in  by  granulation,  and 
the  patient  left  the  hospital  entirely  healed,  and  with  a  firm  scar. 

Of  all  the  cases  treated  in  this  manner,  this  case  appeared  to  be  the 
most  stubborn.  It  seemed  as  if  the  edges  of  the  wound  lacked  the 
necessary  tone  for  healing,  and  there  was  a  question  of  possible  tuber- 
cular condition  of  the  area.  However,  the  pathological  report  upset  this 
theory. 

Conclusion. 

In  conclusion,  I  would  heartily  advocate  the  use  of  the  cupping 
method  as  one  of  inestimable  value  in  such  cases  where  there  is 
an  inflammatory  condition,  even  utilizing  it  before  the  stage  of 
the  active  pus  process  is  present,  as  well  as  in  those  conditions 
where  the  tissues  apparently  lack  the  proper  tone.  Here  the 
application  seems  to  impart  the  vigor  that  is  necessary  in  granu- 
lation. It  is  to  be  especially  noted  that  in  the  active  purulent 
stage,  the  hot-packs  give  great  aid  in  helping  to  throw  off 
necrotic  particles,  and  keep  up,  to  a  material  extent,  the  hyper- 
emic  condition  supplemented  by  the  application  of  the  cup  at 
definite  intervals. 

Concerning  definite  rules  for  the  treatment,  it  can  be  said  that 
there  are  none,  save  those  that  forbid  of  the  severe  application 
of  the  cup,  such  as  to  cause  pain  to  the  individual. 

I  would  suggest  that  a  large  series  of  cases  be  tried  with  this 
treatment,  and  statistics  collected,  thus  helping  to  establish  cer- 
tain definite  lines  for  indication  of  the  method. 


848 


EDITORIAL 


BWtortal 

Now  Dr.  Middleton  was  a  clever,  sensible  man,  who 
had  no  wish  to  impose  upon  anyone.  As  for  his  taking 
a  guinea  for  putting  on  a  piece  of  sticking-plaster, 
his  conscience  was  very  easy  on  that  score.  His  time 
was  equally  valuable,  whether  he  was  employed  for 
something  or  nothing;  and,  moreover,  he  attended  the 
poor  gratis. 

Mr.  Midshipman  Easy.  Captain  Marryat. 

+     *  + 

The  proposal  to  invigorate  the  Association  of 
The  Alumni      the  Alumni  of  the  Albany  Medical  College  made 
Association       last  spring  by  the  Executive  Committee  has  been 
given  further  consideration  by  the  Committee, 
and  on  November  7th  a  meeting  was  held  for  the  purpose  of 
promoting  the  interests  of  the  Association.    The  treasurer's  re- 
port indicated  a  very  gratifying  response  to  the  circular  letter 
of  May  10th,  1906,  which  was  mailed  to  the  members  of  the 
Association. 

The  Committee  indulged  in  an  informal  discussion  of  the  best 
manner  of  celebration  of  Alumni  Day,  and  a  sub-committee  of 
five  was  appointed  to  suggest  a  program  of  entertainment.  The 
principal  topic  was  that  of  the  method  of  electing  officers  of  the 
Association,  and  it  was  unanimously  agreed  that  the  so-called 
blanket  ballot  to  permit  voting  by  mail,  now  in  use  with  so  many 
organizations  of  learned  and  honorable  gentlemen,  would  best 
answer  the  purposes  of  the  Association. 

For  carrying  out  the  details  of  this  form  of  ballot  the  follow- 
ing series  of  resolutions  was  adopted : 

Resolved,  That  the  Executive  Committee  prepare  annually  a  printed 
ballot  to  be  used  by  members  of  the  Association  for  the  election  of  officers 
of  the  Association,  which  shall  be  mailed  to  every  member  of  the  Asso- 
ciation where  name  and  address  are  on  its  rolls,  not  less  than  one  month 
before  the  annual  meeting. 

Resolved,  That  any  member's  ballot  is  valid  which  bears  his  signature 
and  address,  and  is  received  on  Alumni  day,  not  later  than  an  hour  to 
be  specified  by  three  tellers  appointed  by  the  President  of  the  Association. 

Resolved,  That  the  President  of  the  Association  be  empowered  to 
appoint  each  year  three  tellers  from  the  membership  of  the  Executive 
Committee  to  collect  and  count  the  ballots  at  the  annual  meeting,  one  of 
said  tellers  to  be  designated  by  the  President  to  receive  the  ballots. 


LITTLE  BIOGRAPHIES 


849 


Resolved,  That  nominations  for  the  various  offices  to  be  elected  at  the 
annual  meeting  of  the  Association  be  made  by  the  Executive  Committee 
at  such  time  as  to  permit  the  printing  and  distribution  of  ballots  to 
meet  the  requirements  of  the  resolution  regulating  the  preparation  and 
mailing  of  the  ballots. 

Resolved,  That  the  Recording  Secretary  be  directed  to  notify  the 
secretaries  of  the  Alumni  Associations  of  New  York,  New  England  and 
Central  New  York,  respectively,  of  the  action  taken  by  the  Executive 
Committee  and  request  them  to  nominate  two  candidates  each  for  the 
office  of  Vice-President. 

Resolved,  That  the  Executive  Committee  nominate  each  year  two  can- 
didates from  the  Association  at  large  for  Vice-President  and  that  from 
the  five  Vice-Presidents  elected  select  hereafter  each  year  two  candidates 
for  the  Presidency  of  the  Association  to  be  the  nominees  of  the  official 
ballot. 

Resolved,  That  on  the  official  ballot  prepared  by  the  committee  space 
be  left  for  the  insertion  of  names  for  each  office,  to  be  written  in  at  the 
pleasure  of  the  member  signing  the  ballot. 

The  Committee  has  undoubtedly  taken  an  important  step,  and 
places  it  in  the  power  of  individual  members  of  the  Association 
to  express  any  personal  preferences  as  to  the  methods  of  con- 
ducting its  affairs.  With  an  active  membership  of  fifteen  hun- 
dred, there  is  every  reason  to  believe  that  the  Association  will 
make  itself  felt  in  the  affairs  of  the  College  and  will  exert  an 
influence  for  good  upon  the  progress  and  principles  of  medical 
education. 


Xittle  Btoarapbtes 

XII.  WRISBERG. 

HEINRICH  AUGUST  WRISBERG,  a  celebrated 
anatomist,  was  born  June  20th,  1739,  in  St.  Andreas- 
berg,  Harz,  and  died  March  29th,  1808.  At  the 
time  of  his  death  he  was  Professor  of  Anatomy 
and  Director  of  the  Anatomical  Institute  at  Gottingen.  He  was 
Roederer's  successor  in  the  University,  and  also  taught  obstetrics 
for  several  years.  After  completing  his  studies  at  Gottingen 
he  took  a  post-graduate  course  in  France  and  Holland.  He 
received  his  professorship  in  1763. 

Wrisberg  was  renowned  for  his  profound  and  general  knowl- 
edge and  his  remarkable  skill  in  practical  anatomy,  but  par- 
ticularly for  his  large  number  of  investigations  of  the  nervous 


SCIENTIFIC  REVIEW 


system.  He  was  one  of  the  first  to  describe  the  occasional 
presence  of  the  supreme  splanchnic  nerve.  The  ganglion  Wris- 
bergii  magnum  is  named  after  him,  as  is  also  the  lesser  internal 
cutaneous  nerve.  He  also  minutely  described  the  nerve  plex- 
uses of  the  female  genital  organs. 

Wrisberg  did  an  enormous  amount  of  literary  work.  He  pub- 
lished A.  V.  Haller's  physiological  works,  Roederer's  works  on 
obstetrics,  and  Zinn's  Descriptio  Oculi  Humani,  in  two  editions. 
He  also  published  a  large  number  of  original  papers  in  the 
"  Gottinger  Gesellschaft  der  Wissenschaft."  The  following  is 
the  list  of  these  contributions:  Descriptio  Anat.  Embryonis 
Observationibus  Illustrata  (1764),  Observatio  Anat.  de  Genito 
Pare  Nervorum  Encephali  (1777),  De  Testiculorum  ex  Abdomine 
in  Scrotum  Descensu,  Observationum  Anat.  de  Nervis  Viscerum 
Abdom.  Partic:  P.  I,  Quae  de  Ganglio  Plexuque  Seminali  Agit, 
P.  II,  De  Nervis  Hepatis  et  Splenicis,  P.  Ill,  De  Nervis  Viscerum 
Abdom.;  Observationes  Anatomicae  de  Corde  Testudinis  Marinae 
Mydas  Dictae,  Collectae  et  cum  Corde  Humano  Collatae  (1800), 
Sylloge  Commentationum  Anatomicarum  (1786),  Experimenta 
et  Observ.  Anat.  de  Utero  Gravido,  Tubis,  Ovariis  et  Cor  pore 
Luteo  Quorundam  Animalium  cum  Iisdem  Partibus  in  Homine 
Collatis  (1780),  etc.  He  also  described  the  laryngeal  cartilages 
called  by  his  name.  Clement  F.  Theisen. 


Scientific  1Rev>iew 

On  the  Physiology  of  Heart-Block  in  Mammals,  With 
Special  Reference  to  the  Causation  of  Stokes-Adams 
Disease.  By  Joseph  Erlanger. 

(The  Journal  of  Experimental  Medicine,  Vol.  7,  No.  6;  Vol.  8,  No.  1. 
November,  1905;  January,  1906.) 

This  important  study  by  Erlanger  is  divided  into  three 
parts :  1.  Observations  on  an  instance  of  heart-block  in  man  ; 
2.  on  the  physiology  of  heart-block  in  the  dog;  3.  on  the 
relation  of  heart-block  to  Stokes-Adams  disease. 

At  the  present  time,  two  views  are  held  with  regard  to  the 
path  taken  by  the  impulse  which  normally  causes  the  various 
chambers  of  the  heart  to  beat.  According  to  the  older  view,  the 
impulse  arises  in  the  automatic  ganglia  of  the  heart  and  is  dis- 
tributed to  the  musculature  through  the  medium  of  nerves.  Ac- 


LITTLE  BIOGRAPHIES 


851 


cording  to  the  more  recent  view,  the  impulse  arises  from  the 
automatically  rhythmical  musculature  of  the  great  veins  and 
passes  thence  to  the  various  chambers  of  the  heart  through  the 
muscles,  after  the  nature  of  peristalsis.  The  greatest  stumbling 
block  for  the  supporters  of  the  latter  or  myogenic  theory  con- 
sisted in  the  view  that  in  mammals  the  musculatures  of  the  auri- 
cles and  ventricles  are  completely  separated  from  one  another 
by  connective  tissue.  Until  it  could  be  shown  that  this  is  not 
the  case,  this  myogenic  view  was  untenable  at  least  in  so  far 
as  it  concerned  the  mammals. 

To  His,  Jr.,  belongs  the  credit  of  being  the  first  to  find  a 
muscular  connection.  He  has  shown,  and  this  has  since  been 
abundantly  confirmed,  that  in  mammals  there  is  a  narrow  band 
of  muscular  tissue  joining  the  auricles  with  the  ventricles.  This 
connecting  bundle  lies  in  the  ventricular  septum  just  above  the 
muscular  and  below  the  membranous  portions  and  about  ten 
millimeters  below  the  posterior  cusp  of  the  aortic  valves.  It 
then  curves  over  the  upper  edge  of  the  muscular  septum  and 
sends  its  fibres  into  the  wall  of  the  right  auricle  and  into  the 
musculature  of  the  auricular  valves.  In  the  heart  of  adult 
man  the  band  is  eighteen  millimeters  long,  twro  and  five-tenths 
millimeters  wide  and  one  and  five-tenths  millimeters  thick. 
The  anatomy  of  this  bundle  in  other  mammals  is  essentially 
similar  to  that  in  man.  As  the  auriculo-ventricular  bundle  of 
His  represents  the  only  demonstrable  muscular  connection 
between  the  auricles  and  ventricles  in  the  heart  of  mammals, 
it  follows  that  if  the  myogenic  theory  is  correct,  destruction 
of  this  bundle  should  prevent  the  passage  of  the  impulse  from 
one  chamber  to  the  other. 

Erlanger  mentions  the  attempts  which  have  been  made  by  va- 
rious investigators  to  destroy  this  connection.  They  have  here- 
tofore been  only  partially  successful  and  the  studies  have  been 
incomplete.  He  describes  the  investigations  made  by  himself 
upon  the  mode  of  conduct  of  this  impulse  with  the  hope  that  a 
solution  of  the  problem  might  throw  some  light  on  the  patho- 
genesis of  heart-block.  In  fourteen  preliminary  experiments  he 
was  successful  in  only  three,  owing  to  the  fact  that  he  was 
unable  to  properly  destroy  the  bundle  of  His.  Finally  a  specially 
devised  clamp  was  made  which  proved  to  be  entirely  successful. 
By  means  of  it  the  portion  of  the  heart  containing  the  bundle  of 
His  was  effectively  grasped,  and  the  pressure  upon  it  was  modi- 
5 


SCIENTIFIC  REVIEW 


fied  by  a  properly  adjusted  thumb-screw.  Though  the  results 
of  the  experiments  carried  out  in  this  manner  varied  slightly  in 
detail,  it  was  possible  in  every  case  to  obtain  heart-block  with 
comparative  ease. 

If  the  clamp  had  been  properly  adjusted  on  the  heart  the 
latter  continued  to  beat  with  undisturbed  sequence  and  rhythm. 
Upon  gradually  tightening  the  clamp  the  first  effect  was  often 
an  increase  in  the  time  intervening  between  the  beginning  of  an 
auricular  contraction  and  the  beginning  of  the  ventricular  con- 
traction, the  "  intersystolic  period,"  of  the  same  cardiac  cycle. 
The  duration  of  this  intersystolic  period  then  gradually  increased 
in  the  succeeding  cycles  until  eventually  the  ventricles  failed  to 
respond  to  an  auricular  contraction  (a  "  ventricular  silence"). 
At  first  the  ventricular  beats  were  dropped  rather  irregularly, 
but  soon  the  silences  recurred  regularly ;  the  same  number  of 
small  beats  were  always  interposed  between  them.  These 
rhythms  varied  from  two  to  one  to  nine  or  ten  to  one  (stages 
of  "partial  block").  On  further  clamping  this  partial  block 
was  changed  into  a  "  complete  "  block,  in  which  the  beats  of 
the  ventricles  were  totally  independent  and  very  much  slower 
than  those  of  the  auricles.  The  reverse  order  of  changes 
occurred  when  the  clamp  was  gradually  released.  Partial 
block  could  not  be  maintained  over  a  long  period  of  time  with- 
out changing  to  either  complete  block  or  normal  sequence. 
It  was  possible,  however,  to  keep  the  block  complete  for  over 
an  hour  and  still  have  the  normal  sequence  properly  return 
upon  releasing  the  grasp  of  the  clamp.  These  two  perfect  and 
independent  rhythms  are  characteristic  of  complete  block. 
The  rate  of  the  ventricles  is  always  considerably  less  than 
that  of  the  auricles — the  average  rate  being  about  one  to 
three. 

Erlanger  details  experiments  done  by  him  to  test  the  relative 
influence  of  the  vagus  nerve  upon  the  contraction  of  the  auricles 
and  ventricles.  He  found  that  in  any  stage  of  partial  block, 
both  may  be  completely  inhibited  by  appropriate  stimulation  of 
this  nerve ;  this  inhibition  was  obtained  as  easily  as  under  normal 
conditions.  When  the  block  was  complete,  stimulation  of  the 
peripheral  end  of  the  vagus,  although  it  decreased  the  auricles, 
showed  absolutely  no  effect  upon  the  ventricles.  This  loss  of 
the  influence  of  the  vagus  over  the  ventricles  was  always  exactly 
synchronous  with  the  establishment  of  complete  heart-block. 


SCIENTIFIC  REVIEW 


853 


Under  these  conditions  section  of  both  vagi  had  little  or  no 
effect  upon  the  rate  of  the  ventricles,  although  the  usual  change 
in  the  rate  of  the  auricles  occurred.  Stimulation  of  the  accel- 
erator, however,  as  a  rule,  increased  the  rate  of  the  ventricles 
as  much  proportionately  as  that  of  the  auricles.  Other  experi- 
ments, such  as  alterations  in  variation  of  blood  pressure,  cutting 
of  the  splanchnics,  general  asphyxia  carried  to  the  convulsive 
stage,  blocking  of  one  coronary  artery,  etc.,  had  no  effect  on  the 
ventricular  rate. 

Though  at  autopsy  upon  cases  in  which  heart-block  had  been 
obtained  it  was  always  macroscopically  evident  that  the  bundle 
of  His  had  been  embraced  by  the  clamp,  in  order  to  have  more 
exact  control  of  this  important  condition,  the  tissue  was  ex- 
amined microscopically  in  some  cases.  Invariably  these  histo- 
logical examinations  showed  that  the  auriculo-ventricular  bundle 
of  His  had  been  included  in  the  clamp.  On  the  other  hand,  in 
the  cases  in  which  heart-block  was  not  obtained,  it  was  found 
that  the  His  bundle  had  not  been  so  included. 

In  the  first  part  of  Erlanger's  paper  he  describes  the  experi- 
ments made  by  himself  upon  a  case  of  Stokes-Adams  disease. 

The  clinical  history  of  this  case  was,  briefly,  as  follows :  Male, 
colored,  aged  thirty-four  years ;  complained  of  vertigo,  soreness 
in  chest  and  shortness  of  breath  on  exertion.  In  his  past 
history  there  was  nothing  of  importance,  except  a  clear  history 
of  syphilis  contracted  about  seven  years  before  onset  of  present 
trouble,  and  including  a  costal  gumma  about  three  years 
before.  The  attacks  of  dizziness  had  appeared  about  two 
months  before  admission ;  at  first  very  slight,  then  gradually 
increased  in  severity  and  about  a  week  before  admission  he 
had  had  his  first  attack  of  dizziness  accompanied  by  uncon- 
sciousness. On  examination,  pulse  at  wrist  was  eight  to  the 
quarter  minute,  but  at  the  apex  thirty-one  beats  to  the 
quarter  were  heard.  The  cardiac  impulse  was  diffused  and 
difficult  to  localize;  sounds  were  clear,  one  strong  beat 
followed  usually  by  two  extremely  feeble  impulses,  the  sounds 
of  which  were  just  heard ;  all  first  sounds  were  associated  with 
feeble  but  clear  second  sounds.  The  veins  in  the  neck  were  very 
full,  especially  on  the  right  side;  waves  were  seen  in  these,  the 
rapidity  of  which  it  was  difficult  to  make  out.  The  patient  was 
admitted  to  the  hospital  on  November  nth.  Up  to  January  23rd 
he  had  but  five  definite  syncopal  attacks  in  which  he  lost  con- 


854 


SCIENTIFIC  REVIEW 


sciousncss  or  fell,  but  very  often  had  spells  of  dizziness.  On 
March  20th  he  had  many  attacks,  but  at  this  time  it  was  noted 
that  a  steady  increase  in  heart  rate  was  in  progress.  On  March 
29th  the  heart  was  apparently  normal — rate  seventy-two  per 
minute.  Following  that  time  the  condition  of  the  heart 
remained  normal  and  the  patient  had  no  syncopal  attacks. 
The  improvement  in  condition  followed  treatment  with  potas- 
sium iodide. 

The  physiological  observations  of  the  patient  were  as  follows: 
Tracings  of  the  cardiac  impulses  were  made  by  means  of 
Marey's  cardiograph.  At  the  same  time  tracings  of  the  venous 
pulsations  were  obtained  in  the  external  jugular  vein  and  the 
arterial  pulsations  were  recorded  with  the  author's  sphygmomano- 
meter. Examples  of  the  tracings  thus  obtained  are  given  with 
a  careful  analysis  of  the  waves  recorded.  The  analysis  demon- 
strates that  the  tracings  of  the  apex  beat,  jugular  pulse  and 
brachial  pulse  of  this  patient  show  two  perfectly  regular  and 
independent  rhythms,  each  recurring  without  reference  to  the 
other.  The  waves  due  to  ventricular  contraction  and  those  due 
to  auricular  contraction  are  easily  distinguished  one  from  the 
other.  When  by  accident  they  are  synchronous,  the  resulting 
wave  is  an  algebraic  sum  of  the  two.  The  only  known  con- 
dition in  which  such  waves  might  occur  is  one  in  which  the 
impulse  causing  the  auricles  to  contract  does  not  reach  the 
ventricles ;  these  two  regions  of  the  heart,  therefore  beating 
rhythmically  and  independently  of  one  another,  complete 
heart-block.  During  the  improvement  in  the  condition  of  the 
patient,  tracings  were  obtained  which  showed  that  the  con- 
dition of  partial  heart-block  existed;  the  ratio  varying  from 
two  to  one  to  sometimes  seven  or  eight  to  one. 

Erlanger  experimented  with  the  effect  of  extrinsic  influences 
upon  the  rates  of  the  auricles  and  ventricles  in  both  complete 
and  partial  heart-block.  Influences  which  apparently  act  upon 
the  heart  by  means  of  a  vagus  control,  such  as  posture,  inhala- 
tions of  ammonia  or  oxygen,  the  giving  of  atropine,  etc.,  in 
complete  block  had  no  influence  over  the  pulse  (ventricular  rate), 
though  the  influence  over  the  auricles  was  that  normally  shown 
toward  the  whole  heart.  During  partial  block  a  proportional  in- 
fluence upon  the  ventricles  was  also  noted.  Influences  acting 
upon  the  heart  through  the  accelerator  nerves,  however,  such  as 


SCIENTIFIC  REVIEW 


855 


exercise,  showed  a  proportional  effect  upon  both  ventricles  and 
auricles. 

The  effect  of  atropine  will  be  spoken  of  more  in  detail. 

Atropine.  Dehio  first  suggested  the  use  of  atropine  for  the 
purpose  of  determining  the  part  played  by  the  inhibitory  ap- 
paratus in  the  causation  of  the  slow  heart  beat.  This  method 
of  diagnosis  was  used  by  him  in  a  case  of  Stokes-Adams  disease, 
with  the  result  that  no  effect  upon  the  pulse  rate  was  noticed. 
His  observation,  together  with  other  similar  ones  which  have 
since  been  made,  indicates  that  in  cases  of  this  disease  the  vagi 
do  not  act  upon  the  ventricles,  but  no  one  has  compared  the  effect 
of  this  drug  on  the  rate  of  ventricles  with  its  effect  on  the  rate 
of  the  auricles.  Erlanger  performed  three  such  experiments. 
After  giving  one  milligram  of  atropine  subcutaneously  it  was 
found  that  the  auricles  responded  as  the  whole  heart  normally 
responds ;  that  is,  after  a  preliminary  slowing,  the  rate  began 
to  increase  and  reached  a  maximum  in  about  three-quarters  of 
an  hour.  It  then  decreased  slowly  and  somewhat  irregularly. 
In  the  meantime  the  ventricular  rate  was  practically  un- 
changed except  for  a  very  slight  reduction.  In  partial  block 
the  effect  upon  the  auricles  was  the  same.  The  ventricular 
rate  varied  irregularly,  but  these  irregularities  were  explained 
by  the  change  in  rhythm  which  takes  place  during  partial 
block. 

Erlanger  has  determined  that  during  the  syncopal  attacks  in 
addition  to  the  well  known  slowing  of  the  ventricular  rate,  there 
is  a  decided  increase  in  the  auricular  rate.  This  acceleration  is 
at  first  gradual  and  the  return  to  normal  is  also  gradual.  Inas- 
much as  this  increase  in  the  auricular  rate  always  occurs  at  the 
time  of  an  attack,  and  furthermore  any  influence  which  brings 
on  an  attack  first  increases  the  auricular  rate,  he  believes  that 
this  increase  is  the  most  important  factor  in  causing  the  syncopal 
attacks.  He  definitely  excludes  a  decrease  of  the  ventricular 
rate  and  the  fall  in  blood  pressure  as  the  cause  of  the  increased 
auricular  rate.  He  notes  that  asphyxia  increases  the  auricular 
rate  and  at  the  same  time  decreases  the  ventricular  rate ;  as- 
phyxia in  several  cases  both  experimental  and  in  the  course  of 
Cheyne-Stokes  respiration  brought  on  typical  attacks.  He  notes 
as  well  that  the  effect  of  the  atropine  was  to  decrease  the  fre- 
quency of  the  syncopal  attacks.  This  apparent  inconsistency  he 
explains  by  the  fact  that  the  increase  in  auricular  rate  is  here 


856 


SCIENTIFIC  REVIEW 


gradual  and  not  sudden  as  in  the  other  cases.  This  freedom 
from  attacks  following  atropine  is  perhaps  due  to  the  fact  that 
the  auricles  are  thus  relieved  from  the  influence  of  the  vagi,  and 
thus  one  of  the  factors  causing  sudden  variations  in  the  rate  of 
the  auricles  is  abolished. 

He  finds  that  the  cardiac  signs  (slowing  of  the  ventricles  and 
increase  in  the  rate  of  auricles)  always  preceded  the  subjective 
symptoms  connected  with  the  approach  of  an  attack.  This  ob- 
servation is  in  accord  with  the  results  of  other  investigators  and 
indicates  that  the  attacks  of  syncope  are  the  result  of  deficient 
blood  supply  to  the  brain. 

It  was  found  that  during  complete  block  the  maximum  blood 
pressure  was  slightly  higher,  whereas  the  minimum  blood  pres- 
sure was  considerably  lower  than  during  the  normal  state.  This, 
of  course,  indicates  that  the  mean  blood  pressure  is  higher  when 
the  heart  is  normal  than  when  complete  heart-block  exists.  It 
was  noticed  that  during  complete  block  the  respirations  and  ven- 
tricular rhythms  were  synchronous,  and  if  for  any  reason  the 
respiratory  rate  is  momentarily  disturbed,  it  quickly  returns  to 
the  ventricular  rhythm.  When  block  is  partial,  this  rule  did 
not  hold. 

Erlanger  also  observed  a  second  case  of  Stokes-Adams  disease, 
though  he  had  but  one  opportunity  of  making  tracings  of  the 
heart  movements.  This  cardiogram,  however,  shows  all  the 
features  seen  in  the  first  case.  The  case  is  of  interest,  because 
this  patient,  too,  gives  a  history  of  former  syphilis. 

He  summarizes  his  observations  upon  these  cases  of  Stokes- 
Adams  disease  as  follows:  (i)  The  investigation  shows  that 
the  symptoms  of  this  case  undoubtedly  are  caused  by  some  lesion 
of  the  heart,  which  gives  rise  to  the  condition  now  generally 
termed  heart-block.  (2)  Practically  all  degrees  of  heart-block 
have  been  observed,  partial  block  occuring  during  recovery.  (3) 
Experiments  testing  the  reaction  of  the  heart  to  various  ex- 
trinsic influences  demonstrate  that  when  the  block  is  complete 
the  ventricles  do  not  respond  to  influences  presumably  of  vagus 
origin,  though  the  auricles  still  respond  freely  to  such  influences. 
(4)  The  effects  probably  exerted  upon  the  heart  through  the  ac- 
celerator nerves  still  influence  the  rate  of  the  ventricles  as  well 
as  that  of  the  auricles.  (5)  When  the  block  is  partial,  ven- 
tricular rate  varies  proportionately  with  the  auricular  beat,  but 
only  within  certain  limits.    When  these  limits  are  exceeded  the 


SCIENTIFIC  REVIEW 


857 


block  becomes  more  complete.  (6)  The  syncopal  attacks  are 
in  all  probability  directly  dependent  upon  a  marked  reduction 
of  the  ventricular  rate.  Such  reduction  of  the  ventricular  rate 
is  always  associated  with  an  increase  in  the  auricular  rate,  and 
it  is  believed  that  the  latter  is  the  cause  of  the  former. 

A  comparison  of  parts  one  and  two  will  show  that  the  rela- 
tionship between  the  results  of  the  study  of  a  case  of  heart- 
block  in  man  and  heart-block  in  the  dog  is  so  close  that  there 
is  no  reason  to  doubt  that  the  condition  in  man  was  caused  by 
the  same  factor  as  in  the  dog.  That  heart-block  in  man  is  due 
to  a  diminution  in  the  conductivity  of  the  auriculo-ventricular 
bundle  of  His  is  borne  out,  not  only  by  the  fact  that  the  con- 
dition exists,  but  also  that  the  vagus  has  lost  its  influence  over 
the  ventricles ;  that  presumably  the  accelerator  nerves  still 
preserve  their  influence  over  the  ventricles  and  that  the  ven- 
tricles may  stop  beating  over  long  periods  of  time  while  the 
auricles  "continue  to  beat  without  interruption. 

The  writer  here  discusses  the  question,  Will  a  lesion  in  the 
vicinity  of  the  auricular-ventricular  bundle  account  for  all  the 
typical  symptoms  of  Stokes-Adams  disease?  Such  symptoms 
are  (1)  slow  pulse,  sometimes  associated  with  pulsations  in  the 
veins  of  the  neck,  which  may  be  more  than  twice  as  frequent  as 
the  ventricular  beats;  (2)  syncopal  attacks,  either  epileptiform 
or  apoplectiform  in  character  and  in  which  the  pulse  rate  is  un- 
usually slow\  That  the  first  symptom  has  already  been  satis- 
factorily explained  by  the  presence  of  the  condition  of  heart- 
block  is  evident;  in  regard  to  the  latter,  it  has  been  shown  that 
in  heart-block  there  may  be  periods  of  unusually  slow  pulse.  It 
has  also  been  shown  that  the  syncopal  attacks  are  due  to  the 
slowing  of  the  ventricular  rate.  Other  writers  have  called  at- 
tention to  the  fact  that  the  epileptiform  seizures  of  Stokes-Adams 
disease  may  be  due  to  anaemia  of  the  brain,  caused  by  failure 
of  the  heart  to  supply  a  sufficient  quantity  of  blood,  and  thus 
are  similar  to  the  convulsions  often  seen  after  profuse  hemor- 
rhage in  man  and  animals  and  to  those  seen  after  ligature  of 
the  great  vessels  of  the  neck.  The  apoplectiform  attacks  might 
also  be  accounted  for  in  much  the  same  way ;  with  somewhat  less 
slowing  of  the  ventricles,  venous  congestion  would  be  great  and 
the  fall  in  arterial  pressure  might  not  be  extreme.  Apoplecti- 
form attacks  have  been  noted  by  other  writers  in  marked  venous 
or  arterio-venous  congestion  of  the  brain. 


858  SCIENTIFIC  REVIEW 

Having  proved  that  heart-block  will  cause  all  the  symptoms 
of  Stokes-Adams  disease  and  that  in  his  two  cases  heart-block 
did  exist,  Erlanger  has  attempted  to  analyze  all  cases  of  Stokes- 
Adams  disease  thus  far  reported  with  the  purpose  of  ascertaining 
whether  or  not  heart-block  existed  in  them  all.  The  complete 
analysis  was  found  impracticable  owing  to  the  meagre  details 
given  in  many  of  the  reports,  but  he  has  come  to  the  conclusion 
that  in  no  single  instance  among  the  many  cases  examined,  has 
the  description  of  a  typical  Stokes-Adams  disease  precluded  the 
existence  of  heart-block.  He  has  selected  from  all  cases  de- 
scribed those  that  have  been  studied  by  methods  of  sufficient  ac- 
curacy to  permit  of  exact  diagnosis  and  has  found  that  all  have 
proved  to  be  instances  of  heart-block. 

As  any  interference  with  the  transmission  of  a  normal  im- 
pulse from  auricle  to  ventricle  should  be  included  under  the  head 
of  heart-block,  it  is  only  necessary  to  show  that  the  ventricles 
more  or  less  regularly  fail  to  respond  to  one  or  more  of  the 
regular  recurring  auricular  impulses  in  order  to  make  diagnosis 
of  heart-block.  Though  the  best  method  of  reaching  a  correct 
diagnosis  in  these  cases  is  by  making  tracings  of  either  one  or 
all  of  the  following:  apex  beat,  jugular  pulse  and  arterial  pulse, 
and  finding  therein  the  marks  of  two  perfectly  regular  rhythms 
due  to  the  auriculo-ventricular  beats;  however,  in  most  cases 
it  should  be  possible  to  arrive  at  the  diagnosis  of  heart-block 
with  the  aid  of  the  usual  clinical  methods.  Though  the  earliest 
stages  of  the  condition,  that  is,  lengthening  of  the  intersystolic 
period  and  occasional  ventricular  silences  would  usually  remain 
undiscovered  because  giving  no  symptoms  and  hence  not  looked 
for,  later  stages  when  the  difference  between  the  auricular  and 
ventricular  pulse  rates  is  marked  should  cause  no  trouble  in 
diagnosis.  Erlanger  gives  the  differential  diagnosis  between 
this  condition  and  the  only  others  which  might  be  confused  with 
it — (1)  alternating  pulse;  (2)  extra  systole  of  ventricular  origin. 
The  writer  believes  that  the  distinction  between  heart-block  with 
and  without  syncopal  attacks  is  an  arbitrary  one  and  that  the 
two  conditions  merely  represent  two  stages  of  the  same  disease. 

The  wrriter  speaks  of  the  various  causes  which  have  been  de- 
scribed for  this  disease  and  shows  their  inadequacy  as  a  general 
rule.  He  has  been  able  to  find  only  three  cases  in  which  there 
was  a  probable  lesion  of  the  auriculo-ventricular  bundle,  prob- 
ably because  such  lesions  have  not  been  looked  for.    That  both 


PUBLIC  HEALTH 


859 


of  his  cases  gave  a  clear  history  of  syphilis  and  that  one  of  them 
practically  recovered  under  the  use  of  potassium  iodide,  as  did 
a  patient  of  Jaquet's,  the  writer  considers  significant.  But,  if 
syphilis  causes  heart-block,  it  certainly  is  not  the  only  cause; 
at  least  it  does  not  seem  to  be  mentioned  more  frequently  in 
the  history  of  cases  of  Stokes-Adams  disease  than  in  the  histories 
of  other  diseases.  He  also  points  out  the  probability  of  a  lesion 
of  the  mesial  leaflet  of  the  tricuspid  valve  causing  a  disturbance 
of  the  function  of  the  auriculo-ventricular  bundle  on  account 
of  their  normal  close  association. 

In  addition  to  the  value  of  potassium  iodide  in  the  treatment 
of  some  cases  he  also  points  out  the  value  of  atropine  in  tem- 
porarily stopping  the  attacks  of  syncope. 

His  conclusions  are  as  follows : 

(1)  All  of  the  cardinal  symptoms  of  Stokes-Adams  disease 
may  be  duplicated  by  heart-block,  resulting  from  a  lesion  in  or 
near  the  auriculo-ventricular  bundle  of  His,  and  by  this  alone. 

(2)  No  typical  case  of  Stokes-Adams  disease  has  been  de- 
scribed in  which,  heart-block  might  not  have  been  the  cause  of 
the  trouble. 

(3)  It  can  be  shown  that  all  cases  of  Stokes-Adams  disease 
which  have  been  studied  by  sufficiently  accurate  methods  were 
cases  of  heart-block. 

(4)  It  would  appear  that  heart-block  without  and  with  syn- 
copal attacks  are  two  stages  of  the  same  disease  process. 

Abstracted  by  H.  C.  Gordinier. 


public  Dealtb 

Edited  by  Joseph  D.  Craig,  M.  D. 

Department  of  Health — Albany,  N.  Y. 


Arstract  of  Vital  Statistics  for  October,  1906. 


Deaths. 

1902 

1903 

1904 

1905 

1906 

26 

16 

21 

20 

16 

Typhoid  Fever  

0 

3 

0 

2 

0 

Scarlet  Fever  

0 

1 

0 

0 

0 

Measles   

0 

5 

0 

0 

0 

Whooping-cough   

2 

0 

0 

0 

0 

Diphtheria  and  Croup  

4 

0 

0 

4 

1 

86o 


PUBLIC  HEALTH 


DffntU e 

1902 

1903 

1904 

i9°5 

1906 

0 

2 

O 

0 

0 

Tii^rfnfipoi  Tiicaicpo 

5 

7 

3 

4 

5 

1— '  noiitrintlia 

9 

7 

12 

7 

5 

0 

0 

0 

ft 
O 

0 

HrifTnf  c   T  iicAocA 

1 1 

12 

15 

ft 

O 

Io 

10 

14 

2 

14 

II 

8 

7 

9 

4 

7 

7 

Q 
O 

9 

3 

13 

10 

20 

23 

17 

33 

9 

14 

.0 
Io 

17 

12 

Total  deaths  

136 

137 

136 

135 

141 

Death  rate  

16.00 

l6.  12 

16.00 

15.88 

16.59 

Death    rate    less  non-resi- 

14-35 

14-35 

14.83 

13.65 

I4-3S 

Deaths  in  Institutions. 
1902         1903        1904         1905  1906 

N»n-  Non-  Non-  Non-  Non- 

Resi-  resi-  Resi-  rcsj-  Reai-  resi-  Resi-  rrsi-  Resi-  resi- 
dent    dent    dont     dent    dent    dent    dent    dent    dent  denl 

Albany  Hospital    7      6     10     10     18      8      8      7      9  9 

Albany  Orphan  Asylum.  1  130101200 

County  House   2      2      3      o      4      1      2      2      1  0 

Homeopathic  Hospital..  2000202012 

House  of  Shelter   1      0      o      o      1      0      o      0      0  0 

Home  for  the  Friend- 
less   o      0      2      0      o      0      0      o      0  0 

Little    Sisters    of  the 

Poor    2      o      o      o      o      0      0      o      1  0 

Child's  Hospital   0000000001 

Public  Places   0302000016 

St.   Frances   de  Sayles 

Orphan  Asylum   0000000010 

St.  Margaret's  Home...  001  1316501 

St.  Peter's  Hospital   2101  102252 

Sacred  Heart  Convent..  0010000000 

Births    57 

Marriages    30 

Still   Births   7 


Bureau  of  Plumbing. 

In  the  Bureau  of  Plumbing,  Drainage  and  Ventilation  there  were  two 
hundred  and  forty  inspections  made,  of  which  one  hundred  and  fifty-four 
were  of  old  buildings  and  ninety-six  of  new  buildings.  There  were  sixty 
iron  drains  laid,  twenty-eight  connections  to  street  sewers,  thirty-four  tile 
drains,  eighteen  urinals,  two  latrines,  ninety-seven  cesspools,  two  hundred 
and  fifty-two  wash  basins,  eighty-four  sinks,  one  hundred  and  ninety-one 


PUBLIC  HEALTH 


86l 


bath  tubs,  forty-six  wash  trays,  three  butler's  pantry  sinks,  four  trap 
hoppers  in  yard,  two  hundred  and  ninety-four  tank  closets,  nineteen  slop 
hoppers,  twelve  shower  baths.  There  were  one  hundred  and  twenty-nine 
permits  issued,  of  which  one  hundred  and  five  were  for  plumbing  and 
twenty-four  for  building  purposes.  There  were  twenty-six  plans  sub- 
mitted, of  which  eight  were  of  old  buildings  and  eighteen  for  new  build- 
ings. There  were  four  houses  tested,  on  complaint,  with  peppermint  test. 
There  were  fifteen  water  tests  made.  Two  houses  examined  on  com- 
plaint and  twenty-six  re-examined.  Eleven  complaints  were  found  valid 
and  ten  without  cause. 


Bureau  of  Contagious  Diseases. 


Cases  Reported.  1902 

1903  1904 

1905 

1906 

3  9 

10 

3 

5  2 

22 

10 

24  9 

24 

20 

3  1 

0 

0 

Measles    0 

4  4 

0 

3 

0  I 

0 

0 

Consumption    0 

0  1 

4 

0 

Totals   87 

39  27 

60 

36 

Contagious  diseases  in  relation  to  public 

schools : 

Reported. 

Deaths. 

D.    S.  F. 

D. 

S.  F. 

•  4 

.  l 

Public  School  No.  9  

I 

Public  School  No.  14  

I 

Public  School  No.  15  

1 

Public  School  No.  17  

2  1 

1 

Public  School  No.  20  

4 

1 

Albany  Business  College  

1 

Number  of  days  quarantine  for  diphtheria: 

Longest             59  Shortest  

3         Average . 

213-4 

Number  of  days  quarantine  for  scarlet  fever: 

Longest   67         Shortest   19         Average   35  5-6 


Cases  of  diphtheria  reported   20 

Cases  of  diphtheria  in  which  antitoxin  was  used   16 

Cases  in  which  antitoxin  was  not  used   4 

Deaths  after  use  of  antitoxin   1 


Fumigations : 
Houses. . 


27  Rooms 


7i 


86a 


SOCIETY  PROCEEDINGS 


Society  proceedings 

Medical  Society  of  the  County  of  Albany. 

The  semi-annual  meeting  of  the  Society  was  held  in  the  Alumni  Hall 
of  the  Albany  Medical  College  on  Wednesday  evening,  October  loth,  1906. 
The  meeting  was  called  to  order  by  the  President,  Dr.  G.  G.  Lempe.  The 
following  members  were  present:  Drs.  Archambault,  J.  L.,  Bailey, 
Baldauf,  Bedell,  A.  J.,  Beilby,  Bendell,  Blair,  Case,  Classen,  Cook,  Cox, 
De  Voe,  Goewey,  Gutmann,  Hacker,  Huested,  Jenkins,  Joslin,  Le  Brun, 
Lipes,  Lomax,  Macdonald,  MacFarlane,  Mereness,  Merrill,  Mitchell, 
Montmarquet,  Moore,  C.  H.,  Moore,  J.  M.,  Moston,  Muller,  Murray, 
Meyers,  Nellis,  Neuman,  O'Leary,  D.  V.,  Jr.,  Papen,  G.  W.,  Sr.,  Pearce, 
Peltier,  Pease,  Rooney,  Rulison,  H.,  Shanks,  Silcocks,  Stevenson,  Traver, 
Trego,  Troidle,  Vander  Veer,  A.,  Vander  Veer,  E.  A.,  Van  Auken,  Ward, 
Zeh. 

1.  Reading  of  the  minutes  of  the  last  regular  meeting. 

Dr.  Lipes  moved  that  the  minutes  as  printed  in  the  Albany  Medical 
Annals  be  adopted.    The  motion  was  seconded  and  carried. 

2.  Reception  of  reports  of  officers  and  committees.  No  committees 
reported  at  this  time  in  the  order  of  business. 

3.  Election  of  members. 

A  communication  was  read  by  the  Secretary  from  the  Secretary  of  the 
Board  of  Censors  recommending  for  membership  Drs.  W.  P.  Brierly, 
J.  N.  B.  Garlick,  M.  J.  Keough,  W.  D.  B.  Lester,  Henry  F.  C.  Muller, 
Harry  Rulison,  and  Luman  B.  Rulison. 

Dr.  Craig  moved  that  the  Secretary  be  instructed  to  cast  one  ballot  for 
the  names  presented.    This  motion  was  seconded  and  carried. 

The  Secretary  cast  one  ballot  and  the  President  announced  the  election 
of  Drs.  Brierly,  Garlick,  Keough,  Lester,  Muller,  Rulison  and 
Rulison  as  members  of  the  Society. 

4.  The  Vice-President's  address. 

The  Vice-President,  Dr.  J.  D.  Montmarquet,  delivered  an  address 
entitled  "  Hysteropexy  Followed  by  Repeated  Pregnancies.  Report  of 
Three  Cases." 

At  the  conclusion  of  Dr.  Montmarquet's  address  Dr.  MacFarlane 
moved  a  vote  of  thanks  to  Dr.  Montmarquet  for  his  interesting  and 
able  paper,  and  recommended  its  publication.   The  motion  was  seconded. 

Dr.  Vander  Veer  said  that  the  paper  was  a  contribution  of  great 
value.  Although  surgeons  are  not  entirely  agreed  on  any  one  operation, 
he  approved  in  large  measure  of  what  the  speaker  had  said  regarding 
the  Kelly  operation.  There  could  be  no  difference  of  opinion,  he  said, 
regarding  the  great  value  of  the  publication  of  such  cases  as  had  been 
described  in  the  address,  and  he  felt  personally  grateful  to  the  author 
for  it. 

The  motion  was  carried. 

5.  Election  of  delegates. 

The  President  called  for  nominations  for  the  office  of  delegate  to  the 
State  Society,  two  delegates  to  serve  for  two  years  and  one  for  one 


SOCIETY  PROCEEDINGS 


863 


year.  Dr.  Vander  Veer  nominated  Dr.  W.  G.  Macdonald  to  serve  tor 
two  years,  Dr.  Ward  nominated  Dr.  L.  H.  Neuman  to  serve  for  two 
years,  Dr.  E.  A.  Vander  Veer  nominated  Dr.  J.  D.  Craig  to  serve  for 
one  year,  and  Dr.  Cook  nominated  Dr.  A.  H.  Traver  to  serve  for  one 
year. 

Dr.  Merrill  moved  that  the  Secretary  cast  one  ballot  of  the  Society 
for  the  two  delegates  nominated  to  serve  for  two  years. 
The  motion  was  seconded  and  carried. 
The  Secretary  cast  the  ballot. 

The  President  declared  Drs.  W.  G.  Macdonald  and  L.  H.  Neuman 
elected  delegates  to  the  State  Society  to  serve  for  two  years. 

The  President  appointed  as  tellers  in  the  balloting  for  delegates  for 
one  year  Drs.  MacFarlane  and  Classen. 

The  ballots  were  collected  and  counted. 

Dr.  Traver  received  twenty-four  votes  and  Dr.  Craig  twenty-three 
votes. 

The  President  declared  Dr.  Traver  elected  as  delegate  to  the  State 
Society  to  serve  for  one  year. 

Dr.  Neuman  stated  that  inasmuch  as  his  position  as  Chairman  of  the 
Committee  on  Scientific  Work  carried  with  it  the  privilege  of  voting  in 
the  House  of  Delegates  of  the  State  Society,  he  thought  that  he  should 
not  also  serve  as  Delegate  from  the  Society.  The  Albany  County  Society 
should  have  as  many  votes  as  possible  in  the  House  of  Delegates,  and 
therefore  he  declined  the  office  to  which  he  had  just  been  elected. 

The  President  called  for  nominations  for  Delegate  to  the  State  Society 
to  serve  for  two  years  in  place  of  Dr.  Neuman,  resigned. 

Dr.  Neuman  nominated  Dr.  J.  H.  Mitchell. 

Dr.  Traver  nominated  Dr.  J.  D.  Craig. 

The  President  appointed  Drs.  Cook  and  Ward  as  tellers. 

After  the  balloting  the  tellers  announced  the  result  of  the  ballot : 

Dr.  Craig  received  29  votes  and  Dr.  Mitchell  20  votes. 

The  President  then  declared  Dr.  Craig  elected  as  delegate  to  the  State 
Society  to  serve  for  two  years. 

Dr.  E.  A.  Vander  Veer  moved  that  the  Society  proceed  to  the  election 
of  Delegates  to  the  District  Branch.  The  motion  was  seconded  and 
carried.    The  President  called  for  nominations. 

Dr.  Cook  nominated  Dr.  J.  H.  Mitchell. 

Dr.  Mereness  nominated  Dr.  Andrew  MacFarlane. 

Dr.  Neuman  nominated  Dr.  F.  L.  Classen. 

Dr.  Ward  nominated  Dr.  F.  M.  Joslin. 

The  President  appointed  Drs.  Traver  and  De  Voe  as  tellers. 
Dr.  E.  A.  Vander  Veer  moved  that  the  Society  return  to  reports  of 
committees  while  the  tellers  were  counting  the  ballots. 
The  motion  was  seconded  and  carried. 

Dr.  Craig,  chairman  of  the  committee,  appointed  at  the  last  annual 
meeting  of  the  Medical  Society  of  the  County  of  Albany  to  consider  the 
question  of  bacteriological  tests  which  might  be  made  by  the  city  of 
Albany  at  public  expense,  read  the  following  report: 


864 


SOCIETY  PROCEEDINGS 


Majority  Report. 

Albany,  N.  Y.,  Oct.  ioth,  1906. 
The  committee  appointed  at  the  last  annual  meeting  of  the  Medical 
Society  of  the  County  of  Albany  to  consider  the  question  of  bacterio- 
logical tests  which  might  be  made  by  the  city  of  Albany  at  public 
expense,  met  on  the  21st  of  August  last  and  gave  careful  consideration 
to  the  subject  of  municipal  bacteriological  examinations.  The  com- 
mittee was  unable  to  arrive  at  an  unanimous  conclusion,  and  therefore 
respectfully  submits  to  the  Society  the  following  majority  recommenda- 
tions : 

It  is  the  opinion  of  the  undersigned  that  all  bacteriological  tests 
necessary  for  the  diagnosis  of  disease  should  be  made  by  the  city  of 
Albany  at  public  expense.  It  is  therefore  recommended  that  an  appro- 
priation be  made  by  the  city  for  such  purpose. 

D.  H.  Cook, 
O.  D.  Ball. 

Minority  Report. 

Albany,  N.  Y.,  Oct.  ioth,  1906. 
The  committee  appointed  at  the  last  annual  meeting  of  the  Medical 
Society  of  the  County  of  Albany  to  consider  the  question  of  bacterio- 
logical tests  which  might  be  made  by  the  city  of  Albany  at  public 
expense,  met  on  the  21st  of  August  last  and  gave  careful  consideration 
to  the  subject  of  municipal  bacteriological  examinations.  The  com- 
mittee was  unable  to  arrive  at  an  unanimous  conclusion,  and  therefore 
respectfully  submits  to  the  Society  the  following  minority  recommenda- 
tions : 

It  is  the  opinion  of  the  undersigned  that  the  present  method  of  making 
bacteriological  examinations  of  all  cases  of  diphtheria  and  tuberculosis 
both  for  purposes  of  diagnosis  and  to  ascertain  the  clinical  progress  of 
these  diseases  at  public  expense  should  be  continued.  It  is  further  the 
opinion  of  the  undersigned  that  bacteriological  tests  should  be  made  at 
public  expense  for  the  indigent  poor,  in  such  other  cases  of  contagious 
disease  as  may  from  time  to  time  seem  necessary  in  the  public  interest, 
and  as  may  be  determined  upon  by  the  Commissioner  of  Public  Safety 
or  his  qualified  representative.  It  is  therefore  recommended  that  an 
appropriation  be  made  by  the  city  for  such  purpose. 

Joseph  D.  Craig,  Chairman. 

Dr.  Ward  moved  the  adoption  of  the  minority  report. 
The  motion  was  seconded. 

Drs.  Ward,  Vander  Veer  and  Craig  spoke  in  favor  of  the  motion; 
Drs.  Cook,  Mereness  and  Macdonald  against  it. 

The  motion  to  adopt  the  minority  report  was  carried  by  a  vote  of 
twenty-eight  to  thirteen. 

The  tellers  announced  the  result  of  the  balloting  for  Delegates  to  the 
Third  District  Branch. 

Dr.  Mitchell  received  thirty-seven  votes. 

Dr.  MacFarlane  received  twenty-eight  votes. 

Dr.  Classen  received  twenty-five  votes. 


SOCIETY  PROCEEDINGS 


865 


Dr.  Joslin  received  twenty-one  votes. 

The  President  declared  Dr.  J.  H.  Mitchell  and  Dr.  Andrew  Mac- 
Farlane  elected  as  delegates  to  the  Third  District  Branch. 
6.   New  Business. 

Dr.  MacFarlane  moved  that  the  Secretary  purchase  note-books  on 
which  the  members  might  record  their  remarks  in  discussion,  thereby 
securing  an  accurate  report  of  the  same  in  the  minutes.  Dr.  MacFarlane 
stated  that  this  method  had  been  used  in  the  meetings  of  the  British 
Medical  Association,  Toronto,  with  good  results  and  that  no  stenogra- 
phers were  employed,  the  official  reports  of  the  meeting  being  compiled 
from  the  members'  own  notes. 

The  motion  was  seconded  and  was  lost. 

Dr.  Neuman  moved  that  the  minutes  prepared  by  the  Secretary  be 
offered  for  publication  to  such  journals  as  desired  them,  but  without  the 
payment  of  $50  for  publication,  as  had  been  customary  in  the  past. 

Drs.  Traver,  Cook  and  Neuman  spoke  in  favor  of  the  motion  and 
Drs.  MacFarlane  and  Rooney  against  it. 

Dr.  Lipes  moved  as  an  amendment  to  the  motion  that  a  committee  should 
be  appointed  to  ascertain  what  it  would  cost  to  employ  a  stenographer  to 
take  notes  of  the  Society's  proceedings. 

The  amendment  was  seconded. 

Dr.  Nellis  spoke  in  favor  of  the  amendment. 

Dr.  A.  Vander  Veer  moved  as  an  amendment  to  the  amendment  that 
the  Secretary  prepare  the  minutes  as  usual  and  send  to  each  man  taking 
part  in  discussion  a  report  of  his  remarks,  to  be  corrected  and  returned 
to  the  Secretary  within  five  days;  if  not  returned  within  five  days  it  is 
to  be  supposed  that  the  member  does  not  wish  to  correct  the  report  of 
his  remarks,  and  the  minutes  may  be  printed  without  further  correction. 

Drs.  A.  Vander  Veer,  Jenkins,  Macdonald,  Neuman,  Gutmann, 
Laird,  Moore,  C.  H.,  Mitchell  and  Cook  spoke  in  the  discussion. 

Dr.  Macdonald  stated  that  he  believed  that  the  minutes  should  not  be 
printed  until  they  were  adopted  by  the  Society,  and  asked  for  a  ruling 
by  the  Chair  as  to  whether  Dr.  Vander  Veer's  amendment  was  in  order. 

The  decision  of  the  Chair  that  the  amendment  was  in  order  was 
sustained  on  appeal  to  the  Society. 

Dr.  Macdonald  moved  to  lay  the  motion  and  amendments  on  the  table. 

The  motion  to  table  was  seconded  and  carried. 

The  Society  adjourned. 

Arthur  T.  Laird,  Secretary. 

George  Gustave  Lempe,  President. 

The  Medical  Society  of  the  County  of  Albany. 

A  regular  meeting  of  the  Society  was  held  in  Alumni  Hall  on  Wednes- 
day evening,  November  7,  1906.  The  meeting  was  called  to  order  at  8.45 
P.  M.,  the  President,  Dr.  Lempe,  in  the  chair.  Forty-three  members 
were  present. 

The  scientific  program  consisted  of  the  reading  of  the  following  papers : 
"  Report   of   Cases   Treated   by   a  Modified   Bier-Klapp    Method  of 
Hyperemia."    J.  N.  Vander  Veer. 


866 


MEDICAL  NEWS 


"  Congenital  Stenosis  of  the  Duodenum.  Report  of  a  Case."  H.  L.  K. 
Shaw  and  Leon  K.  Baldauf. 

Both  papers  called  forth  interesting  discussion.  Dr.  Vander  Veer 
demonstrated  suction  apparatus  used  in  the  application  of  the  Bier-Klapp 
method.  Dr.  Shaw  demonstrated  a  specimen  of  the  stomach  and 
duodenum  from  the  case  reported. 

Many  of  the  members  signed  the  new  by-laws  of  the  Society. 

At  the  close  of  the  meeting  a  lunch  was  served  in  the  faculty  room. 

The  corrected  minutes  of  this  meeting  will  appear  in  the  Annals  after 
the  next  meeting  of  the  Society,  December  12,  1906. 

Program  for  December  12,  1906. 

"  What  Shall  We  Eat ;  What  Shall  We  Drink  and  How  Shall  We  Be 
Saved?"    George  S.  Eveleth,  M.  D.  (by  invitation),  Little  Falls,  N.  Y. 

"  The  Importance  of  Waldeyer's  Lymphatic  Ring."    C.  F.  Theisen. 

"The  Importance  of  Intra-Cellular  Enzymes  in  Physiology  and 
Pathology."  Holmes  C.  Jackson,  Ph.  D.  (by  invitation),  Professor  of 
Physiological  Chemistry,  Albany  Medical  College. 


fl&efctcal  "Hews 

Edited  by  Arthur  J.  Bedell,  M.  D. 

The  Albany  Guild  for  the  Care  of  the  Sick— Statistics  for  Octo- 
ber, 1906.  Number  of  new  cases  90;  Classified  as  follows:  Dispensary 
cases  receiving  home  treatment,  2;  district  cases  reported  by  health 
physicians,  10;  charity  cases  reported  by  other  physicians,  40;  patients  of 
limited  means,  38;  old  cases  still  under  treatment,  66;  total  number  of 
patients  under  nursing  care  during  the  month,  156.  Classification  of 
diseases  (new  cases):  Medical,  25;  surgical,  6;  gynecological,  2;  obstetri- 
cal, 28;  mothers  and  23  infants  under  professional  care;  dental,  4;  skin,  2; 
contagious  diseases  in  medical  list,  7;  transferred  to  hospitals,  4;  deaths,  6. 

Special  Obstetrical  Department — Number  of  obstetricians  in  charge  of 
cases,  3;  attending  obstetricians,  2;  medical  students  in  attendance,  8; 
Guild  nurses,  8;  patients,  11;  visits  by  head  obstetricians,  27;  by  attend- 
ing obstetricians,  10;  by  the  medical  students,  64;  by  the  Guild  nurses, 
129;  total  number  of  visits  for  this  department,  230. 

Visits  of  Guild  Nurses  (all  departments)  :  Number  of  visits  with  nursing 
care,  1,237;  for  professional  supervision  of  convalescent,  214;  total  num- 
of  visits,  1,451.  Five  graduate  nurses  and  4  assistant  nurses  were  on 
duty.  Cases  were  reported  to  the  Guild  by  three  of  the  health  physicians 
and  by  31  others  and  by  4  dentists. 

New  York  Skin  and  Cancer  Hospital — The  governors  of  the  hospital 
announce  that  Dr.  L.  Duncan  Bulkley  will  give  an  eight-series  of  clinical 
lectures  on  diseases  of  the  skin  in  the  Out-Patient  Hall  of  the  hospital 
on  Wednesday  afternoons  commencing  November  7th,  1906,  at  4:15 
o'clock.    The  course  will  be  free  to  the  medical  profession. 

New  Ellis  Hospital,  Schenectady,  N.  Y. — On  October  12th  the  new 
hospital  was  opened  to  the  public.    On  October  15th  the  patients  were 


MEDICAL  NEWS 


867 


moved  from  the  old  to  the  new  building.  The  new  hospital  is  very 
completely  equipped  and  has  a  capacity  of  eighty  patients.  Dr.  C.  G. 
Duryee  has  been  elected  President;  Dr.  E.  J.  Wiencke,  Vice-President, 
and  Dr.  W.  W.  Goddard,  Secretary  of  the  medical  staff. 

New  England  Alumni  Association  of  the  Albany  Medical  College — 
At  a  meeting  held  in  Boston,  October  9th,  1906,  Dr.  Harvey  W.  Van 
Allen,  Springfield,  Mass.,  was  elected  President;  Dr.  Craighton  W. 
Skelton,  Providence,  R.  1^  Vice-President;  Dr.  Alfred  H.  Hoadley, 
Northampton,  Treasurer;  Dr.  Walter  G.  Murphy,  Hartford,  Conn., 
Secretary. 

A  Magazine  for  the  Sightless,  the  first  of  its  kind  in  the  United 
States  and  the  second  in  the  world  is  being  planned  and  will  be 
issued  soon.  The  magazine  will  contain  subjects  of  the  day,  amusements 
and  things  of  special  interest  to  the  blind.  Mr.  W.  G.  Holmes,  No.  1931 
Broadway,  New  York  city,  desires  the  addresses  of  the  blind  who  can 
read  either  the  Braille  or  New  York  point. 

Index  Medicus — Second  Series — Each  number  of  the  Index  presents 
the  literature  of  the  month  named  on  its  cover  and  is  issued  as  early  as 
possible  in  the  succeeding  month,  time  being  allowed  for  the  arrival  of 
foreign  journals.  The  present  editors  are  Robert  Fletcher,  M.  D.,  and 
Fielding  H.  Garrison,  M.  D. 

This  publication  consists  of  the  titles  in  full  of  the  books,  pamphlets, 
theses,  contributions  to  co-operative  works  and  original  articles  in  journals, 
transactions  of  medical  and  scientific  societies,  and  the  like,  arranged 
under  subject-headings.  The  titles  in  certain  languages,  as  Russian, 
Polish,  Swedish,  Danish,  Finnish,  Hungarian,  Bohemian,  Roumanian,  and 
Japanese,  are  translated  into  English. 

The  Index  Medicus  offers  an  extensive  monthly  bibliography,  especially 
to  those  in  charge  of  public  and  private  sanitation,  and  it  is  desired  to 
call  the  attention  of  such  officials  to  the  merits  and  practical  value  of 
this  publication.  Every  month,  among  the  subdivisions  under  the  class 
of  Public  Hygiene,  appear  articles  on  Sewerage,  Drainage,  Water  Supply, 
Inspection  of  Food  and  Drugs,  Disposal  of  Dead,  and  Hygiene  of  Habi- 
tations, Occupations,  Persons,  Schools.  The  subjects  of  Medical  Chari- 
ties, Medical  Education  and  schools,  and  Medical  Jurisprudence  are  also 
included. 

A  table  of  contents  accompanies  each  number,  and  a  few  months  after 
the  completion  of  each  volume  an  "Annual  Index  of  Authors  and  Sub- 
jects" is  issued.  The  subject  part  of  this  annual  index  is  elaborately 
sub-divided,  the  classification  closely  resembling  that  of  the  Index  Cata- 
logue of  the  Library  of  the  Surgeon-General's  Office,  U.  S.  Army. 

The  volume  for  1905  contains  1,241  pages  and  the  index  to  the  volume, 
208  pages,  the  latter  in  double  and  triple  columns. 

Upon  request  a  sample  copy  of  the  Index  Medicus  will  be  forwarded  to 
any  address. 

The  subscription  price  to  the  Index  Medicus  (to  be  paid  in  advance) 
is  five  dollars  a  year  in  the  United  States,  Canada,  and  Mexico,  with 
60  cents  additional  for  postage  to  other  countries. 
6 


868 


MEDICAL  NEWS 


Subscribers  are  requested  to  remit  by  money  order  or  New  York 
exchange. 

Communications  relative  to  subscriptions  should  be  addressed :  Carnegie 
Institution  of  Washington,  Washington,  D.  C. 

Communications  concerning  the  bibliography  should  be  sent  to:  Editor 
of  Index  Medicus,  Army  Medical  Museum,  Washington,  D.  C. 

Unless  it  appears  that  the  Index  Medicus  is  of  greater  service  to  the 
medical  profession  and  can  help  to  support  itself  to  a  greater  extent  than 
in  the  past,  it  may  become  advisable  to  discontinue  its  publication. 

Consolidation  of  Medical  Journals— On  January  i,  1907,  the  Thera- 
peutic Gazette  will  be  consolidated  with  the  Medical  Age  and  Medicine. 
"The  Therapeutic  Gazette,  incorporating  Medicine  and  the  Medical  Age," 
will  be  the  title  of  the  consolidated  journals.  The  publication  will  be 
under  the  able  editorship  of  Doctors  Hobart  A.  Hare  and  Edward  Martin, 
long  associated  in  the  editorial  conduct  of  the  Therapeutic  Gazette  and 
widely  recognized  as  among  the  most  distinguished  medical  journalists  in 
the  United  States.  The  subscription  price  will  be  the  same  as  the 
present  subscription  price  of  the  Therapeutic  Gazette,  $2.00  per  annum. 
The  greater  Therapeutic  Gazette  will  be  conducted  with  a  view  to  the 
needs  of  active  practitioners.  Mr.  Harry  Skillman,  Business  Manager, 
and  Mr.  E.  G.  Swift,  Publishers,  promise  that  the  consolidated  publication 
will  be,  in  the  broadest  sense,  a  journal  of  practical  therapeutics — ably 
representative  of  what  is  best  in  medicine. 

The  Prize  of  the  Association  for  the  Study  of  Epilepsy. — Dr.  W. 
P.  Spratling  announced  a  prize  of  $500  offered  by  the  Association  for 
the  Study  of  Epilepsy  for  the  best  essay  on  the  etiology  of  epilepsy. 
The  prize  is  given  by  persons  interested  heart  and  soul  in  the  work  of 
the  Association,  and  the  conditions  governing  the  award  are  as  follows : 

All  essays  submitted  must  be  in  English,  written  in  a  clear,  legible 
hand  or  on  the  typewriter,  on  one  side  of  the  paper  only,  and  they  must 
not  contain  more  than  15,000  words.  Essays  must  be  in  the  possession 
of  Dr.  W.  P.  Spratling,  at  Sonyea,  N.  Y.,  not  later  than  September  1, 
1907. 

The  name  of  the  person  submitting  the  essay  must  not  appear  on  the 
same,  but  be  put  in  a  sealed  envelope  on  which  is  written  a  motto,  and 
which  motto  should  also  appear  at  the  top  of  the  first  page  of  the  essay. 

All  essays  received  will  be  placed  in  the  hands  of  three  physicians  to 
determine  their  merit.  Two  of  these  physicians  are  members  of  this 
Association ;  the  third  a  member  of  the  American  Neurological  Associa- 
tion. Announcement  of  the  award  will  be  made  at  the  November,  1907, 
meeting  of  the  Association.  The  Association  will  not  feel  bound  to 
award  the  prize  should  no  essay  submitted  be  deemed  of  sufficient  value 
to  merit  it.  Original  research  work  into  the  etiology  of  epilepsy  will  be 
a  leading  factor  in  fixing  the  award. 

Personals — Dr.  H.  Judson  Lipes  (A.  M.  C,  1897)  is  suffering  from 
an  infected  finger,  which  has  confined  him  to  the  hospital  for  several 
days. 


CURRENT  MEDICAL  LITERATURE 


869 


—Dr.  Lemuel  R.  Hurlbut  (A.  M.  C,  1905)  has  given  up  his  position 
in  the  State  Hospital  at  Binghamton,  N.  Y.,  and  has  started  practice  in 
Lockpcrt,  N.  Y. 

— Dr.  Edward  A.  Dean  (A.  M.  C,  1906)  has  started  practice  at  West 
Seneca,  N.  Y. 

— Dr.  Fred.  C.  Conway  (A.  M.  C,  1906)  has  started  practice  in 
Middle  Granville,  N.  Y. 

Marriages — Resseguie — Sanson — Dr.  Fred  J.  Resseguie  (A.  M.  C, 
1895)  and  Miss  Helen  B.  Sanson,  the  youngest  daughter  of  the  late 
Henry  B.  Sanson,  of  Saratoga,  were  married  on  October  24th,  1906,  at 
Montclair,  N.  J.  After  an  extended  tour  Dr.  Resseguie  and  bride  will 
return  to  Saratoga,  where  the  Doctor  has  a  very  large  practice. 

— Keens — Dowse — Dr.  William  G.  Keens  (A.  M.  C,  1904)  and  Miss 
Jane  Dowse  were  married  at  Albany,  N.  Y.,  November  19,  1906.  Dr.  and 
Mrs.  Keens  will  reside  at  85  West  street,  Albany. 

— Hurlbut— Clayton. — At  Binghamton,  N.  Y.,  in  July,  1906,  Dr. 
Lemuel  R.  Hurlbut  (A.  M.  C,  1905)  and  Dr.  Mary  Clayton,  of 
Buffalo. 


Deaths— Dr.  H.  E.  Babcock  (A.  M.  C,  1855)  of  New  London,  N.  Y., 
died  September  19,  1906,  aged  79  years. 

— Dr.  Floyd  D.  Michael  (A.  M.  C,  1906)  died  of  phthisis  at  his 
home  in  Lassellsville,  October  29,  1906. 


Current  /fDefctcal  literature 

REVIEWS  AND  NOTICES  OF  BOOKS 

Surgery:  Its  Principles  and  Practice.  By  Various  Authors.  Edited  by  Wil- 
liam Williams  Keen,  M.  D.,  LL.  D.,  Professor  of  the  Principles  of 
Surgery  and  of  Clinical  Surgery,  Jefferson  Medical  College,  Phila- 
delphia. Volume  I,  with  261  text-illustrations  and  17  colored  plates. 
Philadelphia  and  London :  W.  B.  Saunders  Company,  1906. 

Systems  of  surgery  to  which  a  considerable  number  of  authors  con- 
tribute portions  have  of  recent  years  become  rather  numerous,  and  many 
of  them  far  from  satisfactory,  because  the  list  of  contributors  has  not 
been  selected  with  sufficient  care.  It  thus  happens  that  many  of  the 
so-called  "  systems "  are  of  but  comparatively  little  value  because  a 
general  standard  of  excellence  is  not  maintained  throughout. 

In  this  new  work,  which  is  to  embrace  five  volumes,  the  first  of 
which  has  just  appeared,  there  is  every  indication  that  all  of  the  contribu- 
tions will  be  of  a  high  standard  of  excellence.  Dr.  Keen  has  associated 
with  himself  the  very  best  of  the  productive  American  surgeons,  as  well 
as  some  of  the  most  prominent  in  foreign  countries,  and  the  list  of  con- 


870 


CURRENT  MEDICAL  LITERATURE 


tributors  gives  all  the  necessary  assurance  of  a  complete  and  cohesive 
presentation  of  the  surgery  of  to-day.  Volume  I  contains  nearly  a 
thousand  pages  of  subject  matter,  contributed  by  twelve  authors.  The 
volume  is  subdivided  into  twenty-two  chapters.  It  begins  with  a  most 
fascinating  chapter  on  the  history  of  surgery,  with  brief  sketches  of 
those  who  in  the  earlier  times  did  the  most  to  perfect  and  advance  the 
art.  Following  this  is  a  chapter  devoted  to  surgical  physiology,  which 
is  somewhat  unique  in  character  and  of  the  highest  importance,  emphasiz- 
ing as  it  does  the  close  relationship  of  physiology  to  surgery.  Following 
this  is  a  series  of  chapters  dealing  with  surgical  pathology,  all  of  the 
important  pathological  processes  involved  in  surgical  diseases  being  con- 
sidered in  more  or  less  detail.  An  excellent  chapter  is  that  devoted  to 
the  processes  of  repair,  the  healing  of  wounds  of  all  the  organs  and 
tissues  being  unusually  well  presented.  Erysipelas,  tetanus  and  diseases 
caused  by  special  infections,  as  well  as  diseases  derived  directly  from 
animals,  insects  and  reptiles,  all  receive  considerable  attention.  Separate 
chapters  treat  of  scurvy,  rickets,  surgical  tuberculosis,  chancroid  and 
syphilis.  The  volume  concludes  with  chapters  on  tumors  and  wounds  and 
contusions. 

It  will  thus  be  seen  that  this  volume  is  really  an  introduction  to  the 
general  subject  of  surgery,  and  on  the  general  principles  established  in 
this  volume  the  succeeding  discussion  of  the  more  practical  phases  of 
surgery  will  be  based.  One  striking  feature  of  this  volume  is  the  gen- 
eral excellence  of  all  the  chapters,  for  there  is  not  one  that  does  not  show 
the  greatest  care  in  the  arrangement  and  presentation  of  the  subject  in  hand. 
The  illustrations,  of  which  there  are  261,  with  seventeen  colored  plates, 
are  most  excellent  in  every  particular,  and  the  book-making  is  of  the 
best.  From  a  careful  perusal  of  this  volume  we  are  led  to  believe  that 
this  work  will  represent  a  distinct  contribution  to  the  literature  of  surgery 
and  one  which  will  be  a  classic.  It  comes  also  at  an  opportune  time 
and  we  believe  it  will  merit  and  receive  a  most  cordial  welcome  from 
the  surgical  profession  at  large.  Arthur  w.  elting. 


Diseases  of  the  Nervous  System,  Resulting  from  Accident  and  Injury. 
By  Pearce  Bailey,  A.  M.,  M.  D.,  Clinical  Lecturer  in  Neurology, 
Columbia  University,  New  York  City.  Consulting  Neurologist  to 
the  Roosevelt,  St.  Luke's  and  Manhattan  State  Hospitals,  etc.  New 
York  and  London:  D.  Appleton  and  Company,  1906. 

In  1898,  Dr.  Bailey  issued  a  book  called  "Accident  and  Injury:  Their 
Relation  to  Diseases  of  the  Nervous  System,"  which  was  the  first  Ameri- 
can work  of  pretension  developed  out  of  the  nervous  conditions  resulting 
from  injuries.  There  was  need  of  the  information  given  by  Dr.  Bailey 
arising  from  the  rapidly  increasing  number  of  cases  and  the  multitude  of 
questions  involved,  not  only  of  medical,  but  also  of  legal  import.  Dr. 
Bailey  wisely  incorporated  a  scheme  of  examination  of  the  function  of 
the  nervous  system,  and  gave  as  far  as  was  possible,  an  analysis  of  symp- 
toms for  the  purpose  of  separating  possible  malingerers.  The  task  was 
not  an  easy  one,  and  expert  opinion  on  the  reality  or  the  fraudulence  of 


CURRENT   MEDICAL  LITERATURE 


871 


so-called  traumatic  neuroses  was  not  established.  At  the  present  time, 
there  is  more  general  acceptation  of  the  diagnosis  of  neurasthenia,  hysteria 
or  neurosis  originating  in  trauma,  even  when  this  cause  is  as  much  or 
more  pronounced  in  its  mental  effects. 

In  the  volume  now  issued  the  conditions  are  described  upon  a  surer 
and  more  intelligent  basis,  and  organic  affeciions  of  the  nervous  system 
due  to  injury  are  given  a  place.  The  more  comprehensive  title,  then, 
represents  revision,  enlargement  and  completeness,  and  is  justified  by  the 
contents.  The  book  consists  of  an  Introduction  upon  the  general  history* 
and  examination  of  the  patient;  Part  I,  upon  the  Organic  Effects  of  In- 
jury to  the  Nervous  System ;  Part  II,  upon  the  Functional  Effects  of  In- 
jun-, and  Part  III,  on  Medico-Legal  Considerations. 

In  Part  I,  the  effects  of  injuries  upon  the  brain,  spinal  cord  and  peripheral 
nerves  are  described.  Among  the  noteworthy  suggestions  may  be  repeated 
the  statement  that  in  head  injuries  the  blood  pressure  should  be  measured 
every  fifteen  or  twenty  minutes,  as  long  as  the  patient  is  in  danger,  as  a 
sudden  rise  of  twenty  millimeters  or  more  is  strong  indication  of  cerebral 
compression.  The  author  believes  the  ideal  treatment  of  traumatic  epilepsy 
to  be  colony  life,  and  surgical  measures  to  be  useful  in  recent  cases,  only 
when  followed  by  medical  care.  He  recognizes  14  delirious  and  confusional 
states  and  dementia  *'  as  the  manifestations  of  insanity  following  injuries, 
by  which  are  probably  meant  what  another  author  has  more  happily  termed 
the  "shock  and  exhaustion  psychoses."  Chapter  IX,  which  concludes 
Part  I,  discusses  the  relations  of  trauma  to  certain  chronic  degenerative 
diseases,  as  general  paresis,  locomotor  ataxia,  progressive  muscular  atrophy, 
paralysis  agitans,  multiple  sclerosis,  tumors,  syphilis  and  diabetes  mellitus. 
This  chapter  is  not  superfluous  as  these  diseases  are  frequently  attributed 
to  injury.  The  author's  discussion,  however,  is  wisely  in  the  line  of  a 
search  for  symptoms  preceding  the  injury  which  is  more  apt  to  be  an 
incident  in  the  course  of  the  affection  rather  than  its  cause.  Thus  Prince 
analyzed  forty-  cases  of  tabes  alleged  to  have  been  traumatic,  and  rejected 
all  of  them  as  presenting  insufficient  evidence. 

In  Part  II  are  five  chapters  dealing  with  the  traumatic  neuroses,  trau- 
matic neurasthenia,  traumatic  hysteria,  insanity  from  nervous  shock  and 
unclassified  forms.  These  topics  are  treated  on  familiar  lines.  The  mental 
element  of  fright  and  its  more  or  less  serious  consequences  are  now 
generally  admitted  by  corporations,  even  in  the  absence  of  physical  injury- 
The  paragraph  devoted  by  the  author  to  injuries  by  electricity  is  not 
explicit.  Little  is  said  of  functional  disorders  arising  from  the  transmis- 
sion of  electrical  currents  through  the  body,  where  the  element  of  fright 
is  excluded,  as  in  the  case  of  employees  who  are  familiar  with  the  currents. 
It  is  not  probable  that  currents  which  do  not  cause  death  result  in  organic 
nervous  affections,  and  the  victim  "  receives  his  injury  and  dies  of  it,  or 
quickly  gets  over  the  effect  of  it."  Of  litigation,  it  is  said  that  "  it  may 
help  the  pocket,  only  by  making  large  demands  on  health."  The  medico-legal 
possibilities  are  thus  aptly  summarized:  "The  jurors  may  be  convinced 
of  the  honesty  of  all  the  views  they  have  heard  expressed  and  yet  they 
are  unable  to  determine  from  the  character  of  the  testimony  which  of 
the  opposing  opinions  is  the  more  likely  to  be  correct.    They  are  therefore 


872 


CURRENT  MEDICAL  LITERATURE 


obliged  to  rely  upon  the  impression  made  upon  them  by  the  injured 
person  himself.  They  see  a  person  in  an  even  worse  condition,  perhaps, 
than  his  doctors  had  expected.  They  see  an  alleged  paralyzed  limb, 
absolutely  motionless;  they  become  witnesses  of  an  emotional  outburst, 
more  harrowing  than  any  related  in  the  evidence.  And  they  see  these 
things  one  or  two  years  after  the  accident  had  occurred.  Their  natural 
inference  is  that  the  injuries  are  permanent.  They  find  it  hard  to  believe 
that  the  outlook  for  a  malady  which  has  so  long  defied  the  resources  or 
medical  skill  is  anything  but  hopeless.  They  are  unwilling,  if  not  unable, 
to  believe  in  the  unreality  of  physical  symptoms.  They  cannot  compre- 
hend a  part  being  the  seat  of  paralysis  or  insensibility  unless  there  is  some 
grave  physical  defect  behind  it;  they  do  not  know  that  a  limb  which  is 
immobile  to-day  may  be  in  wonted  activity  to-morrow.  Thrown  on  their 
own  resources  by  the  contradiction  in  medical  testimony,  they  render  a 
verdict  in  accordance  with  their  own  impressions  as  to  the  plaintiff's 
injury.  Their  impression  is  that  of  a  person  severely  and  probably  in- 
curably injured;  and  their  verdict,  rendered  accordingly,  is  generally  in 
excess  of  anything  to  which  the  plaintiff  is  entitled." 

Dr.  Bailey's  book  treats  of  a  subject  of  which  there  are  many  unsettled 
and  changing  factors.  It  is  a  faithful  and  practical  presentation  of  the 
aspects  of  traumatic  nervous  conditions,  as  now  understood.  The  language 
is  clear  and  unambiguous  and  the  arrangement  of  the  matter  excellent. 
Physicians  engaged  in  this  line  of  practice  will  find  much  to  help  them  in 
its  pages. 


Les  Embolics  Bronchiqucs  Tubcrculcuses.  Etudes  Cliniques.  Par  le  Dr. 
Ch.  Sabourin,  Directeur  de  Sanatorium  de  Durtol  ( Puy-de-Dome). 
Avec  53  figures  et  7  traces  Thermometriques,  Paris.  Felix  Alcan, 
Editeur,  Ancienne  Librarie  Germer  Bailliere  et  Cie.,  108  Boulevard 
Saint-Germain,  1906. 

In  this  carefully  written  monograph,  the  author  exposes  a  number  of 
important  facts  based  upon  personal  clinical  experience  extending  over 
a  period  of  many  years,  and  pertaining  to  the  pathogenesis  and  evolution 
of  certain  ill  recognized  types  of  pulmonary  tuberculosis.  He  insists  in 
the  first  place,  upon  the  importance  of  differentiating  between  the  primary 
and  the  secondary  lesions  of  the  disease.  The  primary  lesions  are  nodu- 
lar and  disseminated,  and  constitute  what  may  properly  be  called  the  cur- 
able stage  of  pulmonary  tuberculosis.  The  secondary  lesions  are  repre- 
sented mainly  by  pneumonic  processes,  and  are  of  much  more  alarming 
significance  as  they  betray  material  diminution  in  the  resisting-power  of 
the  economy. 

The  author  desires  particularly  to  isolate  a  form  of  secondary  tuber- 
cular lesion,  which  he  calls  "  necrotic  tuberculous  pleuro-pneumonia " 
(pleuro-pneumonie  tuberculeuse  necrosante).  This  lesion  may  kill  the 
patient  by  giving  rise  to  hemorrhage,  but  more  usually  it  either  heals  or 
leads  to  the  formation  of  a  cavity,  thus  constituting  an  intermediary  stage 
in  the  determination  of  vulgar  chronic  pulmonary  tuberculosis.  These 
various  possibilities  render  it  difficult  to  demonstrate  anatomically,  the 
existence  per  se  of  this  pneumonia  type  of  secondary  tuberculosis;  the 


CURRENT  MEDICAL  LITERATURE 


»73 


writer  recognizes  this  fact,  but  insists  that  the  clinical  picture  of  the 
affection  fully  justifies  the  denomination  he  has  proposed.  It  has  indeed 
all  the  features  of  true  croupous  pneumonia:  (a)  consolidation  of  a  well- 
defined  area,  "  lesion  en  bloc  "  of  French  authors,  associated  with  tuber- 
cular breathing  from  the  outset;  (b)  the  detection  of  a  specific  micro- 
organism, the  tubercle  bacillus,  in  the  sputum  (although  other  organisms 
are  also  found  at  a  later  stage  of  the  disease  as  in  other  forms  of  pulmon- 
ary tuberculosis);  (c)  the  almost  constant  association  of  pleurisy;  (d) 
the  early  occurrence  of  central  disintegration,  considering  the  chronicity 
of  the  affection. 

Necrotic  tuberculous  pneumonia  is  a  regional  lesion,  and  the  lobular  mass 
which  it  involves  corresponds  apparently  to  the  area  of  distribution,  either 
of  a  bronchial  system  or  of  a  vascular  branch.  It  is  therefore  more  often 
peripheral  and  only  occasionally  deep-seated  or  central.  The  process  is 
generally  unilateral,  being  bilateral  however  in  one  case  out  of  ten.  Al- 
though pneumonic  tuberculosis  may  affect  any  part  of  the  lung,  its  seat 
of  predilection  is  the  posterior  surface  of  the  superior  lobe,  at  the  point 
of  origin  of  the  pulmonary  fissure  close  to  the  vertebral  border,  being 
situated  much  more  frequently  above  than  below  this  point ;  practically, 
we  may  say,  the  lower  half  of  the  posterior  surface  of  the  superior  lobe. 
More  than  one-third  of  the  cases  present  this  localization.  It  is  much 
less  common  to  find  it  at  the  apex,  and  when  such  is  the  case,  the  lesion 
is  more  often  sub-clavicular  than  supra-spinous.  Then  come  in  order  of 
frequency,  localization  in  the  inferior  lobe,  the  axillary  region,  the  mam- 
mary region,  etc. 

The  etiology  of  this  condition  is  that  of  tuberculosis  in  general;  it  must 
be  remembered,  however,  that  necrotic  tuberculous  pneumonia  is  never 
a  primary  manifestation  of  pulmonary  tuberculosis,  but  a  secondary  lesion 
originating  in  a  pre-existing  focus  of  the  lung  itself.  There  is  a  history 
of  cough  and  expectoration  in  nine  cases  out  of  ten,  and  not  infrequently 
of  recent  hemoptysis.  The  patient  often  traces  his  disease  to  an  attack 
of  pleurisy  or  influenza,  which  however,  is  more  likely  to  have  been  really 
a  tubercular  exacerbation.  The  author  considers  that  the  great  factor  in 
the  determination  of  tuberculous  pneumonia  is  exhaustion ;  it  almost 
invariably  occurs  in  patients  who  have  lost  all  power  of  resistance,  owing 
to  long  continued  strain  or  overwork  while  suffering  from  the  primary 
lesions  of  the  disease.  Patients  remaining  at  Sanataria  or  who  take  proper 
care  of  themselves  by  following  some  form  of  hygienic  treatment  (rest  and 
air  cure)  practically  never  present  the  complication.  The  author  very 
significantly  condenses  the  etiology  of  necrotic  tuberculous  pneumonia  by 
calling  it  "  une  affection  de  surmenage." 

In  a  man  of  apparent  good  health  the  disease  may  set  in  abruptly  and 
with  all  the  acuteness  of  croupous  pneumonia,  but  this  is  a  rare  occurrence ; 
the  mode  of  onset  being  usually  of  a  more  benign  character,  rather  sub- 
acute and  occasionally  insidious.  In  a  fair  number  of  cases,  the  affection 
becomes  well-defined  only  after  a  series  of  short  febrile  attacks,  during 
which  an  aggravation  of  previously  existing  symptoms  is  noted.  Hemor- 
rhages are  not  infrequent  in  this  stage  of  development  and  copious  sweats, 
both  at  night  and  during  the  day,  are  seldom  absent. 


874 


CURRENT   MEDICAL  LITERATURE 


The  symptomatology  of  necrotic  tuberculous  pneumonia  differs  naturally 
very  little  from  that  of  pulmonary  tuberculosis  in  general,  but  certain 
distinctive  features  do  present,  when  one  comes  to  the  physical  exploration 
of  the  chest.  The  most  important  fact  in  this  connection  is,  that  in  nine 
cases  out  of  ten,  one  has  the  immediate  impression  that  a  tubercular  cavity 
exists,  while  in  reality  such  is  not  the  case  (t.  e.,  not  in  the  early  stages  of 
the  disease).  The  author  insists  upon  the  importance  of  this  peculiarity 
as  regards  prognosis. 

As  in  pneumonia,  there  is  dulness  of  variable  extent  and  an  increased 
vocal  fremitus.  Pain  on  pressure  and  muscle  spasm  are  noticed  in  the 
juxta-vertebral  variety  of  the  disease.  The  breathing  is  tubercular,  harsh 
and  often  distinctly  cavernous.  Cracklings  and  crepitations  of  unusual 
dryness  which  the  writer  calls  "  cracquements  xyloidiens "  (resembling 
the  noise  made  by  splitting  up  very  dry  wood),  as  well  as  others  of 
musical  quality,  "  cracquements  xylophoniques,"  are  very  characteristic 
of  the  first  stage  of  tuberculous  pleuro-pneumonia.  Later  in  the  course 
of  the  disease,  moist  rales,  usually  subcrepitant,  are  rarely  absent.  Fric- 
tion rubs,  bronchophony  and  pectoriloquy,  occur  as  in  lobar  pneumonia 
and  require  no  further  consideration.  In  the  early  stages  of  the  disease, 
the  expectoration  has  no  characteristic  features,  but  once  the  pneumonic 
process  is  fairly  constituted,  the  expectoration  becomes  muco-purulent  or 
purulent  and  contains  large  oval  masses  (the  so-called  amygdaloid  and 
bursiform  sputa),  which  represent  the  products  of  lobular  disintegration. 
With  cavity  formation,  the  expectoration  becomes  nummular. 

Certain  facts  bearing  upon  the  clinical  course  of  tuberculous  pneumonia, 
as  well  as  upon  the  evolution  of  the  underlying  morbid  process,  are  of 
sufficient  importance  to  deserve  special  mention.  The  author  maintains 
that  healing  never  takes  place  without  the  occurrence  of  central  necrosis. 
An  absolute  cure  is  common  enough  and  is  not  rare  even  after  the 
formation  of  a  well-marked  cavity.  There  generally  remains  for  a  con- 
siderable length  of  time  a  patch  of  thickening  over  which  the  breathing 
sounds  are  harsh  and  vocal  fremitus  increased.  There  never  develops 
more  than  one  cavity  in  a  focus  of  pleuro-pneumonic  tuberculosis,  and 
once  healed  the  affected  region  rarely  ever  becomes  active  again.  Occa- 
sionally, instead  of  getting  better  entirely,  or  of  gradually  presenting  the 
clinical  features  of  ordinary  chronic  pulmonary  tuberculosis,  the  patient 
suddenly  develops  the  symptom-complex  of  acute  phthisis  or  galloping 
consumption.  The  writer  insists  that  this  mode  of  evolution  is  not  due 
to  extension  of  the  pneumonic  process  but  to  renewed  activity  of  the 
primary  lesions  at  the  apex,  or  else,  to  the  development  of  additional  and 
rapidly  progressive  foci  in  other  hitherto  unaffected  regions  of  the  lung. 

Of  course,  necrotic  tuberculous  pneumonia  is  a  complication  of  suffi- 
cient gravity  to  prove  itself  fatal;  it  is  more  probable,  however,  that  it 
acts  especially  by  sapping  the  patient's  strength,  thus  favoring  further 
bacterial  invasion.  Constituting,  as  it  does  in  a  fair  number  of  cases, 
the  first  appreciable  manifestation  of  galloping  consumption,  one  will 
readily  understand  that  pneumonia  tuberculosis  should  ever  have  been 
considered  as  a  type  exclusively  of  the  acute  form  of  the  disease.  Very 
likely  necrotic  tuberculous  pneumonia  is  the  clinical  expression  of  what 


CURRENT  MEDICAL  LITERATURE 


875 


has  been  termed  anatomically  "  caseous  pneumonia,"  a  lesion  so  frequently 
encountered  in  cases  of  acute  phthisis  that  it  is  practically  never  mentioned 
among  the  changes  occurring  in  the  chronic  affection.  This  conception 
the  author  regards  as  incorrect,  and  maintains  that  pneumonic  processes 
should  be  classed  among  the  lesions  of  both  acute  and  chronic  pulmonary 
tuberculosis. 

The  course  of  necrotic  tuberculous  pneumonia  usually  comprises  two 
fairly  well-defined  stages:  (a)  the  stage  of  development,  which  lasts  from 
eight  to  fifteen  days,  and  (b)  the  stage  of  resolution,  the  duration  of 
which  is  variable,  occasionally  extending  over  a  period  of  months  and 
months. 

There  are  four  incidental  manifestations  occurring  in  the  course  of 
tuberculous  pneumonia  upon  which  the  author  particularly  insists:  (1) 
Hemoptysis,  which  although  common  at  the  onset,  is  relatively  rare  in 
comparison  with  the  other  forms  of  chronic  pulmonary  tuberculosis  once 
the  disease  is  fully  established.  (2)  Congestive  attacks,  with  aggravation 
of  all  the  symptoms,  and  occurring  in  women  at  the  time  of,  or  imme- 
diately preceding,  the  menstrual  period.  The  expectoration  becomes  rust- 
colored,  or  there  may  be  small  hemorrhages,  but  the  attack  is  usually  of 
a  mild  character,  rarely  lasting  more  than  four  or  five  days.  The  author 
believes  that  many  cases  of  so-called  "  vicarious  menstruation "  really 
belong  to  this  type.  (3)  Pleuritic  complications  are  common,  but  the 
fluid  is  not  abundant,  and  moreover,  as  it  is  exuded  into  the  meshes  of  a 
thickened  and  trabeculated  pleura,  the  percussion  note  is  not  influenced 
by  change  of  position.  (4)  Exacerbations  of  the  necrotic  process,  charac- 
terized clinically  by  an  increase  in  the  amount  of  expectoration,  partly 
due  to  the  presence  of  the  products  of  disintegration.  Masses  of  necrosed 
lung  tissue,  often  of  enormous  size,  are  expelled  for  a  number  of  days 
and  impart  a  very  fetid  odor  to  the  expectoration.  This  process  of 
elimination  is  generally  accompanied  by  a  febrile  reaction,  an  evening 
rise  of  from  one  to  two  degrees  being  the  rule. 

The  author  describes  a  number  of  clinical  varieties  of  tuberculous 
pneumonia,  dependent  upon  variations  both  in  the  regional  distribution 
and  in  the  intensity  of  the  process.  Although  the  severe  pneumonic  type 
is  the  most  common  and  the  most  important  of  the  secondary  lesions  of 
pulmonary  tuberculosis,  milder  forms,  described  as  superficial  pleuro- 
pneumonia and  localized  pleuritis,  are  also  frequently  observed  Here, 
again,  the  juxta-vertebral  localization  is  most  common,  and  it  must  be 
remembered  that  in  such  cases  the  painful  points  are  often  reflected  to 
the  side  or  to  the  front  of  the  chest. 

In  exposing  his  views  on  the  pathogenesis  of  these  various  types  of 
secondary  pulmonary  tuberculosis,  the  author  considers  that  they  are 
simply  varying  degrees  in  the  intensity  of  a  single  morbid  process,  which 
may  be  compared  to  that  occurring  in  hemorrhagic  infarction  of  the 
lung.  The  classic  infarct  is  a  mechanical  condition  of  vascular  origin ;  the 
pneumonic  lesion  of  tuberculosis  is  equally  mechanical,  but  is  dependent 
upon  a  bronchial  process  of  infectious  nature.  The  plug  is  formed  by  the 
products  of  bronchial  ulceration,  and  regional  hepatization  is  the  natural 
sequence.    The  superficial  necrotic  penumonia  and  the  localized  pleuritis 


Sf6  CURRENT  MEDICAL  LITERATURE 

arc  milder  forms,  in  which  the  territory  involved  is  of  lesser  extent.  The 
clinical  picture  of  secondary  tuberculous  lesions  is  practically  identical 
with  that  of  pulmonary  infarct.  The  physical  signs  are  the  same,  and 
in  both  cases  the  lesion  may  heal,  suppurate,  undergo  necrosis  or  lead 
to  the  formation  of  a  cavity.  One  could  therefore  speak  of  pneumonic 
infarct  and  subpleural  embolism  —  to  qualify  the  most  important  types  of 
secondary  pulmonary  tuberculosis. 

The  diagnosis  of  tuberculous  necrotic  pleuro-pneumonia  may  present 
considerable  difficulty.  The  disease  has  very  often  been  mistaken  for 
typhoid  fever,  pulmonary  congestion,  broncho-pneumonia  and  especially 
for  influenza.  The  considerable  oscillations  of  temperature  as  well  as 
the  absence  of  a  characteristic  expectoration  in  the  first  stage  of  the 
affection  will  suffice  to  distinguish  pneumonic  tuberculosis  from  ordinary 
croupous  pneumonia.  It  may  be  difficult  in  certain  instances  to  differ- 
entiate between  the  pneumonic  and  the  disseminate  nodular  forms  of  the 
disease,  especially  when  the  lesions  of  the  latter  are  confluent.  Tubular 
breathing  along  with  other  signs  of  consolidation,  is  usually  present, 
but  disappear  rapidly  if  the  patient  is  kept  in  bed  for  a  few  days.  The 
affection  may  also  be  confounded  with  encysted  pleurisy,  pulmonary 
syphilis  and  hydatid  cyst. 

The  prognosis  of  the  milder  types  of  secondary  tuberculosis  (superficial 
pneumonia  and  local  pleuritis)  is  essentially  favorable;  that  of  the  more 
extensive  necrotic  pleuro-pneumonic  variety  is  grave,  but  not  appreciably 
worse  than  the  prognosis  of  pulmonary  tuberculosis  in  general.  In  one 
hundred  cases  reported  by  the  author  an  absolute  cure  took  place  in 
thirty,  nine  of  which  presented  undeniable  evidence  of  a  well-marked 
cavity. 

The  treatment  is  essentially  one  of  absolute  rest  under  perfectly 
hygienic  conditions.  Rest  and  air  cure  are  the  only  efficient  prophylactic 
measures  for  patients  suffering  from  the  disseminate  lesions  of  the  incipient 
stage;  they  equally  constitute  the  best  means  of  combating  the  pneumonic 
complication,  once  established.  It  is  astonishing  how  rapidly  the  area 
of  hepatization  diminishes  and  the  various  rales  disappear,  even  after  a 
few  days'  rest  in  a  favorable  climate.  Superalimentation,  gentle  exercise 
and  tonics  of  various  kinds  are  indicated,  of  course,  in  this  as  in  other 
forms  of  pulmonary  tuberculosis. 

A  special  chapter  is  devoted  to  an  exhaustive  consideration  of  the  juxta- 
vertebral  variety  of  necrotic  tuberculous  pleuro-pneumonia,  a  number  of 
instructive  cases  being  briefly  but  carefully  reported  and  the  lesions 
represented  by  schematic  figures. 

On  the  whole,  it  must  be  admitted  that  the  meagre  part  which  patho- 
logical anatomy  has  had  in  the  genesis  of  the  author's  views  curtails 
necessarily  the  scientific  merit  of  this  otherwise  remarkable  contribution. 
One  soon  feels  that  this  little  volume  is  the  work  of  a  careful  and  experi- 
enced clinician,  a  keen  and  unbiased  observer.  It  is  a  valuable  clinical 
study  of  the  most  important  of  pulmonary  affections,  which  may  be  read 
with  advantage  by  all. 

La  Salle  Archambault. 


CURRENT  MEDICAL  LITERATURE 


The  American  Illustrated  Medical  Dictionary.  All  the  terms  used  in  Medi- 
cine, Surgery,  Dentistry,  Pharmacy,  Chemistry  and  kindred  branches ; 
with  over  100  new  tables.  By  W.  A.  Newman  Dorland,  M.  D. 
Fourth  Revised  Edition.  Octavo  of  836  pages,  with  293  illustrations, 
119  of  them  in  colors.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1906.  Flexible  Morocco,  $4.50  net;  thumb  indexed,  $5.00 
net. 

The  latest  edition  of  Dorland's  Dictionary  is  an  attractive  and  apparently 
complete  work.  A  casual  search  for  new  terms  results  not  only  in  finding 
them,  but  in  obtaining  satisfactory  and  concise  definitions.  A  most  strik- 
ing feature  is  the  mechanical  beauty  of  the  book.  Clear  type,  superior  paper 
and  high  grade  illustrations  are  unfortunately  not  universal  in  technical 
publications.  The  publishers  have  achieved  a  notable  success  in  this 
direction.  The  colored  plates,  printed  from  half-tones,  represent  a  par- 
ticularly gratifying  blending  of  the  various  tints,  and  the  results  are  most 
creditable.  The  volume  is  a  desirable  one,  and  well  sustains  its  claim 
for  compactness,  thoroughness  and  availability. 


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Progress  in  Medicine  and  Surgery.  Under  the  General  Editorial 
Charge  of  Gustavus  P.  Head,  M.  D.,  Professor  of  Laryngology  and 
Rhinology,  Chicago  Post-Graduate  Medical  School.  Volume  VII. 
Pediatrics.  Edited  by  Isaac  A.  Abt,  M.  D.,  Assistant  Professor 
of  Medicine  (Pediatrics  Department),  Rush  Medical  College. 
Orthopedic  Surgery.  Edited  by  John  Ridlon,  A.  M.,  M.  D., 
Professor  of  Orthopedic  Surgery,  Northwestern  University  Medi- 
cal School,  with  the  Collaboration  of  Gilbert  L.  Bailey,  M.  D., 
Instructor  in  Orthopedic  Surgery,  College  of  Physicians  and  Sur- 
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articles  that  are  of  a  practical  nature. 

The  value  of  the  book  is  enhanced  by  frequent  editorial  notes  and 
comments.  J.  M.  b. 


878 


CURRENT  MEDICAL  LITERATURE 


MEDICINE 

Edited  by  Samuel  B.  Ward,  M.  D.,  and  Hermon  C.  Gordinier,  M.  D. 

Convulsions  in  Typhoid  Fever. 

Wm.  Osler.    The  Practitioner,  January,  1906. 

Osier  states  that  although  nervous  symptoms  pointing  to  grave  involve- 
ment of  the  nervous  system  are  common  enough  in  typhoid  fever,  con- 
vulsions are  very  rare.  Murchison  states  that  in  2,960  cases  they  occurred 
in  only  six.  In  one  of  these,  the  convulsions  came  on  after  much  delirium 
on  the  sixteenth  day,  and  the  patient  died  comatose  half  an  hour  after- 
wards. The  kidneys  were  found  diseased.  A  second  case,  a  boy  thirteen, 
died  suddenly  in  convulsions  on  the  thirtieth  day.  In  the  third  case  general 
convulsions  occurred  on  the  eleventh  day;  recovery  followed.  In  the 
fourth  instance  the  patient  recovered  after  a  severe  fit  of  convulsions 
lasting  a  quarter  of  an  hour,  which  occurred  on  the  fourteenth  day.  The 
fifth  case,  a  man  aged  twenty-three  years,  had  on  the  twelfth  day 
two  severe  epileptiform  convulsions  and  recovered.  The  sixth  case,  a 
male,  aged  fifty  years,  had  during  convalescence  four  convulsions.  He 
had  also  thrombosis  of  the  left  femoral  vein.    He  recovered. 

In  Osier's  series  of  i,6oo  cases  at  the  Johns  Hopkins  Hospital,  convul- 
sions occurred  in  eight  cases. 

The  first  case,  a  boy  aged  seven  years,  was  remarkable  because  of  the 
fact  that  he  was  attacked  with  a  convulsion  in  the  street  while  apparently 
in  perfect  health  and  was  brought  to  the  hospital,  not  yet  out  of  the 
attack  which  was  the  starting  point  of  a  severe  and  protracted  typhoid. 
He  left  the  hospital  cured  on  the  sixty-fifth  day. 

The  second  case  was  a  male,  aged  twenty-five  years.  He  was  an 
epileptic  on  entering;  he  could  be  aroused,  but  would  not  answer  ques- 
tions. In  a  few  minutes  he  had  a  right  sided  convulsion.  Subsequently, 
he  had  three  more  convulsions.    He  recovered. 

In  the  third  case  convulsions  began  while  he  was  being  tubbed,  no 
paralysis  followed  and  he  recovered. 

Case  IV.  Age  27  years,  had  on  the  eighth  day  a  very  severe  convulsion, 
which  lasted  fifteen  minutes.  He  had  marked  toxaemia  and  died  from 
perforation  on  the  thirteenth  day. 

Case  V.  Female,  aged  16  years.  Admitted  on  the  twenty-eighth  day 
of  illness  with  an  attack  of  fever  of  great  severity;  she  was  very 
tremulous  and  delirious  and  had  five  very  severe  convulsions  epileptoid 
in  nature ;  one  of  these  came  on  while  being  tubbed,  afterward  she  became 
very  rigid  and  this  rigidity  remained  several  days;  she  developed  bed 
sores  and  died  about  six  weeks  from  the  time  of  admission. 

Case  VI.  Was  a  similar  case  with  profound  toxaemia  and  recurring 
convulsions,  followed  by  rigidity  without  Kernig's  sign  but  with  apathy, 
marked  delirium,  hemorrhages,  purpura  and  ultimate  recovery. 

In  case  VII  the  convulsions  were  the  result  of  thrombosis  of  the 
cerebral  vessels  with  local  extravasations  of  blood. 

Dr.  O.,  interne,  healthy,  set.  twenty-eight  years,  on  the  ninth  day  of 


CURRENT  MEDICAL  LITERATURE 


879 


a  mild  typhoid  was  attacked  with  very  severe  convulsions.  There  was 
profound  unconsciousness,  and  in  the  severer  convulsions  great  embarrass- 
ment of  the  respiration,  so  that  he  became  quite  livid.  The  convulsions 
recurred  with  great  severity,  the  patient  dying  in  one  of  them.  The 
post-mortem  showed  thrombi  in  the  ascending  parietal  and  parieto- 
temporal arteries.  The  meninges  over  these  vessels  contained  small 
hemorrhages  and  the  brain  substance  contained  numerous  extravasations. 
Recent  examination  of  the  brain  sections  from  this  case  showed  extensive 
arteritis  of  the  cerebral  vessels. 

Case  VIIIj  aged  five  years.  The  day  before  admission  he  went  into  a 
convulsion  at  midnight  which  was  several  times  repeated  before  morning. 
Following  these  attacks  he  was  dull  and  listless  and  it  was  thought 
that  he  might  have  tubercular  meningitis,  but  three  days  afterward  a 
positive  Widal  reaction  was  present.  Twenty-one  days  after  admission 
25  c.  c.  of  a  clear  fluid  was  obtained  by  lumbar  puncture  from  which 
typhoid  bacilli  were  grown.  The  autopsy  showed  a  widespread  typhoid 
infection.  The  bacilli  were  isolated  from  the  gall  bladder,  the  liver, 
the  urine,  and  the  meninges.  There  was  also  typical  fresh  tuberculous 
meningitis,  with  extensive  tuberculous  adenitis.  The  case  is  unusual  as 
one  of  combined  typhoid  and  tuberculous  infection. 

Osier  states  that  the  prognosis  is  not  very  grave,  considering  the 
alarming  nature  of  this  complication,  of  the  eight  cases.  Three  died, 
one  from  perforation,  one  of  intercurrent  tubercular  meningitis  and  one 
of  cerebral  thrombosis. 


Recurring  Epistaxis  urith  Multiple  Telangiectases  of  the  Skin. 
C.  O.  Hawthorne.   London  Lancet,  January  13,  1906. 

In  1901  Professor  Osier  described  three  cases  of  recurring  attacks  of 
epistaxis  in  association  with  multiple  telangiectases  of  the  skin  and 
mucous  membranes;  two  of  the  patients  were  brothers  and  several  other 
members  of  the  same  family  were  reported  to  be  simultaneously  affected. 
This  condition  is  stated  by  Professor  Osier  to  be  an  extremely  rare  one 
and  in  his  search  through  the  literature,  resulted  in  the  discovery  of  only 
a  single  reference. 

The  author's  case  was  a  woman,  aged  forty-nine  years,  and  the  mother 
of  nine  children.  Since  her  first  pregnancy  she  had  been  aware  of  the 
presence  of  "  red  spots  "  on  her  face  and  also  on  several  of  the  finger 
tips  of  her  right  hand,  and  from  one  of  the  latter,  situated  just  under 
the  free  edge  of  the  nail,  bleeding  presumably  as  a  result  of  a  slight 
injury  had  often  occurred.  A  mere  glance  at  the  woman's  face  was 
sufficient  to  show  a  number  of  telangiectases  scattered  over  both  cheeks 
and  a  few  were  noticed  on  the  fingers  of  the  right  hand.  In  answer  to 
inquiries  bearing  on  her  personal  history  she  volunteered  the  remark  that 
since  childhood  she  had  suffered  repeated  attacks  of  bleeding  at  the 
nose  and  that  on  one  occasion  it  had  been  necessary  to  plug  the  nostrils. 
Her  father  also  and  a  sister  were  troubled  in  the  same  fashion  and  each 
of  these  as  well  as  her  eldest  daughter  had  "  spots  "  which  she  recognized 


88o 


CURRENT   MEDICAL  LITERATURE 


as  similar  to  those  present  on  her  own  face.    Further,  every  one  of  ker 

own  children  had  had  more  or  less  numerous  attacks  of  epistaxis. 

These  facts  are  sufficient  to  show  that  the  family  belongs  to  the  group 
first  described  by  Osier.  He  distinguishes  the  condition  from  haemophilia 
by  the  telangiectases  and  from  the  fact  that  victims  are  supplied  from 
both  sexes. 

The  woman  whose  condition  is  here  described  denied  that  spontaneo»s 
hemorrhage  either  in  herself  or  the  members  of  her  family,  ever  occurred 
from  any  other  part  than  the  nose  and  she  did  not  consider  that  there 
was  any  family  disposition  to  bleed  in  excess  from  any  slight  injury. 


Concerning  a  Case  of  Malignant  Mediastinal  Tumor  with  an  Extremely 
Rapid  Course.  (Ueber  einen  Fall  von  malignen  Mediastinal-tumor 
mit  aussergewbhnlich  schnellen  Verlauf.) 

Voltolini.    Deutsche  medicinische  Wochenschrift,  March  i,  igo6. 

The  author  reports  the  following  interesting  case :  R.  G.,  aged  forty- 
five  years,  a  railroad  official,  had  always  been  well  up  to  his  present 
illness.  He  had  occasionally  noticed  a  sudden  swelling  of  the  neck,  which 
subsided  after  a  short  time.  His  illness  started  rather  suddenly  with 
dyspnoea  and  a  feeling  of  constriction  of  the  chest.  On  examination, 
it  was  found  that  the  whole  upper  part  of  his  body  was  markedly 
oedematous  and  swollen,  the  face  was  cyanotic  and  oedematous,  the  eyes 
were  swollen,  the  neck  was  thick,  the  veins  of  the  anterior  chest  wall  were 
enlarged,  and  the  right  external  jugular  vein  was  partly  thrombosed. 
The  lower  part  of  the  body  was  entirely  free  of  oedema.  There  was  no 
temperature,  but  the  pulse  was  rapid  (120  beats  to  the  minute),  regular 
and  strong.  The  left  radial  pulse  appeared  weaker  than  the  right.  The 
symptoms  pointed  to  pressure  upon  the  veins  in  the  region  of  the  vena 
cava  superior.  Examination  of  the  chest  showed  that  the  apex  beat 
was  in  the  fifth  intercostal  space,  a  finger  breadth  outside  the  mammillary 
line.  The  heart  sounds  were  normal.  Above  the  area  of  cardiac  dullness, 
and  merging  into  it,  a  dullness  on  percussion  was  discovered,  extending 
upwards  to  the  first  rib,  and  above  the  left  sternal  margin.  On  percus- 
sion over  the  right  lung  anteriorly,  light  tympanitic  resonance  was 
elicited,  but  from  the  third  rib  downwards  the  percussion  note  was  abso- 
lutely flat. 

This  pleural  effusion  was  found  to  be  hemorrhagic  in  nature.  There 
was  no  dysphagia  and  only  slight  hoarseness.  It  was  not  possible  to 
make  a  laryngoscopic  examination.    The  spleen  was  slightly  enlarged. 

The  liver  dullness  extended  slightly  above  the  border  of  the  ribs.  The 
diagnosis  of  a  neoplasm  in  the  anterior  mediastinum  was  made,  and 
from  the  rapid  onset  of  the  symptoms,  and  the  hemorrhagic  pleural 
effusion,  a  diagnosis  of  a  probable  malignant  neoplasm  was  made.  An 
X-ray  examination  was  made  by  Prof.  Lensden,  of  Berlin,  and  a  shadow 
situated  in  the  median  line,  extending  to  the  neck,  and  projecting  over 
the  sternal  line  on  both  sides,  was  obtained.    The  heart,  which  was 


CURRENT  MEDICAL  LITERATURE 


88l 


displaced  towards  the  left,  could  be  seen  pulsating  at  the  lower  margin 
of  the  shadow,  while  the  tumor  remained  immovable.  Mercurial  inunc- 
tions were  employed,  but  had  no  effect  on  the  rapid  growth  of  the 
tumor.  In  a  short  time  the  entire  left  anterior  chest  wall  was  dull  on 
percussion.  The  patient  died  about  six  weeks  from  the  time  he  was  first 
seen  by  the  author. 

At  the  autopsy  it  was  found  that  almost  the  entire  cavity  of  the 
thorax  was  filled  with  a  firm,  grayish  white,  tumor  mass,  which  projected 
over  the  pericardium  anteriorly,  and  was  adherent  to  it,  as  well  as  to 
both  lungs  and  the  anterior  chest  wall.  The  parietal  leaf  of  the  peri- 
cardium was  infiltrated  by  the  tumor  mass  above  and  anteriorly. 

The  ascending  aorta  and  the  arch  of  the  aorta  were  embedded  in  the 
tumor  mass,  the  arch  being  so  much  narrowed,  that  a  finger  could  barely 
be  inserted  in  it. 

Anatomical  diagnosis :  Round  celled  sarcoma  of  the  anterior  medi- 
astinum. 

In  conclusion,  the  writer  states,  that  his  case  was  rather  unusual 
because  of  the  extremely  rapid  course  of  the  disease,  simulating  almost 
an  infectious  disease. 


The  Modification  of  Diseases  of  the  Blood  by  Erysipelas.    (Ueber  Beein- 
Hussung  von  Blutkrankheitcn  dutch  das  Erysipel.) 

The  writer  describes  a  typical  case  of  pernicious  anaemia  in  which  the 
examination  of  the  blood  showed  792,000  red  blood  cells,  2,600  whites  and 
20  per  cent  haemoglobin.  There  were  many  nucleated  red  blood  cells. 
The  patient  grew  gradually  worse  in  the  clinic  and  in  spite  of  injections 
of  caccodylate  preparations  gradua^y  v/eiu  into  a  deep  coma.  She  no 
longer  took  nourishment/ showed 'great  motor,  ey.citfment  with  at  times 
intense  delirium.  Ths  'pulse*  "was  thready  and u tracheal '  rales  appeared. 
In  fact  she  was  mqnbund.  ErysipeJ^s  then  began  11/  fetyig  right  nostril 
and  in  a  few  (lays  spread  over  the'  entire  face.  The  teinp^rdture  rose 
to  1040.  On 'the  third  day  the  patient  had.  occasional  periods,  of  clear 
consciousness,*  was  much  quieter  'and- irequer/tly  a^ked  for  a  drink.  The 
condition  of  the  patiem  fmpfo'ved '  f rom' 'day  to  day.  Sufficient  food  was 
taken,  vomiting  no  longer  occurred,  the  erysipelas  cleared  up,  the  bron- 
chitis subsided  and  the  cardiac  power  increased.  The  splenic  tumor  dis- 
appeared and  the  only  evidence  of  disease  was  a  feeling  of  quick  ex- 
haustion due  to  the  slight  anaemia.  Two  weeks  after  convalescence 
the  examination  of  the  blood  showed  2,288,000  red  blood  cells  4,000 
leucocytes  and  forty-five  per  cent,  haemoglobin.  The  last  examination, 
two  months  after  admission,  showed  3,776,000  red  blood  cells,  6,000  leuco- 
cytes and  eighty  per  cent,  haemoglobin. 

The  question  at  once  arises  whether  the  erysipelas  is  responsible  for 
this  change  or  whether  it  was  an  accidental  complication  with  no  influence 
whatever. 

Such  blood  crises  in  pernicious  anaemia  have  been  described  without 
any  special  cause.  1 

Similar  observations  in  other  diseases,  however,  justify  the  conclusion 


882 


CURRENT  MEDICAL  LITERATURE 


that  the  erysipelas  gave  the  first  impetus  to  the  regeneration  of  the 
blood.  In  local  diseases  of  the  skin  the  curative  action  of  erysipelas 
has  been  known  since  the  middle  of  the  previous  century.  Lupus,  syphilis 
and  sarcomata  have  been  favorably  influenced  by  erysipelas. 

The  local  effect  is  probably  due  to  fatty  metamorphosis  and  destruction 
of  the  cellular  elements. 

The  effect  upon  general  conditions  has  not  been  explained,  although 
it  has  been  attributed  to  the  increase  of  temperature  by  some  and  to  the 
hyperleucocytosis  by  others. 


The  Method  of  Dissemination  of  Tuberculosis  from  the  Clinical  Stand- 
point. (Die  Verbreitungswege  der  Tuberkulose  vom  klinischen 
Standpunkte.) 

Frankel.    Zentralblatt  fur  innere  Mcdicin,  1906,  No.  10. 

Infection  with  the  tubercle  bacillus  and  its  further  dissemination  follows 
its  entrance  into  the  deeper  respiratory  tract  or  into  the  lymph  channels 
or  blood  vessels.  All  three  theories  have  their  special  supporters,  who, 
however,  often  consider  the  subject  from  a  single  point  of  view. 

Experiments  upon  animals  are  of  the  greatest  importance  for  a  rational 
prophylaxis,  since  little  more  can  be  determined  upon  tubercular  patients 
as  to  the  method  of  entrance  of  the  bacillus.  The  haematogenous  infec- 
tion in  utero  appears  to  be  more  frequent  than  was  formerly  accepted. 

Schmorl  found  tuberculosis  in  nine  placentae  out  of  twenty  in  tubercu- 
lar patients  and  once  in  incipient  tuberculosis. 

The  lymphogenous  development  of  tuberculosis  has  been  emphasized 
by  the  two  addresses  of  Behrirg .and,  by. the  work  of  Austrian  authorities. 
The  tubercle  bacilli  ta"k"es  .the  mcst  direct  pa$h  from  the  place  of  primary 
infection  by  way  of  thVlymph  glands  to  the  hionchial  glands,  where  they 
collect.      .        .      "  .  .  ;\  • 

Heubner  regards  the  phthisis  iuciniens  of  childhood,  a  tuberculosis  of 
the  bronchial  glands.  In^  adults  the  lymphogenous  development  seems 
conclusive  for  at  least'  many  cases  The  w/\Ur ,  observed  three  cases  in 
which  the  cervical  glands  weie  fiist  aiTectcd,  then  the  lungs. 

In  general  the  first  recognizable  evidences  of  tuberculosis  appear  in 
the  bronchi  of  pulmonary  apices.  The  writer  is  convinced  that  primary 
bronchial  tuberculosis  of  adults  is  usually  a  true  inhalation  tuberculosis. 

That  tubercle  bacilli  can  reach  the  pulmonary  apices  by  inhalation  is 
shown  by  pneumonokoniosis. 

The  author  recognizes  three  types  of  acute  pulmonary  tuberculosis: 

(1)  the  hemorrhagic  form  developing  after  a  pulmonary  hemorrhage; 
(2)  the  peribronchitic  form  in  which  there  is  no  initial  hemorrhage  but 
there  are  small  bronchitic  areas  of  consolidation;  (3)  the  form  with  a  tend- 
ency to  a  rapid  breaking  down  of  the  pulmonary  tissue.  This  is  especially 
seen  in  diabetes  and  pregnancy.  In  this  type  of  acute  tuberculosis  mixed 
infections  are  frequently  observed. 


IND1SX  TO  VOLUME  XXVII  883 


Index  to  Volume  XXVII 


PAGE. 

Abrams,  Alva  E.,  M.  D.    President's  Address   821 

Acne  Vulgaris.    By  James  W.  Wiltse,  M.  D   781 

Adams-Stokes  Disease,  The.    With  the  Report  of  Three  Cases.  By 

Hermon  C.  Gordinier,  M.  D   385 

Address.   By  Samuel  B.  Ward,  M.  D   759 

Adrenal,  Tumors  of  the,  Diagnosis  of   138 

Albany  City  Homeopathic  Hospital   812 

Albany  Department  of  Health,  Vital  Statistics  

46,  119,  207,  277,  364,  455,  5io,  663,  738,  808,  859 

Albany  Guild  for  the  Care  of  the  Sick,  The  

48,  122,  210,  284,  368,  458,  517,  598,  671,  740,  811,  866 

Albany  Guild,  The  262,  791 

Albany  Hospital  123,  210 

Albany   Hospital*    Pavilion   F,    Department   for    Mental  Diseases, 
Fourth  Annual  Report,  for  the  Year  Ending  February  28,  1906. 

By  J.  Montgomery  Mosher,  M.  D   332 

Albany  Hospital  Training  School  Alumnae,  The   460 

Albany  Hospital  Training  School  for  Nurses  210,  459 

Albany  Medical  College  Alumni  Association  of  New  England  812,  867 

Albany  Medical  College,  Association  of  the  Alumni  of  the, 

Thirty-third  Annual  Meeting   •  409 

Address  of  Welcome.   By  Prof.  Howard  Van  Rensselaer,  M.  D..  410 

Report  of  the  Executive  Committee  and  Recording  Secretary   413 

Treasurer's  Report.   By  Robert  Babcock,  M.  D   413 

President's  Address.    By  Charles  B.  Tefft,  M.  D   414 

Report  of  the  Historian.    By  Eugene  E.  Hinman,  M.  D   418 

Necrology   418 

History  of  the  Class  of  1846.    By  Eugene  E.  Hinman,  M.  D   419 

History  of -the  Class  of  1856.    By  Eugene  E.  Hinman,  M.  D   422 

History  of  the  Class  of  1866.    By  Daniel  V.  O'Leary,  M.  D   426 

History  of  the  Class  of  1886.   By  W.  P.  Brierley,  M.  D   429 

History  of  the  Class  of  1896.   By  Thomas  Avery  Rogers,  M.  D. . .  432 

Election  of  officers  4  437 

The  Alumni  Dinner   441 

Albany  Medical  College  in  War  Time.    By  T.  D.  Crothers,  M.  D   398 

Albany  Medical  College,  The   740 

Albany  Medical  College,  The  Record  of  the   724 

Alumni  Association,  The  442,  848 

Alumni  Day,  1906   350 

Alypin,  A  New  Local  Anesthetic,  Concerning   152 

Amebiasis:  Its  Etiology,  Pathology,  Symptomatology  and  Treatment. 

By  Kenneth  D.  Blackfan,  M.  D   797 

American  Gastro-Enterological  Association   286 

American  Journal  of  Clinical  Medicine   50 

American  Roentgen  Ray  Society,  The   598 

American  Surgical  Trade  Association,  The   742 

Anaesthesia,  Spinal,  The  Methods  and  Indications  for  the  Use  of.  By 

Arthur  W.  Elting,  M.  D   321 

Annals,  Back  Numbers  of  the   285 

Antidiphtheritic  Serum  in  the  Treatment  of  Stomatitis  and  Vulvo- 
vaginitis in  Children,  The  Use  of   149 

Aortitis,  Primary  Ulcerative,  of  Probable  Tuberculous  Origin   68 

Aphasia,  Motor,  without  Agraphia,  A  Case  of   382 

7 


884 


INDEX  TO  VOLUME  XXVII 


Archambault,  La  Salle,  M.  D.    The  Cerebro-Spinal  Fluid  in  Health 

and  Disease  353,  447,  499 

Army  Medical  Corps  Examinations   210 

Arteriosclerosis,  Experimental.    By  Richard  M.  Pearce,  M.  D.,  and 

E.  MacD.  Stanton,  M.  D   77 

Asthma  Thymicum,  Concerning  Extirpation  of  the  Thymus  in   817 

Atropin,  Concerning  Irritation  Caused  by  the  Use  of   820 

Basedow's   Disease,   The   Permanent  Results   After  the  Operative 

Treatment   of   135 

Bcilby,  George  E.,  M.  D.    Jacobus  Sylvius   593 

Bcilby,  George  E.,  M.  D.  The  Hypertrophies  of  the  Thyroid  Gland..  11 1 
Bender  Hygienic  Laboratory.    Annual  Report  of  the  Director  for  the 

Year  Ending  August  31,  1905.    By  Richard  M.  Pearce,  M.  D..  31 

Beri-beri,  An  Enquiry  Into  the  Etiology  and  Pathology  of   63 

Beri-beri,  On  the  Classification  and  Pathology  of   64 

Berry,  John  M.,  M.  D.    A  Brace  to  Aid  in  the  Treatment  of  Flat  or 

Weakened   Feet   628 

Berry,  John  M.,  M.  D.    Hypernephroma  of  the  Kidney   773 

Berry,  John  M.,  M.  D.    The  Fiat-Foot  Series  of  Disabilities  and 

Deformities  of  the  Foot   250 

Bier-Klapp  Method  of  Passive  Hyperemia,  Report  of  Cases  Treated 

by  a.    By  James  N.  Vander  Veer,  M.  D   836 

Blackfan,  Kenneth  D.,  M.  D.    Amebiasis:  Its  Etiology,  Pathology, 

Symptomatology  and  Treatment   797 

Blumer,  G.  Alder,  M.  D.    An  Address  to  the  Graduates  of  the 

Samaritan  Hospital  Training  School  for  Nurses   711 

Blumer,  George,  M.  D.    Francis  Glisson   444 

Bontecue,  Reed  Brockway,  M.  D.    History  of  the  Medical  Society  of 

the  County  of  Rensselaer,  N.  Y   244 

Book  Reviews. 

Abdominal  Operations.    By  B.  G.  A.  Moynihan,  M.  S   299 

A  Compend  of  Medical  Chemistry,  Inorganic  and  Organic,  in- 
cluding Urine  Analysis.    By  Henry  LefTmann,  M.  D   373 

A  Laboratory  Manual  of  Physiological  Chemistry.    By  Elbert  V. 

Rockwood,  M.  D   746 

A   Manual   of   Diseases   of   Infants   and   Children.     By  John 

Ruhrah,  M.  D   56 

A  Manual  of  Otology.    By  Gorham  Bacon,  M.  D   816 

A  Manual  of  Practical  Hygiene.  By  Charles  Harrington,  M.  D. .  54 
A  Manual  of  Surgical  Diagnosis.  By  Albert  A.  Berg,  M.  D. . . .  132 
A  Manual  of  the  Practice  of  Medicine.    By  A.  A.  Stevens,  A.  M., 

M.  D   216 

American   Edition   of   Nothnagel's   Practice.     Diseases   of  the 

Kidney,  Diseases  of  the  Spleen,  and  Hemorrhagic  Diseases. 

By  Drs.  H.  Senator  and  M.  Litten   375 

American  Edition  of  Nothnagel's  Practice.    Malaria,  Influenza, 

and  Dengue.    By  Dr.  J.  Mannaberg  and  Dr.  O.  Leichtenstern. .  374 

Anatomy,  Descriptive  and  Surgical.    By  Henry  Gray,  F.  R.  S   745 

A  Non-Surgical  Treatise  on  Diseases  of  the  Prostate  Gland  and 

Adnexa.    By  George  Whitfield  Overall,  M.  D   745 

A  Pocket  Formulary.    By  E.  Quinn  Thornton,  M.  D   605 

A  Primer  of  Psvchology  and  Mental  Disease.    Bv  C.  B.  Burr, 

M.  D   814 

A  System  of  Physiologic  Therapeutics.    Edited  by  Solomon  Solis 

Cohen,  A.  M.,  M.  D   54 

A  Text-Book  of  Clinical  Diagnosis  by  Laboratory  Methods.  By 

L.  Napoleon  Boston,  A.  M.,  M.  D   132 

A  Text-Book  of  Diseases  of  Women.    By  Barton  Cooke  Hirst, 

M.  D   524 

A  Text-Book  of  Materia  Medica,  Therapeutics  and  Pharmacology. 

By  George  F.  Butler,  M.  D   37* 


INDEX  TO  VOLUME  XXVII 


885 


Book  Reviews — Continued. 

A  Text-Book  of  Medical  Chemistry  and  Toxicology.    By  James 

W.  Holland,  M.  D   377 

A  Text-Book  of  Physiology.    By  Winfield  S.  Hall,  M.  D   53 

A  Text-Book  of  Physiology.    By  William  H.  Howell,  Ph.  D., 

M.  D   301 

A  Text-Book  on  the  Practice  of  Gynecology.    By  W.  Easterly 

Ashton,  M.  D   680 

A  Text-Book  of  the  Practice  of  Medicine.    By  James  Anders, 

M.  D   602 

A  Text-Book  on  Modern  Materia  Medica  and  Therapeutics.  By 

A.  A.  Stevens,  M.  D   371 

Atlas  and  Epitome  of  Diseases  of  the  Skin.    By  Prof.  Dr.  Franz 

Mracek   59 

Atlas  and  Text-Book  of  Typographic  and  Applied  Anatomy.  By 

Prof.  Dr.  O.  Schultze   127 

A  Treatise  on  Diagnostic  Methods  of  Examination.    By  Prof. 

Dr.  H.  Sahli   130 

A  Treatise  on  Diseases  of  the  Skin.    By  Henry  W.  Stelwagon, 

M.  D   378 

A  Treatise  on  Surgery.    By  George  R.  Fowler,  M.  D  522,  749 

A  Treatise  on  the  Diseases  of  Infancy  and  Childhood.    By  Henry 

Kopiik,  M.  D   525 

Biographic  Clinics.    By  George  M.  Gould,  M.  D   57 

Bovee's  Gynecology.    Edited  by  J.  Wesley  Bovee,  M.  D   603 

Case  Teaching  in  Medicine.    By  Richard  C.  Cabot,  M.  D   748 

Christianity  and  Sex  Problems.   By  Hugh  Northcote,  M.  A   815 

Cleft  Palate  and  Hare  Lip.    By  W.  Arbuthnot  Lane,  M.  S., 

F.  R.  C.  S   299 

Clinical  Treatises  on  the  Pathology  and  Therapy  of  Disorders  of 

Metalbolism  and  Nutrition.    By  Prof.  Dr.  Carl  von  Noorden...  129 
Differential  Diagnosis  and  Treatment  of  Disease.    By  Augustus 

Caille,  M.  D   295 

Diseases  of  the  Eye.    By  G.  E.  De  Schweinitz,  M.  D   746 

Diseases  of  the  Heart  and  Aorta.    By  Thomas  E.  Satterthwaite, 

M.  D   55 

Diseases  of  the  Nervous  System,  Resulting  from  Accident  and 

Injury.    By  Pearce  Bailey,  M.  D   870 

Dose-Book  and   Manual  of  Prescription-Writing.     By  E.  Q. 

Thornton,  M.  D   371 

Eczema.    By  Samuel  H.  Brown,  M.  D   680 

Essentials  of  Materia  Medica,  Therapeutics   and  Prescription- 
Writing.    By  Henry  Morris,  M.  D   371 

Food  and  Diet  in  Health  and  Disease.    By  Robert  F.  Williams, 

M.  D   604 

Golden  Rules  of  Surgery.    By  Augustus  Charles  Bernays,  M.  D..  746 

Gynecology.    By  E.  C.  Dudley  and  C.  von  Bachelle   814 

Handbook  of  Anatomy.    By  James  K.  Young,  M.  D   52 

International  Clinics.    Edited  by  A.  O.  J.  Kelly,  A.  M.,  M.  D., 

60,  215,  529,  605 

International  Medical  Annual,  1906.    Published  by  E.  B.  Treat 

and  Co   530 

Lectures  on  Auto-Intoxication  in  Disease.  By  Ch.  Bouchard....  303 
Les  Embolies  Bronchiques  Tubercuhuse.  Par  le  Dr.  Ch.  Sabourin.  872 

Man  and  His  Poisons.    By  Albert  Abrams,  M.  D   530 

Manual  of  Chemistry.    By  William  Simon,  Ph.  D.,  M.  D   126 

Manual  of  Diseases  of  the  Nose  and  Throat.    By  Cornelius  G. 

Coakley,  A.  M,  M.  D   57 

Materia   Medica  and   Pharmacy.     By   Reynold  Webb  Wilcox, 
M.  D   37I 


886 


INDEX  TO  VOLUME  XXVTI 


Book  Reviews— Continued. 

Minor  and  Operative  Surgery,  including  Bandaging.  By  Henry 
R.  Wharton,  M.  D   300 

Modern  Clinical  Medicine.    Edited  by  Richard  C.  Cabot,  M.  D. . .  302 

Nervous  and  Mental  Diseases.  By  Archibald  Church,  M.  D.,  and 
Frederick  Peterson,  M.  D   302 

Neurotic  Disorders  of  Childhood.    By  B.  K.  Rachford,  M.  D   58 

Nursing  in  the  Acute  Infectious  Fevers.  By  George  P.  Paul, 
M.  D   531 

Operative  Surgery.    By  John  J.  McGrath,  M.  D   133 

Pathology  and  Morbid  Anatomy.  By  T.  Henry  Green,  M.  D., 
F.  R.  C.  P   215 

Pharmacology  and  Therapeutics.  By  Reynold  Webb  Wilcox, 
M.  D   371 

Physical  Diagnosis,  Including  Diseases  of  the  Thoracic  and  Ab- 
dominal Organs.    By  Egbert  Le  Fevre,  M.  D   56 

Psychiatry.    By  Stewart  Paton,  M.  D   214 

Reference  Handbook  of  the  Diseases  of  Children.  By  Prof.  Dr. 
Ferdinand   Friihwald   604 

Studies  in  the  Psychology  of  Sex.    By  Havelock  Ellis   815 

Surgery:  Its  Principles  and  Practice.  Edited  by  William  W. 
Keen,  M.  D   869 

The  American  Illustrated  Medical  Dictionary.  By  W.  A.  New- 
man Dorland,  M.  D   877 

The  Diagnostics  of  Internal  Medicine.  By  Glentworth  Reeve 
Butler,  Sc.  D.,  M.  D   128 

The  Diseases  of  the  Nose,  Throat  and  Ear.  By  Charles  Prevost 
Grayson,  M.  D   815 

The  Examination  of  the  Function  of  the  Intestines  by  Means  of 
the  Test-Diet.    By  Prof.  Dr.  Adolf  Schmidt   528 

The  Operating  Room  and  the  Patient.  By  Russell  S.  Fowler, 
M.  D   526 

The  Physical  Examination  of  Infants  and  Young  Children.  By 
Theron  Wendell  Kilmer,  M.  D   303 

The  Physician's  Visiting  List  (Lindsay  &  Blakiston's)  for  1906. 
Published  by  P.  Blakiston's  Son  &  Co   60 

The  Practical  Medicine  Series.  General  Medicine.  Edited  by 
Frank  Billings,  M.  D   602 

The  Practical  Medicine  Series.  General  Surgery.  Edited  by  John 
B.  Murphy,  M.  D   601 

The  Practical  Medicine  Series.  The  Eye,  Ear,  Nose  and  Throat. 
Edited  by  Casey  A.  Wood,  M.  D.,  Albert  H.  Andrews,  M.  D., 
and  Gustavus  P.  Head,  M.  D   679 

The  Practical  Medicine  Series.  Pediatrics.  Edited  by  Isaac  A. 
Abt,  M.  D. ;  Orthopedic  Surgery.  Edited  by  John  Ridlon, 
M.  D   877 

The  Principles  of  Bacteriology.    By  A.  C.  Abbott,  M.  D   131 

The  Surgical  Assistant.    By  Walter  M.  Brickner,  B.  S.,  M.  D   52 

The  Treatment  of  Fractures.  With  Notes  on  a  Few  Common 
Dislocations.    By  Charles  L.  Scudder,  M.  D   126 

The  World's  Anatomists.    By  G.  W.  H.  Kemper,  M.  D   814 

Books,  Announcement  of  New   679 

Brierley,  W.  P.,  M.  D.    History  of  the  Class  of  1886   429 

Bronchial  Lymph  Glands,  Palpation  of  the,  by  Means  of  Sounds  in 

Cases  of  Mild  Tubercular  Infection   606 

Brown,  Lawrason,  M.  D.    Some  Points  in  the  Diagnosis  and  Treat- 
ment of  Pulmonary  Tuberculosis   229 

Bryant,  Joseph  D.,  M.  D.    The  President's  Address   175 

Cancer  of  the  Uterus,  A  Discussion  of  the  Diagnosis  and  Treat- 
ment of   538 


INDEX  TO  VOLUME  XXVII  887 

Carcinoma  of  the  Intestine?    What  Are  the  Chances  of  an  Early 

Diagnosis  in   136 

Carey,  H.   W.,  M.  D.    The  Spirochaete   Pallida    (Schaudinn)  in 

Syphilis   40 

Centennial  Celebration  at  Troy,  The   261 

Cerebro-Spinal  Fluid  in  Health  and  Disease,  The.     By  La  Salle 

Archambault,  M.  D  353,  447,  499 

Cerebro-Spinal  Meningitis,  Epidemic,  A  Contribution  to  the  Study  of.  222 
Chlorines  in  the  Blood  and  in  the  Urine  in  the  Puerperal  State,  and 
Particularly    in    Eclampsia,    On    the    Freezing    Point  and 

Amount   of   754 

Cholangitis,  General  Infection  Associated  with   818 

Chorea  and  Acute  Infectious  Processes  in  the  Central  Nervous  Sys- 
tem, Contributions  to  the  Pathogenesis  of   381 

Cirrhosis  of  the  Liver,  Experimental.  By  Richard  M.  Pearce,  M.  D..  89 
Civil    Service   Examinations   for   the    State   and    Countv  Service., 

49,  124,  211,  742 

Clark,  Frederick  T.,  M.  D.    Iridocyclitis :  Its  Commoner  Forms  and 

Their  Treatment,  with  Report  of  Cases   12 

Claudication,  Intermittent.  Due  to  Angio-Sclerosis  of  the  Extremities. 

By  R.  H.  Irish,  M.  D   482 

Cleveland,  Grover.    The  Plea  of  the  Patient   153 

Commencement   Exercises   438 

Contagious  Hospital,  The   263 

Coroner's  Physicians  of  Albany  County   123 

Craig,  Joseph  D.,  M.  D.   Modern  Scientific  Medicine  and  Its  Relation 

to  Union  University   640 

Crothers,  T.  D.,  M.  D.    Albany  Medical  College  in  War  Time   398 

Cumston,  Charles  Greene,  M.  D.    The  Victims  of  the  Medicis  and 

the  Borgias  in  France  from  a  Medical  Standpoint   567 

Curtis,  Frederic  C,  M.  D.  Memorial  of  Samuel  Huntington  Free- 
man, M.  D   288 

Dawes,  Spencer  L.,  M.  D.    Julius  Caesar  Arantius   205 

Deaths. 

Babcock,  H.  E.,  M.  D   869 

Benedict.  Fordvce  H.,  M.  D  287,  369 

BlaidsdeU,  E.  Collins,  M.  D   461 

Buckbee.  Israel  I.,  M.  D   461 

Campbell,  John,  M.  D   461 

Carr,  James.  M.  D   461 

Dearborn,  George  F.,  M.  D   369 

Draper,  George  W.,  M.  D   520 

Havnes,  John  U.,  M.  D   287 

Head,  Adelbert  D.,  M.  D   287 

Kellev,  James  E.,  M.  D   461 

Michael,  Flovd  D.,  M.  D   869 

Newton,  Luther  B.,  M.  D   461 

O'Haire,  John  C,  M.  D   600 

Russell.  Selwyn  A.,  M.  D   124 

Sherman,  Norman  B.,  M.  D   124 

Smart,  Frederick  A..  M.  D   369 

Smeallie.  J.  A.,  M.  D   51 

SpafTord,  George  H.,  M.  D   673 

Stockwell.  George  Archie,  M.  D   287 

White.  William  M.,  M.  D   212 

Wood,  Levi,  M.  D   51 

Wright,  Thomas  G.,  M.  D   212 

Dental  Conventions.  Greatest  of   599 

Diarrhea,  with  Reference  to  B.  Dysenteriae,  A  Study  of  the  Dejecta 
of  Normal  Children  and  of  Those  Suffering  from  Acute  and 
Subacute    611 


888  INDEX  TO  VOLUME  XXVII 

Donhauser,  J.  Lewi.    Malignant  Ovarian  Tumors  in  Children;  with 

Report  of  a  Case   20 

Dwyer,  William  M.,  M.  D.    Eustachius   352 

Dysentery  in  Children,  A  Further  Contribution  on  the  Bacteriology 

and   Contagiousness   of   149 

Ellis  Hospital,  The   105 

Elting,  Arthur  W.,  M.  D.    Hyperemia  in  the  Treatment  of  Acute 

Infections    828 

Elting,  Arthur  W.,  M.  D.    The  Methods  and  Indications  for  the  Use 

of  Spinal  Anaesthesia   321 

Endocarditis,  Acute,  Concerning  the  Pathology  and  Clinical  Diagnosis 

of    219 

Epilepsy    285 

Epilepsy  Prize   50,  868 

Epilepsy,  The  Treatment  of   614 

Epistaxis,  Recurring,  with  Multiple  Telangiectases  of  the  Skin   879 

Ergot,  Concerning  a  New,  Active  Constituent  of,  Soluble  in  Water..  615 

Eruptions,  Observations  Concerning  Some  Palmar   70 

Erysipelas,  The  Modification  of  Diseases  of  the  Blood  by   881 

Erythema  Nodosum,  The  Etiology  and  Pathogenesis  of   71 

Examination  for  the  Medical  Corps  of  the  Army   518 

Experts,  A  Hint  for  the   796 

Eye,  Human,  Is  the  Use  of  Electric  Light  Injurious  to  the   304 

Ferguson,  Dr.,  Dinner  to   457 

Fibroma  Molluscum  Gravidarum   752 

Fiat-Foot  Series  of  Disabilities  and  Deformities  of  the  Foot,  The. 

By  John  M.  Berry,  M.  D   250 

Flat  or  Weakened  Feet,  A  Brace  to  Aid  in  the  Treatment  of.  By 

John  M.  Berry,  M.  D   628 

Food  in  Health  and  Disease   50 

Frederick,  E.  V.,  M.  D.    Opsonins  and  Aggressins   730 

Frederick,  E.  V.,  M.  D.    Santorini   796 

Freeman,  Dr.  Samuel  H.    Memorial  Meeting  of  the  Medical  Society 

of  the  County  of  Albany   282 

Gastroenterostomy  or  Resection  in  Ulcer  of  the  Stomach   816 

Germantown  Homeopathic  Medical  Society  of  Philadelphia,  The   285 

Glandular  Formation  in  the  Ovarian  Stroma,  Comparative  Histological 

Investigations  on  the  Occurrence  of   756 

Glaucoma,  Adrenalin  in  the  Treatment  of   820 

Goitre,  The  Treatment  of  Exophthalmic,  without  Reference  to  Surgi- 
cal Intervention.    By  D.  V.  O'Leary,  Jr.,  M.  D   595 

Gonococcus  in  the  Puerperium,  with  Report  of  Seventeen  Cases,  The.  539 

Gordinier,  Hermon  C,  M.  D.    Our  Laboratory  Advantages   101 

Gordinier,  Hermon  C,  M.  D.    The  Adams-Stokes  Disease,  with  the 

Report  of  Three  Cases   385 

Gould,  George  M.,  M.  D.    Nil  Desperandum  as  an  Article  of  the  Re- 

fractionist's  Materia  Medica   681 

Haemophilia,  As  to  the  Cause  of   609 

Harvard  Medical  School,  The  New   520 

Heart,  Acute  Dilatation  of  the   380 

Heart-Block  in  Mammals  850 

Heart,  Unusual  Dilatation  of  the,  with  Suspended  Functions  of  the 

Auricles    608 

Hemorrhoids,   The   Etiology   and   Treatment  of.    By  Douglas  C. 

Moriarta,  M.  D   545 

Hinman,  Eugene  E.,  M.  D.    History  of  the  Ciass  of  1846   419 

Hinman,  Eugene  E.,  M.  D.    History  of  the  Class  of  1856   422 

Hinman,  Eugene  E.,  M.  D.    Report  of  the  Historian   418 

Historical  Letter,  An   792 

Hoff,  John  Van  Rensselaer,  M.  D.    The  Sanitary  Department  of 

Armies  and  the  Military  Medical  Officer   555 


INDEX  TO  VOLUME  XXVII 


889 


Holding,   Arthur,    M.    D.     The  Roentgen   Rays   as   a    Factor  in 

Medicine    97 

Hospitals  of  Greater  New  York,  Communications  to  the   49 

Hun,  Henry,  M.  D.    An  Address  to  the  Graduating  Class  of  St. 

Peter's  Hospital  Training  School  for  Nurses   541 

Hyperemia  in  the  Treatment  of  Acute  Infections.    By  Arthur  W. 

Elting,  M.  D   828 

Hypernephroma  of  the  Kidney.    By  John  M.  Berry,  M.  D   773 

Hysteropexy  followed  bv  Repeated  Pregnancies.    By  J.  D.  Montmar- 

quet,"M.  D  .'   787 

Index  Medicus,  The   867 

In  Memorial. 

Babcock,  Henry  E.,  M.  D   812 

Bacon,  Charles  G.,  M.  D   813 

Bliss,   William  A.,   M.   D   744 

Bliss,  William  A.,  M.  D.    By  Flavius  Packer,  M.  D   813 

Buckbee,  Israel  I.,  M.  D   461 

Featherstonhaugh,  James  D.,  M.  D.    By  Willis  G.  Tucker,  M.  D.  289 

Fitzgerald,  Reynaldo  J.,  M.  D   744 

Freeman,  Samuel  Huntington,  M.  D.    By  Frederic  C.  Curtis, 

M.  D   288 

Haynes,  John  U.,  M.  D   295 

Hudson,  Abisha  Shumway,  M.  D   125 

Kelley,  James  E.,  M.  D   521 

Russell,  Selwyn  A.,  M.  D  ,  212,  369 

Smart,  Frederick  Adams,  M.  D   370 

Smith,  James  E.,  M.  D   078 

Walradt,  William  D.,  M.  D   744 

Webster,  Harrison  Edwin,  LL.  D   673 

Wheeler,  Isaac  G.,  M.  D   521 

White,  William  M.,  M.  D   370 

Wood,  Levi,  M.  D   51 

Insane,  After  Care  of  the   495 

Insane,  The  Nursing  and  Care  of  the   204 

Inspector  of  Nurse  Training  Schools   671 

Iridocyclitis.    Its  Commoner  Forms  and  Their  Treatment,  with  Re- 
port of  Cases.    By  Frederick  T.  Clark,  M.  D   12 

Irish,  R.  H.,  M.  D.    Intermittent  Claudication,  Due  to  Angio-Sclero- 

sis  of  the  Extremities   482 

Jackson,  Holmes  C,  Ph.  D.    Andreas  Vesalius   652 

Korsakoff's  Symptom-Complex,  Anatomical  Findings  in  Two  Cases  of.  379 

Laboratory  Advantages,  Our.    By  Hermon  C.  Gordinier,  M.  D   101 

Laird,  Arthur  T.,  M.   D.    Spigelius   726 

Laryngeal  Papillomata,  Some  Facts  in  Regard  to  the  Origin  of....  143 

Lempe,  George  Gustave,  M.  D.    Osteomyelitis  of  the  Femur   489 

Lincoln  Hospital  in  New  York  City   123 

Little  Biographies. 

I.  Herephilus  the  Chalcedonian.    By  J.  M.  Mosher,  M.  D   38 

II.  Antonio  Scarpa.    By.  H.  E.  Robertson,  M.  D   109 

III.  Julius  Caesar  Arantius.    By  Spencer  L.  Dawes,  M.  D   205 

IV.  Valsalva.    By  Charles  K.  Winne,  Jr.,  M.  D   265 

V.  Eustachius.    By  William  M.  Dwyer,  M.  D   352 

VI.  Francis  Glisson.    By  George  Blumer,  M.  D   444 

VII.  Fallopius,  1523-1563.    By  John  A.  Sampson,  M.  D   496 

VIII.  Jacobus  Sylvius.    By  George  E.  Beilby,  M.  D   593 

IX.  Andreas  Vesalius.    By  Holmes  C.  Jackson,  Ph.  D   652 

X.  Spigelius.    By  Arthur  Turner  Laird,  M.  D   726 

XI.  Santorini.    By  E.  V.  Frederick,  M.  D   796 

XII.  Wrisberg.    By  Clement  F.  Theisen,  M.  D   849 

Lupus  Erythematosus,  The  Combined  Quinine-Iodine  Treatment  of, 

after  the  Method  of  Hollander  and  its  Explanation   71 


8po 


INDEX  TO  VOLUME  XXVII 


Mabon,  William,  M.  D.    After  Care  of  the  Insane   495 

McKelway,  St.  Clair,  LL.  D.   The  State  and  the  Doctor   160 

Mediastinal   Tumor,    Malignant   880 

Medical  Association  of  Troy  and  Vicinity   211 

Medical  Journals,  Consolidation  of   868 

Medical  Society  of  the  County  of  Albany..  121,  279,  366,  512,  598,  810, 

862,  865 

Medical  Society  of  the  County  of  Albany.    Memorial  Meeting,  Dr. 

Harriet   A.    Woodward   668 

Medical  Society  of  the  County  of  Albany.    Memorial  Meeting,  Dr. 

James  E.   Smith   670 

Medical  Society  of  the  County  of  Rensselaer,  New  York,  History 

of  the.    By  Reed  Brockway  Bontecue,  M.  D   244 

Medical  Society  of  the  State  of  New  York,  Centennial  Anniversary 

of  the,  Addresses  Delivered  at  the   153 

Medicine  in  the  State  of  New  York  in  the  Last  Hundred  Years,  His- 
tory of.    By  Samuel  B.  Ward,  M.  D   179 

Medicine,  Organization,  Methods  and  Responsibilities  in  the  Study  of. 

By  A.  Vandcr  Veer,  M.  D   1 

Medicine,  The  Antiquity  of   647 

Medicis  and  the  Borgias  in  France  from  a  Medical  Standpoint,  The 

Victims  of  the.    By  Charles  Greene  Cumston,  M.  D   567 

Mesentery,  Concerning  Cysts  of  the   137 

Meningitis,  Some  Conditions  Which  May  Be  Mistaken  for   147 

Metrorrhagia  Myopathica   751 

Modern  Scientific  Medicine  and  Its  Relation  to  Union  University. 

By  Joseph  D.  Craig,  M.  D   640 

Montmarquet,   J.   D.,   M.    D.    Hysteropexy   followed   by  Repeated 

Pregnancies    787 

Moriarta,  Douglas  C,  M.  D.    The  Etiology  and  Treatment  of  Hemor- 
rhoids  545 

Mosher,  J.  Montgomery,  M.  D.    Albany  Hospital,  Fourth  Annual  Re- 
port of  Pavilion  F,  Department  for  Mental  Diseases,  for  the 

Year  Ending  February  28,  1906   332 

Mosher,  J.  Montgomery,  M.  D.    Herophilus  the  Chalcedonian   38 

Myasthenia  Gravis  with  Autopsy,  A  Case  of   379 

Nasal  Cavities,  Concerning  Primary  Cancer  of  the   146 

Newberry  Library,  The   284 

New  York  Medical  Journal,  The   211 

New  York  Skin  and  Cancer  Hospital  285,  866 

New  York  State  Association  for  Promoting  the  Interest  of  the  Blind. .  123 

New  York  State  Journal  of  Medicine   368 

New  York  State  Library   134 

New  York  State  Medical  Library  61,  532 

Night-Blindness,  Hereditary  Congenital,  without  Visible  Ophthalmo- 
scopic Changes   556 

O'Leary,  Daniel  V.,  M.  D.    History  of  the  Class  of  1866   426 

O'Leary,  D.  V.,  Jr.,  M.  D.    The  Treatment  of  Exophthalmic  Goitre 

without  Reference  to  Surgical  Intervention   595 

Oliver,  Ellwood,  M.  D.    Professional  Circumspection   633 

Opsonins  and  Aggressins.    By  E.  V.  Frederick,  M.  D   730 

Osteomyelitis  of  the  Femur.    By  George  Gustave  Lempe,  M.  D   489 

Packer,  Flavius,  M.  D.    Memorial  of  Dr.  William  A.  Bliss   813 

Paralysis  Agitans  and  the  Parathyroid  Glands   36 

Pearce,  Richard  M.,  M.  D.,  and  Stanton,  E.  MacD.,  M.  D.  Experi- 
mental Arteriosclerosis   77 

Pearce,  Richard  M.,  M.  D.    Bender  Hygienic  Laboratory.  Annual 

Report  of  the  Director,  for  the  Year  Ending  August  31,  1905..  31 
Pearce,  Richard  M.,  M.  D.    Experimental  Cirrhosis  of  the  Liver   89 


INDEX  TO  VOLUME  XXVII  89 1 

Personal. 

Abrams,  Alva  E.,  M.  D   124 

Bailev,  Chas.  L.,  M.  D   460 

Barney,  Fred  M.,  Mi  D   286 

Becker,  Isaac,  M.  D   460 

Bedell,  Edward  J.,  M.  D   460 

Beilby,  George  E.,  M.  D   460 

Blackfan,  Kenneth  D..  M.  D   743 

Blumer,  George,  M.  D   743 

Bolt,  Frederick  E.,  M.  D   600 

Boyd,  Donald,  M.  D   287 

Bovnton,  Henry  W.,  M.  D   460 

Bu'shnell,  H.  A.,  M.  D   287 

Campbell,  William  B.f  M.  D   460 

Canfield,  John  E.,  M.  D   520 

Chapelle,  A.  B.,  M.  D   287 

Qyne,  James,  M.  D   460 

Co'ffin,  Kenn  R.,  M.  D   287 

Conwav,  Fred  C..  M.  D   869 

Cox,  Joseph  A.,  M.  D   286 

Covle,  Edward  S.,  M.  D   743 

Crane,  John  D.,  II  D   673 

Cunningham,  Thomas  H.,  M.  D   211 

Dean,  Edward  A.,  M.  D   869 

Dwyer,  William  M.,  M.  D   212 

Faber,  J.  P.,  M.  D   673 

Fosbury,  Leland  D.,  M.  D   812 

Gregory,  M.  S.,  M.  D   672 

Griffin,  Gerald,  M.  D  124,  460 

Hale,  Wilfred  S..  M.  D  286.  460 

Hasbrouck,  Ira  D..  II  D   460 

Hinkley,  Frank,   If.   D   124 

Hinman,  Eugene  E.,  M.  D  124,  812 

Hoyt,  Harold  E,  M.  D   673 

Hurlbut,  Lemuel  R.,  II  D  460,  869 

Hurley.  Frank  J.,  M.  D   600 

Hurst^  Frank  H..  If.  D   211 

Keator.  Frank,  If.  D  124,  743 

Keens.  William  G.,  II  D   869 

Lanahan.  Joseph  A.,  If.  D   743 

Le  Brun.  Louis,  11  D   672 

Lester,  Whittlesey  D.,  If.  D  ••   520 

Lincoln,  Harry  M.,  If.  D,   460 

H.  Judson  Lipes,  If.  D  :   868 

Martin.  Elmer  E.,  M.  D   672 

Merriman,  George  C,  If.  D   287 

Merriman.  Willis  E..  Jr.,  M.  D   369 

Moscrip,  Ransom  S.,  M.  D   600 

Munson.  George  S.,  If.  D   520 

Olin,  Joseph  Day,  If.  D   673 

Parent,  Joseph  S.,  M.  D   460 

Reece,  Herbert  B.,  I£   D   287 

Resseguie.  Fred  J.,  If.  D   869 

Rogers.  Sidnev  F.,  If.  D   212 

Rommel,  W.  G.,  If.  D   369 

Roonev,  James  F..  M.  D   460 

Schaible,  Frank  G.,  If.  D  ....287 

Schuvler,  Arthur  H.,  If.  D   812 

Scott,  Jesse  M.  W.,  M.  D   51 

Shaw,  Henry  Larned  Keith,  M.  D   50 

Sicard,  Clarence  T.,  If.  D   812 


s 


892  INDEX  TO  VOLUME  XXVII 

Personal — Continued. 

Slocum,  Clarence  Jonathan,  M.  D   212 

Stanwix,  George  B.,  M.  D   600 

Sweet,  Charles,  M.  D   812 

Thornton,  Michael  J.,  M.  D   369 

Travell,  Howard  C,  M.  D   211 

Traver,  Alvah  H.,  M.  D   600 

Vander  Veer,  Albert,  M.  D  286,  460 

Vander  Veer,  James  N.,  M.  D   460 

Van  Buren,  James  Harvey,  M.  D   212 

Van  Gasbeek,  Geo.  H.,  M.  D   124 

Van  Hoesen.  Isaac  G.,  M.  D   743 

Waterbury,  Roscoe  C,  M.  D  460,  812 

Wheeler,  Frank,  M.  D   287 

White,  James  W.,  M.  D   812 

Will,  Arthur,  M.   D  286,  287,  743 

Pertussis,  A  Study  of  the  Bacteriology  of,  with  Special  Reference  to 

the  Agglutination  of  the  Patient's  Blood   221 

Plea  of  the  Patient,  The.    By  Grover  Cleveland   153 

Pneumonia  Bacterium,  The  Observance  of,  in  the  Saliva  of  Healthy 

Individuals    227 

Pocahontas  Hospital  at  Jamestown  Exposition   458 

Pregnancy,  Some  Recent  Reports  upon  the  Toxaemias  of.  .By  John  A. 

Sampson,  M.  D   267 

President's  Address.    By  Alva  E.  Abrams,  M.  D   821 

President's  Address,  The.    By  Joseph  D.  Bryant,  M.  D   175 

Professional  Circumspection.    By  Ellwood  Oliver,  M.  D   633 

Psychiatry  in  Germany   672 

Purdue   University   369 

Quarterly  Journal  of  Inebriety,  The  520,  671 

Refractionists'  Materia  Medica.    Nil  Desperandum  as  an  Article  of 

By  George  M.  Gould,  M.  D   681 

Robertson,  H.  E.,  M.  D.    Antonio  Scarpa   109 

Robertson,  H.  E.,  M.   D.    The  Effect  of  the  X-Rays  on  Living 

Tissues    655 

Roemer  Pneumococcus  Serum  in  Croupous  Pneumonia,  Clinical  In- 
vestigations and  Experiences  with  the   151 

Roentgen  Rays  as  a  Factor  in  Medicine,  The.    By  Arthur  Holding, 

M.    D   97 

Rogers,  Thomas  Avery,  M.  D.    History  of  the  Class  of  1896   432 

Samaritan  Hospital  Training  School  for  Nurses,  An  Address  to  the 

Graduates  of.    By  G.  Alder  Blumer,  M.  D   711 

Sampson,  John  A.,  M.  D.    Fallopius,  1523-1563   496 

Sampson,  John  A.,  M.  D.    Some  Recent  Reports  upon  the  Toxaemias 

of  Pregnancy   267 

Sampson,  John  A.,  M.  D.    Uterine  Myomata  Simulating  Pregnancy; 

with  Special  Reference  to  the  Submucous  Variety   307 

San  Francisco  County  Medical  Society,  Aid  for   459 

Sanitary  Deoartment  of  Armies  and  the  Military  Medical  Officer, 

The.    By  John  Van  Rensselaer  Hoff,  M  D  463,  555 

Saunders'  Catalogue    SO 

Scarlet  Fever  and  Measles,  On  the  Presence  of  Certain  Bodies  in  the 

Skin  and  Blister  Fluid  from   225 

Scarlet  Fever,  Concerning  the  Treatment  of,  with  Antistreptococcic 

Serum   *  . .  613 

Scarlet  Fever  Serum,  Later  Results  with  the  Moser  Polyvalent   383 

Scarlet  Fever,  Serumtherapy  in   384 

School  of  Pharmacy   812 

Schools  for  Nurses,  The  Endowment  of   591 

Serum  Sickness,  Investigations  on  the   150 


INDEX  TO  VOLUME  XXVII  893 

Seminal  Vesiculitis,  Subacute  and  Chronic.    By  James  W.  Wiltse, 

M.  D   619 

Shortsight,  Moderate,  A  New  Operation  for   305 

Sightless,  A  Magazine  for  the   867 

Sinusitis,   Maxillary,  The  Treatment  of  Acute  and  Chronic.  By 

Clement  F.  Theisen,  M.  D   343 

Sinus,  The  Frontal   142 

Smith,  Dr.  James  E.    Memorial  Meeting  of  the  Medical  Society  of 

the  County  of  Albany   670 

Society  of  Internes,  Troy  Hospital,  The   211 

St.  Peter's  Hospital  Training  School  for  Nurses,  An  Address  to  the 

Graduating  Class  of.    By  Henry  Hun,  M.  D   541 

Stanton,  E.  MacD.,  M.  D.,  and  Pearce,  Richard  M.,  M.  D.  Experi- 
mental Arteriosclerosis   77 

State  and  the  Doctor,  The.    By  St.  Clair  McKelway,  LL.  D   160 

State  Medical  Library,  The   107 

State  Medical  Societies,  Consolidation  of  the    49 

State  Medical  Society,  The  Centenary  of  the   203 

State  Sanitary  Conference,  The  .   740 

Stokes-Adams  Disease  with  Autopsy,  A  Fatal  Case  of,  Showing  In- 
volvement of  the  Auriculo-ventricular  Bundle  of  His   217 

Stokes-Adams  Syndrome,  with  Necropsy,  A  Case  of   218 

Syphilis,  The  Spirochaete  Pallida  (Schaudinn)  in.    By  H.  W.  Carey, 

M.  D.   40 

Tefft,  Charles  B.,  M.  D.    President's  Address   415 

Theisen,  Clement  F.,  M.  D   The  Treatment  of  Acute  and  Chronic 

Maxillary  Sinusitis   343 

Theisen,  Clement  F.,  M.  D.    Tumors  of  the  Trachea   686 

Theisen,  Clement  F.,  M.  D.    Wrisberg   849 

Thyroid  Glan,  The  Hypertrophies  of  the.  By  Geo.  E.  Beilby,  M.  D..  ill 
Tonsils,  Dangerous  Hemorrhage  after  Removing  the,  Concerning  the 

Cause  and  Treatment  of   144 

Trachea,  Tumors  of  the.    By  Clement  F.  Theisen,  M.  D   686 

Trauma  in  the  Etiology  of  Carcinoma  and  Sarcoma,  Importance  of. .  140 
Treasury  Department.    Bureau  of  Public  Health  and  Marine  Hos- 
pital Service   599 

Trunecek's  Serum,  in  the  Treatment  of  Glaucoma   306 

Tuberculosis,  Experimental,  of  the  Heart  and  Aorta   66 

Tuberculosis,  Official  Organ  of  the,  National  Association  for  the  Study 

and  Prevention  of   284 

Tuberculosis,  Pulmonary,  Some  Points  in  the  Diagnosis  and  Treat- 
ment of.    By  Lawrason  Brown,  M.  D   229 

Tuberculosis,  The  Diagnosis  of  Urinary  and  Genital   71 

Tuberculosis,  The  Method  of  Dissemination  of   882 

Tucker,  Willis  G.,   M.  D.    A   Biographical   Sketch  of  James  D. 

Featherstonhaugh,  M.  D   289 

Tumors  in  Children,  Malignant  Ovarian,  with  Report  of  a  Case.  By 

J.  Lewi  Donhauser   20 

Typhoid  Bacillus  in  Shell-Fish,  The  Vitality  of  the..,   72 

Typhoid  Bacillus  in  the  Pulmonary  Complications  of  Typhoid  Fever, 

The  Role  of  the   611 

Typhoid  Fever,  Concerning  Variations  in  the  Agglutinating  Power 

of  the  Blood  Serum  in  the  Course  of   616 

Typhoid  Fever,  Convulsions  in   878 

Union  College  Alumni  Association  of  New  York   49 

Union  University   123 

United  States  Civil  Service  Commission,  The   519 

United  States  Civil  Service  Examination   518 

United  States  Pharmacopoeia,  The  New   210 

Urine,  Clinical  Examination  of  the   73 


894  INDEX  TO  VOLUME  XXVII 

Uterine  Myomata  Simulating  Pregnancy;  with  Special  Reference  to 


the  Submucous  Variety.    By  John  A.  Sampson,  M.  D   307 

Vander  Veer,  A.,  M.  D.    Organization,  Methods  and  Responsibilities 

in  the  Study  of  Medicine   1 

Vander  Veer;  James  N.,  M.  D.    Report  of  Cases  Treated  by  a  Modi- 
fied Bier-Klapp  Method  of  Passive  Hyperemia   836 

Ward,  Samuel  B.,  M.  D.    Address   759 

Ward,  Samuel  B.,  M.  D.    History  of  Medicine  in  the  State  of  New 

York  in  the  Last  Hundred  Years   179 

Watervliet  Medical  Society   211 

Wiltse,  James  W.,  M.  D.    Acne  Vulgaris   781 

Wiltse,  James  W.,  M.  D    Subacute  and  Chronic  Seminal  Vesiculitis.  619 

Winne,  Charles  K.,  Jr.,  M.  D.    Valsalva   265 

Woodward,  Dr.  Harriet  A.    Memorial  Meeting  of  the  Medical  Society 

of  the  County  of  Albany   668 

Word-Blindness,  Congenital,  Case  of   584 

X-Rays,  The  Effect  of  the,  on  Living  Tissues.    By  H.  E.  Robertson, 

M.  D   655 

Zoster,  Ethyl  Chloride  in  the  Treatment  of  •  •   72 


ILLUSTRATIONS 

Experimental  Arteriosclerosis  facing  page  88 

Experimental  Cirrhosis  of  the  Liver  facing  page  96 

Model  of  the  Foot  page  255 

Foot  Imprints  facing  page  258 

Brace  to  Fit  Arch  of  Foot  page  259 

Portrait  of  Samuel  Huntington  Freeman,  M.  D  facing  page  288 

Portrait  of  James  Duane  Featherstonhaugh,  M.  D  facing  page  200 

Uterine  Pregnancy  Simulated  by  Pelvic  Haematocele  page  310 

Pregnancy  Simulated  by  Dermoid  Cyst  page  311 

Pregnancy  Simulated  by  Adipose  Tissue  page  312 

Pregnancy  Simulated  by  Multinodular-Myomatous  Uterus  page  314 

Early  Pregnancy  Simulated  by  a  Small  Submucous  Myoma  page  315 

Pregnancy  Simulated  by  a  Large  Submucous  Myoma  page  317 

Changes  in  the  Uterus  Caused  by  a  Large  Submucous  Myoma  page  319 

Portrait  of  Israel  I.  Buckbee,  M.  D  facing  page  461 

Braces  to  Aid  in  Treatment  of  Flat  Feet, 

pages  630,  631,  633,  and  facing  page  632 

Portrait  of  Harrison  E.  Webster,  LL.  D  facing  page  674 

Tumors  of  the  Trachea  facing  page  688 

Lipoma  of  the  Trachea  page  692 

Opsonic  Index,  Chart  page  733 

Hypernephroma  of  the  Kidney  facing  pages  776  and  780 

The  Bier-Klapp  Method  of  Passive  Hyperemia  facing  pages  836-837 


Water-damaged  August  1978. 
Frozen  and  vacuum  freeze-dried  1979. 


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